Shanksteps Bere 2017 #5

I awake about 4AM.  The sound of bats outside in the trees is deafening.  The hospital has electricity 24/7 due to a generator running non stop (that must be a lot of diesel).  Since there is electricity, I have a fan on us at all times when we are in bed, that makes sleeping possible in the heat.  I lay there awake trying not to wake up Audrey, she is all covered up like it’s cold!  I lay there and read my devitional book (Jesus Calling) then continue where I’m reading in the New Testament in John 16.  This is always a peaceful time of morning.  About 6 AM the sun starts to rise and the room slowly gets lighter.  Olens mother-in-law Deloris had left us some granola to eat for breakfast.  She also made us some bread.  I discover during my time here that she is very giving of food, and I never have to go hungry.  It’s a Monday and the busiest day of the week in Bere.  Hospital work occurs all the days, minimal rounds are made on Sabbath, and emergencies attended to.  Sunday there are many consults and full hospital rounds to be made on the 80+ beds.  By Monday there are many people waiting for elective surgeries.  They run anywhere from 10-160 dollars.  The highest being for a prostatectomy, because old guys usually have the money and are definitely willing to spend it on themselves.

At 7:30 we head to the hospital for worship.  It is spoken in French and Nangere.  It takes place in the waiting area for the ER, which is a number of concrete benchs under an awning.  The ER is a room with about 3 beds.  It has no moniters or other signs that it is an ER other than the sign on the door that labels it the “Urgence”.  After the worship thought, the nurses give signout about what happened the day before to all the nurses and doctors.  This all wraps up about 8:30 or 9 and I head to the OR with Rollin and Christian and Audrey.  It appears that there are about 11 people on the waiting list.  It appears to be about 7 hernias, 2 incision and drainage of abscess, and a hysterectomy.  I asked Dr. Rollin and Christian what they wanted me to do and it was decided Id operate.  I like to do hernia repairs with mesh due to the fact that they are longer lasting and the risks are low.  Dr. Rollin doesn’t like using mesh because they’ve seen a number of infections after using them here.  So, since they will have to deal with whatever complications arise after I leave I choose to do the hernia repair with just suture in the method that they are used to using.

The first man is lying on the bed.  his scrotum is larger than a grapefruit with intestine in it and his legs splay far apart to accommodate it between them.  One of the nurses lifts it and puts the legs together and it then sits on top of them.  It’s been a while since I’ve seen one this big.  The patient is given fluids and then a spinal is placed with him in the sitting position.  I discover almost all cases are done with spinal and then some ketamine is given if the incision goes to the upper abdomen.  After the spinal the patient is laid flat and I scrub with Audrey.  It’s been a while since I’ve operated with her and we both enjoy it.  I make an incision in the groin and it barely scratches the skin.  I’d forgotten how hard I need to push with these blades to get through the skin.  After about 5 cuts, I’m finally through the skin.  The scalpels blades are new but not as sharp as I’m used to, and the skin is thicker too.  I slowly dissect through the usual layers to the hernia sac.  I dissect out the hernia sac from the scrotum and separate it from the testicle.  After opeing the sac, I discover that everything is stuck in it.  There is colon and small bowel.  I struggle for about a half hour to make heads or tails out of the mess.  The inside of the abdomen isn’t free either.  Eventually I make the opening in the abdomen larger and shove the whole thing in.  I do the suture repair.  This is about the longest hernia I’ve done in a long time.  I close the various layers and then skin.   I’m tired of my first case here.

Next is a woman with an inguinal hernia.  Less common and also much smaller.  She is about 45, 5’2” tall and weighs in the neighborhood of 100 lbs.  It’s nice to be operating on thin people.  After the spinal she lays there stark naked and is shaved and prepped for surgery.  She is shivering even though the room feels very warm to me.  Of course she is cold, the usual parts of her that are seen are her face, ankles and arms.  The head may or may not be covered.  Muslim women cover their heads and many other women do too.  After I scrub, I cover her body with surgical cloth drapes.  The has the tiniest of hernias and it takes me about 20 min to do the surgery.  So I have the most difficult first and the easiest hernia second.  The remainder of hernias this day were “usual large”.

Rollin and Christian finish rounds and come back to the OR.  Next is a uterine fibroid that the two of them do.  I hang out in the entry room seeing surgical consults and being called to help do an ultrasound to check out something the nurse couldn’t figure out on it.  One ultrasound, the nurse cannot figure out whether the woman’s mass is in the uterus or ovary.  I walk past the hoards of people milling round under the trees to the ultrasound room.  I’m thinking to myself, how can he not tell if it’s in the uterus or not?  Unfortunately I find the same thing.  I cannot tell either and am frustrated.  I guess we will need to do a digital CT to figure it out and take out whatever we find.  Here, digital CT means- cut and touch with our digits! Either she has a uterine tumor or an ovarian tumor.  Whichever it is, she doesn’t want any more children and we will take out either one.  Each elective surgery is required to pay and someone of the family to donate a bag of blood before they will be on the surgical waitlist.

About dark we choose to make the others wait till another day.  I head home to a meal that Audrey and Deborah and Jent have made.  I’m tired, jetlagged and happy to get some rest.

Shanksteps Bere 2017 #5

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