Like most women here she started labor at home. It was her first. Her husband went away because it is shameful for the nomadic women if their husband hears them cry out in pain during delivery. She had contractions and around midnight two days ago she broke her water. Then her labor stopped. The following morning she went to a local health clinic and was watched there for some hours. In the afternoon they referred her to the hospital for better care. I evaluated her, felt she had sufficient room to deliver and decided to wait a few hours. I instructed the nurse to call me if the labor didn’t start again. She was more dilated than when they examined her at the health center, so I felt she was progressing even though she didn’t know it. We were called to see others during the evening and I forgot about her. The nurse never called and I slept fitfully. At 4 AM I awoke to banging and crashing sounds. There was a strong wind storm and thunder in the distance. Tree
branches rubbed and crashed on the tin roof making a terrible racquet. Dust was flying heavily in the air and I felt sand all over the bed and between my teeth. I closed up the windows to the house but it was a little late. Every step left a gritty feeling under my feet. I finally drifted off to sleep again.

At morning worship they talked about the woman who was not progressing in labor. She had now been more than 28 hours after breaking her water, too long! I asked Jacques to check her out, and if she was not close to delivering to take her to the OR and get her ready for a C-section. He called me a few minutes later and said she was in the OR, ready. The power was out since the windstorm and so we started the generator. It started and we began the surgery. Audrey and I pulled out a crying baby and were happy that we had done it early enough to save the baby.

I made rounds on the maternity ward. The boy with the puncture wound to his head is doing well. I tell the family that it is God healing him that is keeping him alive, they smile and nod even though I think they do not believe in God. I am thankful I do, and the He is healing this boy! I see the others and then go to the office. In the office I see about 12 patients. Then the next surgery is finally ready. Three hour turn over! I’m frustrated, but go back to the OR. Frustrated mostly because I expect that it will take about 4 hours to take out a pelvic tumor on this next patient, and it is early afternoon.

Audrey and I start the surgery and we find a lot of small intestine stuck into the pelvis to the top of the mass. After much dissection we determine that it is a huge hematoma, likely an ectopic pregnancy. I guess her having a period a few weeks ago was not correct. We evacuate the hematoma and remove what was left of her blown out uterus. She didn’t want any more children so it made it an easy choice.

Audrey, Jacques and I clean the OR as the cleaner has already left. Then off to the ER to see what patients were waiting for us. We see a large row of people still there. It is about four patients with many family members. We see them in each of our offices. Yaouke, the nurse from maternity comes to my office. He asks me what I want to do with the man that came over with the infection near his scrotum, it smells so bad that the patients are leaving his area because of the odor. I had not heard about him. Someone thought that I had. I went and looked at him. The odor hit me about 100 ft before I arrived at the building. I put on a mask to not show my facial expressions. Lifting up the cloth over him, I see a black area on his perineum. I touch it and feel bubbles under my gloved finger, gas gangrene (Forniers Gangrene). He needs to be operated on right away. He has about a 40% mortality if he were in the US and getting good ICU care. I believe his chances are m
uch better here as we will be praying for him. I take him in the OR. As we go through the doors I fight off the mass of flies trailing him. Only a few make it in the OR with him.

Dr. Okudire and I start the debridement behind his scrotum. Brown, foul smelling fluid runs out. We take off a huge chunk of skin all the way down to muscle and down to anus. There seems to be an area tracking up in his inguinal region. We follow it up. We are now on his lower abdomen. The skin looks normal but the infection runs along his fascia (necrotizing fasciitis). We resect more and more. Off come layers of muscle, fascia and more muscle. The infection is deeply seated. We end up debriding off all the skin on the right half of his abdomen up to the right nipple. The infection skims along on his ribs up to here than back to his right back. Finally we get it all open and removed. Raw muscle and peritoneum are showing everywhere. It looks like an anatomy lesson on a live patient. I put dressings on it and we clean the OR thoroughly. I wish I had done it somewhere else. Will I have wound infections with my other cases now? I say a prayer for him again and
give instructions to Ganava. He will be taking care of him tonight. “God, please send your angles to keep him safe and please heal him of all this infection and the insult I have just created.”

I head home to a loving wife and rice and white beans. The salad is wonderful, fresh vegetables!!! I eat my first meal of the day at 7:30 PM. I guess all those pounds I made in the US are keeping me going. I think I gained about 15 and have now lost about 5 already. It is amazing to me how resilient we are. I can gain and loose weight, and this man can live in spite of the odds. Pray for his recovery.

In His Service, Greg and Audrey

#133 Shanksteps

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