Shanksteps West Africa 2026 #07
Today was a clinic day with a couple ER patients to admit thrown in. Tomorrow we have some hernias and a septic (infected) knee that’s been going on for a few weeks, to drain.
Todays worship with the staff, was about how to treat others as we ourselves want to be treated, as Jesus talked about in Matt 7:12.
We went to round on our hospital patients. One of the first patients we saw was a 12 year old girl I operated on yesterday. She is a girl who came in with what appeared to be signs of appendicitis. I had the GYN doc do an ultrasound and he found what appeared to be appendicitis. This patient was here with her mom and didn’t have much money and (I think because of the lack of money) the mom wanted to wait for the father to arrive. We treated her with antibiotics (Cipro and Flagyl) through the weekend then on Monday the father arrived and agreed and paid for the operation. So Yesterday the other surgeon and I took her to the operating room. After she was put to sleep with a breathing tube in place and a urine catheter placed. We washed our hands with regular bar soap as they have no brushes or other soap. Then we went in and gowned ourselves and then we prepped the patient with betadine mixed with Flagyl- their method here. I cut down on the skin and was nearly directly on the fascia. I opened the fascia and into the peritoneum. There was immediately a large volume of purulent fluid. The intestines were stuck to each other with pus filled gelatinous material called fibrinous exudate. I started separating pieces of intestine that were stuck together. Most of this I could do by pinching my fingers between them to separate them. Frequently another pocket of purulent fluid was encountered. I eventually had enough room to look for the appendix. It wasn’t visible. I had anticipated this because she had appendicitis a long time and on previous exam wasn’t tender everywhere so hadn’t perforated into her abdomen when I had examined her the prior day. This hadn’t occurred because it was a retro-cecal appendix. Hidden behind the cecum (start of the large intestine). Slowly I started to separate the thick inflamed tissue behind the cecum, getting onto a pocket of dense pus. I dissected up further and eventually got to the end of what remained of the appendix. The appendix was in pieces. I couldn’t find the base of it. There was none. I couldn’t get any poop to come out of where a hole should be. The body had closed itself off. So I sewed the parts of the cecum over where it should have been and removed the dead appendix as much as possible. There was so much inflamed tissue it was hard to tell. I left a drain into that area that came out the side of her belly. It looks like a think yellow hollow rubber tube. So that if more pus collected there I hope it will follow the drain and not pool in her abdomen, though that can happen anyway. I closed up her fascia and it was difficult to keep all her swollen intestines inside to close. Then closed her skin. I left some little wicks through her skin, incase the wound got infected it would have a way to drain out.
This afternoon she was out walking with her mom as we requested. She has ileus (intestines sleeping) after her open belly surgery, which is common and can last many days. Walking kind of helps. I’ll give her some gum tomorrow, and that can help some too. An advantage is that we only have Tylenol and ibuprofen for pain, so without narcotics her ileus should resolve faster too.
After rounds Audrey and I went to see who was waiting in clinic. Since the other surgeon was seeing surgical and orthopedic patients, I saw medical patients with Audrey. We tested and treated people with complaints of body swelling, headaches, shortness of breath, burning urination, back ache, stomach ache, painful deification, nausea, epigastric pain…
I was called to see a guy in the ER with a head mass and some significant back pain and body aches. He was a 18 year old guy that was quite tall. But bent over when he walked because of back ache going on for 2 weeks. The mass on his head had been there 8 months and wasn’t painful. Though it was about 3 x4 inches in size and stuck up about ¾ inch. I ordered some lab work and an X-ray of his head. As I left to go back to the office they asked me to see a guy in the dressing room. He had a large ulcer on his leg and both legs were infected and had little areas of pus draining out. I ordered x-rays for his legs.
After more clinic patients I was asked to see another patient in the dressing room. As they took off his dressing I could see a huge cancer on his ankle and maggots coming our of the center and at the edge. It was likely a huge squamous cell carcinoma. This old man also has enlarged inguinal lymph nodes, so it’s already spread there. I’ll try to include a picture, and you’ll see maggots if you zoom in close.
Later the guy with the head mass, didn’t appear to have any boney involvement and I think it is likely a lipoma, on his lab work he had typhoid, possibly rheumatic fever and I gave him some Tylenol and ibuprofen as well as the treatment for those.
The guy with the leg wounds on his x-rays had osteomyelitis (bone infection) of his tibia and fibula. The other leg was cellulitis (skin infection). So I will be giving him antibiotics for many months, and dressing changes for a couple weeks- so he was admitted to the hospital.
The old man with a ankle cancer will go and talk to more of his family and decide whether he will agree to a leg amputation or not.
We got home about 5:30 so feel that we had a much shorter day today. I’m now reading a book about Dr. James Foulkes- To Africa With Love. About a missionary who was in Zambia back in the 1960s. Very interesting. So reading that, looking up Lassa fever, and re-reading about osteomyelitis draining, took most of my evening, before having family worship with my wife.
God, creator of the universe and our Lord, please be with my appendectomy patient and heal her. Heal all the infection that remains in her abdomen. Help her to learn who You really are and be drawn to You. Heal our other patients too. Help the medications we’ve prescribed work well and take away the symptoms of all our clinic patients. Help us to honor you in all we do. Amen
