Chad 2022 #5

Audrey Uncatergorized No Comments

Shanksteps Chad 2022 #5

Hi, Aud here. Usually Greg writes the Shanksteps because his surgeries are just so interesting. I’ll write today to give you a little taste of what this part of Africa is like. Today is Saturday, the Sabbath, and we make this a day of rest. Last evening, we had a fantastic vespers at Megan and Andrew’s home. All the missionaries on this campus got together for dinner, singing and discussion. The food was amazing, the singing was fun, and the discussion was definitely thought provoking. We discussed missionary/physician burnout and working to fatigue, and where do you place the boundaries, or do you place boundaries. Jesus worked until he was exhausted, BUT didn’t turn people away when he was tired, because he had Compassion. See Matthew 14:8-14.  It was a very interesting discussion. 

This morning, we went to the “bush church” under the mango tree. Some of the missionaries  piled into the 4-Runner, while Greg and I took a motorcycle. About half-way there, the Toyota picked up a bunch of kids who were also headed to the bush church. It was a wonderful experience, and church the way I believe “church” should be; a bunch of Jesus lovers meeting under a mango tree, singing songs and hearing the stories about Jesus’ love. 

After church, Greg and I took a detour back to the compound, stopping at “foret du singe” (monkey forest).  We weren’t able to get close to any monkeys, but probably saw 8-10` leaping through the forest. They tell me they are protected in that forest.   

After church and a visit to the monkeys, we came back to the hospital for Greg to see a couple of patients. Soon after, we left (again via moto) for the river. All the missionaries, including some from a nearby village, all brought food for potluck lunch and we spread mats under the trees next to the river. The food was fantastic and so was the company. After eating, we went for a dip in the river. Boy did that water feel great in the 100 degree heat. The name of the river is the Tendjile river, but we have always referred to it has Hippo River due to seeing hippos bathing, and hearing of people being bitten by the hippos over the years. Today no hippos were present. I have been to Bere, Chad many times, but this is was my first time to the river.  I guarantee it won’t be the last.   

Greg and I left the river early to see a couple patients and get ready for surgery. On the way back, the moto ran out of gas about halfway home. So Greg pushed that moto about a mile back in 100 degree heat. 

Now we are back at the hospital compound and getting ready to do an appendectomy.

Chad 2022 #4

Greg Uncatergorized No Comments

Chad 2022 #4

Have you ever heard of the proverbial taking a load off your back expression? I saw it teenage boy yesterday with a significant load on his back. He was born with a little red nodule on his back. Apparently at the age of five he developed a growing mass on his back. It has there since then and has gradually gotten bigger and bigger. It has leaks clear fluid at times.  He denies any pus coming out of it or any blood. He says it weaps the liquid at the bottom of this thing on his back. I evaluated him sitting on the bench and as he sits on the bench the mass trails off behind him. I’ve never seen anything like this. Have you? Look at the picture below. He was sent up to the capital Ndjamena last week to get a CAT scan to figure out what this was. Instead, whoever he saw ordered lab work and did not get a cat. Since they did not know what they needed, they did a lab work and came back with it. They were ready to have the operation. Unfortunately they did not get a CAT scan. Any of you who are medical, I would be happy to have your guesses as to what it is! It seems firm to the touch has some large vessels in it.  It is very sad to see things like this. I hope that it is not attached to his spinal cord like a meningomyelocele.

One of the interesting operations I did was a woman who gave birth a week or so ago to a baby and then developed abdominal pain. She came to the hospital for abdominal pain. She was a evaluated by Dr. Andrew and thought that she should be operated on. He thought that she probably had an intestinal perforation. So he brought her to the operating room first thing and we operated on her together. We opened her up and she had a lot of stool throughout her abdomen. Everything was stuck; intestine attached to intestine and Intestines to the abdominal wall.  Poop everywhere!  This woman didn’t look as sick as she actually was. As we dissected out the various parts of the intestine, some holes were made in the serosa (covering of the intestines). It was a disaster.  There were two pieces of intestine that had died and completely gone to mush.  There was a large hole where the live intestine was open and then a space of white nothingness, and then the other hole where the other piece continued.  And there were two sections like this.  I have no idea how long it takes to look that way, but im very surprised she is still alive to get here.  Eventually we found and dissected out all the small intestine and emptied all the pockets of poop and pus.  She had obvious areas where intestine was ulcerated and doing poorly.  We connected things back together after taking out the bad pieces and hand suturing them back together.  We considered bringing out an ostomy and decided that would give her short intestine syndrome.  While we are working on her abdomen.  She has two rotten teeth that need to come out and have given her a rooten tooth and abscess and mandible.  So as we are working on the abdomen the visiting anesthesiologist and local anesthetist get the dental tools and pry and take out two molars that are deeply impacted and one is broken off at the gum line. Today, she says her teeth dont hurt her any more! Apparently today she passed some gas.  Which is a good,  but I’m not sure I believe it yet as the sign the intestines are working.

God please heal her!

Chad 2022 #3

Greg Uncatergorized No Comments

Chad 2022 #3

It was another full day of operating from 8AM till 9PM.  Dr. Andrew has been doing this for weeks or months, and of course so have the other doctors here.  No need to wonder why  missionaries burn out! We have been running separate ORs all day and the list of waiting people doesn’t seem to be getting much smaller as people are added each day.

If you had difficulty urinating, how long would it take for you to seek help?  I operated on a guy today that had had difficulty peeing for a long time.  And since he has been on a long list waiting for his operation he has still been waiting.  So today after about a month of waiting, I did his operation.  I looked in his little book, and he had an ultrasound that showed a bladder stone.  (Picture below) His operation went like this:

He got a spinal anesthetic, then he was prepped with betadine and the cloth drapes placed.  My surgical gown had a huge hole under the armpit and along the arm so I asked that that one be repaired and took out a throw away one. (That must have come in a container from the US).  it was thin and I wondered if it was even water proof- it wasn’t.  I opened the low abdomen across above the pubis.  Cut down between the rectus muscles and spread around the bladder with my fingers.  I opened the bladder up and down with electrocautery to minimize the bleeding.  I put my finger in and feel a large stone.  I realized I hadn’t opened the bladder far enough to get the stone through the hole so i made it larger.  I grabbed the stone and it was large!  I felt and found another, then another then another.  I could see where the smaller stone had rubbed on the larger stone.  No wonder he had difficulty peeing!  They can create a ball valve effect and block off the stream of urine.

 Next was a postmenopausal lady that had vaginal bleeding.  She had been evaluated with ultrasound and was found to have a large uterus tumor.  She got a spinal anesthetic, we cleaned her abdomen with betadine and we started.  She had had a previous ovarian cyst removed so I was able to use that incision which was vertical and along the midline.  Then inside there was scar tissue to go through.  I wasn’t to difficult and soon I was able to feel around for the uterus.  It seemed to be stuck on one side but the other was mobile.  I started on the mobile side and tried to free up small intestine and large intestine that were stuck to it.  it was densely stuck and so i left it for the time being.   On the stuck side I tried to figure out if it was removable or not.  After freeing up some more adhesions, the cancer had grown into the pelvic side wall.  Taking this out wouldn’t have extended her life and would have made her bleed a lot, and she could die that night.  So i decided to stop her operation and leave the cancer in place.  Here, surgery is the only option for cancer.  There is no radiation or chemotherapy in the country.  If someone has a lot of money, rare, then they could try to go to Yaounde in Cameroon and possibly get chemotherapy.  So I closed up the different layers and took her to our recovery room.  We called her son and nephew in to tell them the news.  We asked them to translate to their mother.  When I got to the part of the cancer not being removed, they didn’t translate.  I asked why they didn’t translate.  They said she will cry and may give up.  They may tell her later.  The students with me agreed that that was the best way.  I doubt she will every know her diagnosis.

I did a hernia and a few other surgeries and was home to eat about 9pm.  Dr. Andrew was there till after i left finishing up another surgery.  Courageaux Andrew!

Chad 2022 #2

Greg Uncatergorized No Comments

Chad 2022 #2
It was a busy day.  All of us doctors worked from morning till late at night.  Even when we were done with the operations we did, there were still about 15 people that wanted to be consulted by a doctor. I was to tired to help any longer with jet lag and lack of sleep.  So about 9 PM i left to eat lunch and supper, then just crashed.  I still woke up to early this morning, but feel pretty good.
Yesterday began with worship at 7AM.  I understood about half of what was said and it takes quite a bit of concentration.  It’s been to long for my French.  After that was a nurses report about what happened over the weekend. I went to the OR to see how things were lining up.  They had lined up a number of surgeries for me.  And to start out were 3 men with inguinal hernias.  Now these were MANLY hernias.  They don’t get them fix when small here, they are obvious and large when they come to have them fixed.  Once the meeting was done with the nurses, we began.  The first three were relatively straight forward.  Then there was another guy that had an incarcerated hernia that they were able to reduce the day before and was ready for his operation.  His was larger and had colon and small bowel down into it.  It went something like this:
Powell is a nurse anesthetist missionary here for a few months.  He placed the spinal and we waited till it took effect and the man couldn’t feel or move his legs any longer.  He was washed and scrubbed in his groin and painted with betadine.  Then I made an incision through the skin, then thin layer of fat down to his hernia and testicular cord structures.  It was quite large so after opening the external fascia, I was able reduce the intestines back into the abdomen and dissect out the hernia sack.  I opened the sack and looked at the intestines that had gone back in, none seemed damaged so I sutured the sack and took off the excess.  Next I did a suture repair of the hernia site.  Ive chosen not to do mesh here for two reasons.   One is Im not certain of the sterility of the surgical packs, and second is that there is very little mesh to be used and so its used sparingly.  I then washed out the incision and closed it.  During the middle of the surgery, the power went out as they changed generators.  This hospital runs 24/7 on generators as there is no local power.  So I operated by headlamp, which I always bring for that reason.  After about a half hour, it came back on.  Ill try to include a pic below of that timeframe.
Next there was a guy with LARGE hydroceles (fluid around the testicles).  Well not large like needing a wheelbarrow for your scrotum large, but larger than anyone in the US would wait.  He walked in normally, but after i saw the hydrocele, I was surprised he wasn’t waddling.  He got his spinal with Powell and then a local Chadian doc assisted me as he is learning surgery.  I cut into the scrotum and into the muscular tissue surrounding the fluid sack of the hydrocele.  I started to shell out the sack then I ended up tearing into it.  A light yellow fluid was everywhere.  We suctioned what was left.  I suspect it contained about a quart of fluid per side!  Then I finished shelling out the side, and took off the excess sack and reversed the sack and sutured it back to itself.  Then I put it back in the scrotum and sutured the testicle back into place.  This keeps it where it belongs and doesn’t let it rotate, which can kill a testicle.  Then I left a piece of sterile glove as a drain and closed the muscle layer then the skin.  Then I repeated the same thing for the other side.
I did a hystorectomy with fascial suspension of the vagina for uterine prolapse, Then another surgery I cant remember this morning.
Now Ive gotten some rest and am ready for another day.  God give me Your strength and wisdom for today and for each patient I see.  Thank You!

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