Shanksteps Bere 2017 #8


Olen and Denae’s kids are sick.  Fortunately it is with malaria!  You, reading that, are gasping!??!??  What? Fortunately malaria?  Yes it is true that malaria is responsible for 1.5-2.7 million deaths a year.  And death is more common in the young the elderly.   So why do I say fortunately? Because two of the kids were bitten by a rabid cat a few weeks back.  An rabies has a 100% mortality rate.   So we continue to ask God for protection from rabies in these kids. (If you want to read further on Olens blog- look up Olen Nettberg on blogspot).  The kids are getting better and are playing again.  So what do missionary kids do to play?  Run around in the yard, playing with sticks or toys.  Interact with other kids or adults.  Run around outside with a purple cape, being a superhero.  Ride a bike.  Visit their grandmother to see if there is different food at their house.  The thing they are not doing is surfing the internet as there isn’t any.  They also like to read and listen to books.  So they are on the mend.

I had a chance to look a the old lady’s leg that was rotten a couple days back.  It is looking cleaner, with only a small amount of pus.  We continue to do a dakins dressing (dilute bleach solution) and it is doing it’s work.  I continue to think she will need an amputation but is improving.  I send home one of the ladies that we took out a uterine fibroma and a number of the hernia patients.  I again appreciate the lack of paperwork here.  Only what is needed when someone sees them again.  Basically they are discharged with medicine and a little book.  In their little book we write what surgery they had and when they are to come back.  Their medicines are explained to them again as to how to take them and they’re off for home.  Discharge in 3 minutes!

I see Olen examining a little girl about 7 years old. She is crying and fell down a well today.  Her abdomen hurts.  Does she have a cracked liver, an injured intestine, a bruised muscle, something unrelated to the trauma- like typhoid or malaria causing abdominal pain?  So many questions and no answers.  He does an ultrasound on her and there doesn’t seem to be any fluid in the abdomen outside the intestines.  So a cracked liver is less likely.  I’d sure like to have a cat scanner!  There aren’t even any plain x-rays here.  Ultrasound only!  She is admitted to the pediatric ward to watching and treating her malaria that was positive on her test.

Amongst the many surgeries a few days ago was a 30 year old guy who had left flank pain.  In the US I’d think of diverticulitis as one of the first on my differential diagnoses.  Here Rollin thinks of a psoas abscess.  Christian and I opened his abdomen.  There was pus inside and a fullness in his flank under the colon, with the colon appearing normal.  We opened into the area and find that Rollin is right, a huge abscess.  We sucked out more than a liter of pus, then put a drain out to the outside and close the area we opened.  Over these past few days the two drains have plugged up with pus so thick it wouldn’t come out.  So we took him back and made a 4 inch opening in his flank to let it drain out.  Each day we flush it out with dakins solution and gobs of pus and debris come out.  He is looking better day by day but the quantity of pus continues.

I’m doing rounds and I see another man with pus draining from a small wound in his chin.  He is in obvious discomfort.  I push around on his neck and pus flows out of the hole.  I decide he needs better drainage.  I suspect this is from a rotten tooth, but he denies having any tooth pain in the past or now.  I take him to the prep room, of the operating room.  That is where we do quick procedures.  I numb him up as best I can with lidocaine.  Then I open a few inches under his chin.  He yells out in pain “my God, my God…”  I feel sad that I am causing him so much pain but know I have to break up the loculations in the abscess and it will take a few seconds more.  I get done and pack the area with gauze.  Now I expect it to heal faster.  He is already on the available antibiotics. (Available antibiotics are ceftriaxone, cipro, ampicillin, amoxicillin, metronidazole)  As I do round, at least half of the people are for dressing changes of infected leg, arm or other wounds, ulcers or abscesses.  Each of these patients tolerate significant pain every day during dressings to get better.  I wish I could give each a shot of ketamine before their dressings so that the changes could go easier for them, but there is no monitoring available if I were to do that, so I continue with doing it as quick as possible to get it over with and not draw out the time it takes.

Shanksteps Bere 2017 #8

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