Shanksteps Bere 2017 #7

I awaken before dawn again. I wasn’t woken up all night. I feel pretty good, but lay there awake anyway. Audrey has left back for the US, as she couldn’t get the same time off that I could. It is quiet and lonely in the place I’m staying. I’ve been told that since Chad has been taken off the list of places US citizens should go, a few years back, there haven’t been any more student missionaries. The birds are chirping, roosters are crowing, and Chad is coming to life. Days have passed since I arrived. Many hernia repairs, and a smattering of other interesting surgeries. Each day there is a list of 8-10 to be done. Most days we get the majority done and the rest wait till the next day. I’ve seen patients from Ndjamena, near the sudan border, near the border with CAR and from Nigeria. I was told today that if you want to be seen in a gov hospital, that you may wait weeks just to see the doctor. He/she may see a few each day then go off to their own clinic through a back door, leaving the rest just sitting there. Here they see a doctor, usually the day they arrive, are consulted for the surgery and can be done in a few days. Each day is filled with as many surgeries as the surgeon and staff can do- one after another.

An old woman is laying on her hospital bed in the corner of the room. Surgical patients line the walls on both sides. A few relatives stand around different patients fanning them with small woven grass fans. It is relatively quiet for the number of people in the small room. We start with the old woman. Her dressing is unwrapped and I see a large patch of black skin covering most of her forearm. This was apparently burned. Pus drains out from under the black skin. I expect to see maggots but none are present. We recommend taking her to the operating room for a surgical debridement.

Another in the room is the gentleman that we drained a psoas abscess on. His drainage tubes are full and haven’t been emptied overnight as they needed to be. Pus is draining around the tube that is full. I guess at least it is making it’s way out. I empty the bulb and thick pus with a bad odor is drained into the basin. Flies hover around the smell I’m sure they can sense a mile away. As the rounds continue, I head back to the OR to check if the first patient is ready. We find a child that has had a hernia stuck out for about 4 days. He is crying and looks sick. He needs a hernia repair right away. A different young man with an inguinal hernia is lying on the OR table, so he is done first.

The second is the young boy of about 10 years. I do his operation with the help of Christian. He is given some inhalational anesthetic (have no idea what was used) and ketamine. I’m glad to have brought a cautery machine that was donated by my hospital in the US. This helps a lot to minimize bleeding. The drape has much to large an opening and nearly exposes the boys whole abdomen. I put clips on the edges to make it a smaller circle. As his hernia is exposed I see dark necrotic (dead) tissue. I open the sac and find dead intestine. I have two options- open my incision into the abdomen to resect dead bowel or open a separate incision to do the same. We choose to extend our current incision. I open up the muscles into the abdomen and find an edge of a loop of intestine is the dead spot. I am able to cut off the dead piece and reconnect good intestine to itself. I re-close those layers and finish the operation.

The next is a gentleman who had difficulty urinating and a large prostate. On the ultrasound report, he was thought to have a large prostate as well, and maybe a bladder stone. He is a bit overweight- uncommon for here. He lays on the OR bed stark naked, is shaved and water is put in the urine catheter till his bladder is full and large. This moves the intestines out of the way so when we go into the abdomen we get directly into the bladder rather than intestines. I make an incision and have to cut down through the fatty layer then the abs. I’m then on top of the bladder. After opening the bladder I feel around inside. The prostate feels like a normal size inside, but there is a bladder stone about a centimeter in size. This can act as a ball valve, plugging off the ureter when it’s down at the bottom. I remove his stone and close him up.

Christian is out debreding the old woman’s arm. Pus and dead tissue are in a pile on the drapes next to where he is working. A lot of the skin of the arm has had to be removed. I’m glad we chose to debrede it today!

After a number of other surgeries I head back to the room where I stay. I’m grateful to eat food with Olen and his kids. Then back to my room to read, write, and eventually take a cold shower and fall asleep.

Shanksteps Bere 2017 #7

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