Bere 5/2025 #2
Sunday- second day in Bere. Sundays are usually slower because we have no planned operations and don’t see surgical consults like every weekday. I did rounds with Dr. Laurel on both the surgical ward as well as the maternity wards. We saw the usual variety of patients. One thing new here is Dr. Andrew has learned to do TURPs. So basically rather than taking out the prostate to help old men pee better, he is able to ream our the inside with a hot loop and get them to pee better. That’s exciting. So we saw a patient who had had a TURP, some burn patients, a child with hirshprungs (disease where the nerves of the large intestine are absent and it doesn’t contract well) who had a colostomy a few days ago, a broken arm, post surgical wound infection, diabetic ulcers, osteomyelitis of a hip that needs debridement, and more and more. Then on the maternity ward, there were many women who had delivered a normal baby and ready to go home, others who had a baby with an unknown infection that were there for antibiotics for the baby, and others with C-section and one after hysterectomy. Many were frustrating because they didn’t have paperwork or it couldn’t be found to easily see why they were there or what meds they were getting. We ended up looking at medications paid for and asked a lot of questions to figure out why they were there.
After rounds I took the call phone to start taking call. When Im here I often bring insecticide to spare in all their houses, to help kill mosquitos. It’s suppose to last 4-6 months, so it should help each family especially as the wet season is coming up. So I sprayed about 7 houses today to kill flies, mosquitos, cockroaches, ants…. About mid way through I got the message that lunch was ready so I detoured for lunch before going back to spraying.
When I was about done with spraying, I got the message that there was a woman who was to have her first baby who was footling breach (butt first). So they recommended that I do a C-section. She had had a previous C-section and wasn’t dilating with usual measures. (Usual measures like a foley catheter put through the cervix and balloon inflated to get the cervix to dilate). So I took her to the OR for the C-section. My nephew Zach would assist me. She got about 1500ml of fluids than a spinal anesthetic by David. I cut across the lower abdomen through the skin, fat, then to the fascia (like gristle). Opened the fascia and separated it from the muscles. Then opened down to the peritoneum exposing the uterus. I incised the uterus and took the bladder out of the way. Then I continued opening the uterus until I got a small about of amniotic fluid. Sticking my hand in the uterus I felt around for a part of the baby to grab. I found the butt. I pulled on either hip and delivered the child out butt first. The head stuck a little, as it’s the largest part of the baby. But with a little twist and maneuvering the head came out. The baby was floppy, but the new (she’s been here 2 weeks) midwife was at the OR bedside to take the baby so I clamped and cut the umbilical cord and passed off the little boy to her. As I sewed up the bleeding uterus, I started to hear the baby cry with the midwifes help getting the baby going. It is always a wonderful sound to hear the newborn cry!! Happy Birthday! Thank you Jesus for another live baby! After closing the uterus and putting the bladder back into place, the rest of the layers were closed leaving a barely visible scar.
I head back to my room and get a text asking if I saw the kid with a facial laceration? I heard they were at the pediatric department so I went there to look at him. I called David to stay around till I found out wether it could be repaired under local or not, but he was already home. The kid and family had gone to the lab to get bloodwork drawn. I got out my headlamp and looked at him. He was a boy of about 5 years old, with a gaping hole and cut on his upper left lip and cheek. I could see muscle and some loose teeth. He had been kicked by a donkey in the face. The blood work looked good and I took him to the OR. Two of the pediatric nurses and Zach came with me. I called David so he would come back in to do anesthesia. The pediatric nurses rummaged around to find the supplies to get an IV. Eventually one was in. Then it blew the vein, so another one had to be placed. Finally another was in and we started. Under ketamine he did pretty well until he started vomiting food. The fatter told us he had eaten 8 hours earlier but that didn’t appear to be the case. Fortunately he didn’t appear to aspirate the food so he continued breathing well as I worked on his face. I discovered that 4 teeth were loose. Loose from the bone and also a maxillary fracture. I asked for arch bars for the maxilla, and they didn’t have any. But David could find wire. So I wired a bad tooth on each Side to the good tooth next to it. Not really stable but better than just leaving that peice move as it would. Then for the laceration on his lip and face. I took off the dead tissue and then brought the obicularis muscle back together. Then I reapproximated the remaining muscles and tissue. I closed the skin and the boy woke enough to go to the ward with his father. I checked with the maternity and there were no concerns there. I went by the surgical ward and they were concerned about the swelling of the abdomen on the kid with Hirshprungs disease. His belly was distended but not very tender and his colostomy looked good. So I reassured the family and headed home. After writing to you, I showered and went to bed dripping wet, in hopes of falling asleep before I got too hot. I dried out but was able to sleep.
Somewhere around 4AM Im called to see two patients in maternity. So I walk over there with my bag containing my ultrasound and other stuff. It goes with me everywhere here. The first patient the nurse shows me is a woman who has her 10th pregnancy and is at term and dilated cervix to 4cm. The nurse can’t find the heart rate and the mother hasn’t felt the baby move since yesterday. She’s having some contractions but hasn’t lost her amniotic fluid yet. So I get out my ultrasound to see if the baby is still alive. As I look around I can’t find any movement. Then I see what looks like a still heart. The baby is cephalic presentation (head first) which is good. I tell the woman and the father my findings. They remain stoic. The nurse tells her to start walking around to help stimulate the cervix to dilate more and we will check her later to see how she is progressing.
The next woman she shows me is a young appearing woman who was in bed under her mosquito net. She heard a commotion and when she opened her eyes a cobra was under her net in front of her and spit venom in her eyes. Her husband killed the cobra and brought it in, in a sack. They washed her eyes and face with water and came in here. Apparently their cat had been stalking the cobra to kill it when it went into her mosquito net. I haven’t encountered this before so I was able to have a good enough cell signal to look it up. So I irrigated her eyes with Ringers Lactate solution until her eye no longer hurt much. About 20 minutes. Then I gave her antibiotic ointment and will check on her later today. I asked the husband to show me the snake so he dumped out the pieces on the floor. Im guessing if I put the pieces back together it would have been 3 feet long.
Now the sun is up and so am I. I usually can’t fall asleep again when I go in, in the night anyway. So I sit here in the cool of my fan, not sweating yet, to write you.
Please pray that God give me wisdom and strength for each patient I see while I’m here and that He give me the words to speak His love to each of them. And that the devil is blocked from influencing or harassing me in this work. Thank you!!!!
