Chad #11 2019
I did my first real X-ray today with the equipment I brought. It was a lady who had an external fixture placed by Dr. Danae with the materials she has available. Dr. Olen and Dr. Stacey were both there see how it’s done with the new machine, and two nurses as well. I am real excited with how the picture turned out. We took two views. The healing callous was not what we had hoped at the fracture site but it showed that the bones were well lined up and the result should be good in the end. The patient wasn’t to happy to hear she has to keep the Ex Fix in place for a while longer, but then who would be.
Philbert and Lazar are in the process of building a radiology bed where the digital plate I brought can be set into the bed with the bed surface being flush afterwards. We are also making a rope and pulley system that will take the plate up the wall for vertical films, like a chest xray. and some shoulder films.
One of the operations during the day is a guy who has had some blood in his urine. An ultrasound shows a bladder stone. He has paid the 90,000cfa ($150) to have the operation. The nurses get an IV in him and preload him with saline. He gets his spinal and his abdomen is prepped with betadine and a urine catheter put in and water I put in to distend his bladder. Once he looks slightly pregnant, with a bulge in his lower abdomen, then he’s ready for surgery. We pray, then I open his lower abdominal skin with a few slices of our poor quality scalpel. I divide the fascia and then use my fingers to spread around the bladder and push the peritoneum with the intestines, up and out of the way. I open into the bladder and feel around with my finger. Sure enough, there is a large stone. I try to get my fingers behind it to bring it up to the incision and there isn’t enough room with the incision I made in the bladder. I put a clamp into the hole, and the stone is to big to get with the clamp. I have to extend the bladder incision about 3 inches to get large enough to get the stone out. The stone ends up looking like sandstone that is about 2x2x1inches in size. I wish I could keep it but the family wanted to take it home. I close up the bladder, in two layers leaving the foley catheter in place. After leaving a piece of glove as a drain, I close the rest of the layers. We put on a dressing, and he’s out of the OR for the next patient.
Mid-day, I’m asked to see a pediatric patient that came in. Her parents tell me that she was sick with a cough and they determined it was the common problem with the uvula and it needed to be cut off. So they had the local guy who does that, cut it off. I imagine it is done like it was in Koza, with a U shaped piece of wood shoved in the back of the throat and then a razor blade is used to trap and cut off the uvula against the piece of wood. All of this was done the previous day around noon. After the uvula was cut, the child started having dark bloody bowel movements. Then overnight they became red blood. I took a tongue depressor and gagged the little girl, and sure enough she had evidence of bleeding and an absent uvula. There was no active bleeding by the time I saw her. She was pale, especially in the whites of her eyes. Her hemoglobin was somewhere around 9.5, but I didn’t believe it. With her being pale and lethargic, I decided to transfuse her anyway. So the nurse ordered blood.
Last night, the nurse came to the door about 9pm. “There is a guy in the ER that was in an accident with his moto going off a bridge near Lai. He is not talking.” I follow him back to the ER room. The guy is laying on the stretcher with no one around. This is odd, usually there is a crowd with an accident. I ask where the family is, the nurse says an ambulance, came and dropped him off. An ambulance??? Apparently he is someone from the local health department and so someone went and brought him in, in a “ambulance”- because it has those words on the side! No first aid or ACLS equipment. I looked him over. His forehead had a burned oval area on it, and this whole forehead was soft with a hematoma. I couldn’t feel any step-off, like a skull fracture. He had a laceration on his upper lip with dirt in it. His mandible and maxilla seemed stable as well as his facial bones- no palpable fractures. He had another oval burn on one of his arms. His heart, lungs, chest, back, pelvis, legs- were all-normal. His pupils reacted normally. Someone came in the room- mid evaluation. I hate it when people are gawking at whatever is going on, so I shine my headlamp in his eyes to make him back out of the room. He puts his hand over his eyes and asks me to stop. I tell him only family is permitted. He says that this guy is one of his workers, so I stop. This guy ends up being very helpful and I apologize later, for being rude to him. Then other people from the health department start showing up. I decide to go get Olen, as these may be local bigwigs that he may need to be a part of. So Olen comes in with me and we decide it is a good time to take an X-ray. Not so much because of it’s medical usefulness, but more because it will make everyone feel we are taking good care of him and also be an advertisement of the X-ray machine the hospital just got. I go in the room I set it up in and turn it all on. About 6 guys carry him in and lay him on the table. He immediately lays on his side. We try to turn him on his back and he starts talking a lot and won’t. He reeks of alcohol. Eventually I think he is still enough for a second, that we shoot one with us still in the room. He moves mid picture. But everyone gets to see his skull and that we have an X-ray machine. As he is very uncooperative, we abandon the films and he’s carried back to the other room and watched overnight. We ask the nurse to wash out and bandage his wounds, give him tetanus vaccine and an IV antibiotic Ceftriaxone. The next morning when I see him, I open the bandages and realize they had sutured the lip shut. I push around on it, and pus comes out one end. I reopen and pack the wound. He is conscious and responds appropriately.