Chad 2022 #9

Audrey Uncatergorized No Comments

Chad 2022 #9

Happy Woman’s Day everyone! (Journée Internationale des Femmes). March 8 is celebrated all over the world (except the US) to empower women, have conversations about women’s rights, encourage girls to become educated etc.  Here in West/Central Africa, it is a day of singing, and speeches. The female nurses all take the day off to be able to go to the festivities, then cook a large meal together and sing and dance, and hang out together. 

This morning we went to the stadium at around 8 am. We had 12 people crammed into a 4Runner.  Slowly, young females from schools all over this district began to arrive, marching, and singing and dancing. Then the “officials” arrived, including the Sous Prefet (like a government appointed representative/sub-governor). Several people made speeches. Several special groups did skits. The hospital nurses did a skit about giving birth outside the hospital and how important the woman is. We all marched across the stadium together.  Then we escaped the cacophony. I am told that the speeches etc go on all day, but as it was about 103 in the shade, and much hotter standing in the sun of the stadium, I was happy to escape to a bottle of ice water. 

Several of us walked back to the hospital compound. The walk was hot, but felt good to stretch my legs. Each of us female docs made rounds on our respective wards and saw patients. 

After rounding, I came back to my “1 day church/house” to relax in front of the fan.  My phone stopped working because of the heat. I decided I could put it in the freezer, or lay my ice water bottle on top. I chose the second option to avoid having to retrieve it from the freezer which is  next door. 

Around 4:30, a bunch of the women all got together to eat a meal together. There was rice, pasta, roast lamb, cabbage and potatoes, and something like hibiscus leaves in a peanut butter sauce.  It was all delicious.  After dinner, about 20 women all went to the river for a swim and to cool off. I decided to stay behind and relax a bit. I played a little badminton with one of the missionary kids that I knew from Cameroon when he was 6 months old. We both worked up a sweat so again the ice water was terribly welcome. 

As I write this it is 8:20pm and Greg is still doing surgery. I think he has one more planned for tonight. He has been at it since 8 this morning. Greg has been trying very hard to lighten the load for the surgeon that is here, so is trying to get through as much of the waiting list as possible during our month here. 

Chad 2022 #8

Greg Uncatergorized No Comments

Chad 2022 #8

What brings you to the hospital today?  I have this sore on my leg.  How long has it been there?  Yes it hurts.  How LONG has it been there?  It drains fluid too.  How looong has it been there?  Since April.  Last year? Yes.  Please take off the dressing.  The cloth is removed revealing a bone sticking out of his lower leg.  It appears like it’s been there a long time.  What happened.  I was in a motorcycle accident.  Can you walk on it?  Yes, I get around.

All of this happens right before he is taken back to the OR for me to do a sequestrectomy.  That is to remove the dead piece of bone sticking out.  I go over to the ER where the X-ray  machine is.  I start the computer and look up the X-rays.  A few of you helped me get that X-ray machine a number of years ago.  What a blessing it has been here.  Thank you!  The X-rays show a healed fracture. With the bones somewhat aligned.  And a piece sticking out from the rest of the bone- the sequestrum.

Back in the OR his leg is prepped with betadine and I make an incision above the bone fragment.  It doesn’t seem to move.  Then below it.  Not moving.  he has grown around it enough that its stuck in the tissues.  I have to open up a few inches to release it and pull it out of the hole the body has been pushing it out through.  He is happy when I tell him it’s out.

Yesterday Lazar tried to fix the AC units the OR.  It’s been 85-95 degrees in the OR each day.  With all the atire on for operating that is extremely hot.  ORs in the US are usually around 65 degrees.  Anyway it’s getting hotter and none of the four units were working.  Finally a technician came from Kelo with freon to charge them.  He charged 3 units and got them working.  Lazar also fix the electrical lines coming into them.  He started them both up in the OR i was working in and the temperature slowly started to go down to about 82.  He was concerned about the two in the OR I was in as the cords were getting warm.  Also when the second one was turned on the lights dimmed and the fan and suction machine slowed down.  But he left them on.  Then all of a sudden there was sparking and an electrical fire in a box near ceiling.  Phillipe and David (anestatist and my assistant) BOLTED from the room.  As they ran their foot caught on the cords of the cautery machine which went crashing to the floor.  Lazar flipped off the breaker to the room and everything went dark and the fire stopped.  Fortunately I had my headlamp on, as I always do.  So I could still see.  The patient had a spinal so was awake and afraid.  I could see it in their eyes.  So the rest of the day Lazar and the technician got them working again and we will run one at a time.  The cord still gets warm so it isn’t good.  One in the other OR works now without getting a hot cord.  So I want to be in that room preferably.  Later during the surgery, when the lights were back on and tension had subsided.  I had a disussion with Phillipe and David about our need to care for the patient in front of us under anesthesia and that if we are afraid we need to take the patient out of the room with us, not just bolt for the door.

Chad 2022 #7

Greg Uncatergorized No Comments

How did my day go you may wonder?  Here is a summary:

-worship at the hospital at 7AM

-about 8 lightning rounds on the surgical ward with the nurse Emmanuel who knows all the patients and tells me any of their problems

-A neck dissection for a salivary gland tumor with enlarged lymph node near by

-removal of a dental mass in the gums displacing the front incisors and removal of a couple of dead teeth

-surgical consultations that wait outside the OR- saw a necrotic/dying foot in a diabetic that needed amputation- he refused

-ER consultation for a burned girl who was burned about a week before

-prostatectomy

-more surgical consultations

Ended about 9pm

Ive realized some things about myself this trip.  The tedious surgeries that take many hours are less enjoyable to me than the faster surgeries that take a couple hours or less.  Thats a new realization.  Doing the thyroid excision the other day and the neck dissection yesterday, they were interesting for a while- but after a couple hours I wish i were doing a different surgery.  

Ill explain more now the dental mass.  It was challenging to me and i did enjoy that.  Ive not resected a dental mass like this before, in that location.  But it was up to me to fix.  A picture of the woman is down below.  I know if you get to the marrow of a bond that granulation tissue can start from there.  That’s how we fixed a child with exposed skull before in Cameroon.  Expose the marrow and it granulated and covered the area.  I wish i had a way to talk to my dental friends and get advise, but I didn’t.

She was brought into the OR and a visiting anesthesiologist from the US and parent of one of the missionaries did a nasal intubation.  After that I placed a gauze in the back of the mouth to catch blood and started removal.  After excising the mass and the involved two front teeth I had difficulty deciding closure.  I created a mucosal flap and rotated it into the area to cover the exposed bone.  I figured since the marrow was exposed it would probably granulate, but since I couldn’t confirm this with my dental friends, I created the flap.  hopefully I will see today if my flap survives.

Chad 2022 #6

Greg Uncatergorized No Comments

TYPHOID!!  I’m in the operating room doing my first case of the day which is another bladder stone (I think i did three different patients with stones yesterday). Andrew did surgical rounds, and he sends the lady back to me that Ive already operated on twice for typhoid perforations.  She was the one with the dead bowel in two sections.  last time i operated on her i left a drain so I would know quickly if she perforated again, meaning that stool would come out the drain and tell me things were bad.  So he was rounding and saw that she had a distended abdomen and that there was stool coming out the site where i had left a sterile glove finger hanging out as a drain.

I feel sad as we get her to the OR and sit her up for the spinal.  Liquid yellow stool gushes from her drain and incision pooling around her then flows over the OR table side and waterfalls down to the floor making a large pool growing pool on the floor.  Im guessing that more than a gallon has leaked on to the floor before the spinal anesthetic is in and she is laid back down on the operating table.  One of the nurses, David, cleans up the floor and the patient and places a urinary catheter, then cleans the abdomen.  in the mean time I rush back to the place we are staying to use the bathroom, then back to the OR.  She was prepped with betadine and I scrub my hands at the sink and put on my cloth surgical gown.  I know this will likely be wet with the patients stool down to my skin- yuck!  But this is what we have to wear here.  They are washable and reusable.  It is 10AM and the OR temperature is already 85 deg F inside.  HOT with all the surgical gab on.  (It will get up to about 98 later on in the day).  We pray for her and us and this operation, then I remove my previous skin stitches and take out the glove drain and open the fascia stitch.  We suck out a couple more liters of liquid yellow stool out of her abdomen.

As I look around the intestines don’t seem stuck together as I expected.  She must be to malnourished to be healing that fast.  Not a good sign.  I look and there are two small 2mm holes in the intestine about 3 inches apart from each-other.  Then i find another.  TYPHOID has made these holes.  We’ve been treating her all along for typhoid but it appears to continue to wreak its havoc.  I choose a piece of intestine to take out that includes all three holes and is about 6 inches long and cut it out.  I tie all the vessels off that went to that section so they don’t bleed.  Then with silk suture, I reconnect the intestine back together.  It takes me about 

45 minutes to hand sew this anastomosis.  With staplers in the US it would take about 5-10 min. I wash out her abdomen with liters of fluid and eventually it becomes clear.  There is residual stuff stuck to the intestine that wont come off.  I close the fascia and leave the skin open as it will become infected if I close it.

In the other OR room Papa and Lazaar, the two fix it guys, are trying to get one of the 4 AC units in the ORs working.  They replace some wires and turn it on.  one runs and cools but then the electrical cord and the one feeding the plug get warm and they turn it off.  We sure need a knowledgeable handyman here!  There are endless things to fix.