Have you ever had to really pee? No REALLY urinate!!!? A thin old man came back to see me today after being treated for prostatitis. He had taken all of his medicines and is having urinary incontinence at night. He feels OK but at times has lower abdominal pain. A lay him back on the examining room table and he looks about 25 weeks pregnant. A mass in his lower abdomen reaches to above his umbilicus. I know immediately what the problem is. He is having overflow incontinence at night. His bladder is so full that it leaks. Though is prostate is so large that he cannot empty his bladder. He needs his prostate removed (as we don’t have prostate medications here, and no one could afford to take them indefinitely, even if they were available). I decide to put in the foley myself, as I have seen a couple nurses or students put in foleys and they are usually not done sterilely. I also suspect this will be in a while till he gets his prostatectomy, so I don’t want his bladder more infected than it already is. I demonstrate to the nursing students how to put one in sterilely and I immediately get 2.4 Liters of urine! As it flows out the abdomen becomes concave again. He develops pain as the bladder contracts down, and in a few minutes this subsides. He leaves the hospital content, and will come back next week if he is ready for surgery. I want there to be even a few more weeks before doing the prostatectomy since I think he had prostatitis about a week ago and this makes the surgery difficult.
I had planned to operate on Gift Edson today. He is a 2yo boy that has a cleft lip. Unfortunately he ate a full breakfast this morning. So we had to postpone his surgery. I don’t want him vomiting and aspirating during surgery.
This afternoon I was asked to see a woman who was in labor and they were unsure of the gestational age and whether there were one or two fetuses. The clinical officer feels that she may need a C-section as she has a small pelvis. I went to the maternity ward and saw a young woman who had had 4 previous children. One normal delivery and 3 C-sections. Now she is on her fifth. She lays on the delivery room table on her side intermittently grimacing in pain but not uttering a peep. She is covered from the waste down with a thin cloth that was her wrap around skirt. As in most of the developing world, breasts are not a sexual organ so they are not necessarily covered. I get the ultrasound machine and take a look. She has twins with one in the head down position and one in a transverse position. She has been draining amniotic fluid since today at 11AM when she came back from working in the fields. I discuss with the nurse that a C-section is NOT needed, but that we DO need to try to stop her contractions. I give her salbutamol and nifedipine, both of which have been shown to not really work for stopping contractions but that is what’s available. Gave her IV fluids and started antibiotics. I checked on her a half hour later and it appeared that her contractions had stopped. I head home to write all of you!