Shanksteps West Africa 2026 #03
I had a restless night turning a lot as I touched the top and bottom of the bed. I’m sure that jetlag has a lot to do with my interrupted sleep. 8 hours difference should take about 8 days to get “normal” again. I awakened to my alarm at 6. I keep plenty of time for my personal time with God and then breakfast and whatever I want to get done before going go the hospital. At 8 I went into the hospital for their morning worship. After praying, singing and listening to the morning worship thought we went to check on one of the patients Audrey and I were concerned about. Not much change over night so at least not worse. (She may tell you about this patient later). I did rounds with the local missionary surgeon and we saw the patients he had then discharged the two SIGN nail femur fracture guys who were ready to go, even though they thought staying longer would be a good idea. We needed to have the beds freed up for our patients we were to operate on today.
After rounds we went to the OR for our first hernia. This guy had a small hernia by the African standards that I’m used to. He was first given a spinal anesthetic then we put on our sterile garb and prepped the patient with betadine. I assisted the other surgeon and he made an incision in the groin and separated the layers down to the hernia. It was a direct small hernia, meaning it came straight out and didn’t follow the testicular structures. This was repaired by sewing over the hernia with surrounding muscle and tissue (shouldice repair). Then those dissected layers were closed back together.
The next surgery was on a man with a moderate size hydrocele (fluid around the testicle making the scrotum look larger on one side. In his case about 3 times as large) The other surgeon was occupied so I did the surgery with the two scrub nurses. After I scrubbed my hands and arms and got myself gowned I prepped the patient with betadine after the nurse had shaved the surgical spot. I used electrocautery (a device that can cut or stop bleeding using electrical current) to incise the skin of the scrotum and go down to the fluid sac. Then I freed up the sack using my finger sliding around it. I opened it and drained the fluid out then removed most of the sac and reversed the remaining part and sewing it back and down into the scrotum again. Then sewed back up the cremasteric muscles (muscles that raise the testicle when cold) and closed the skin. Now I need to remember to treat him for shistosomiasis, a contaminated water disease that is a frequent cause of hydroceles in these parts.
Later in the day, as we were ready to leave, the ER nurse asked Dr. Audrey to see a patient. When I finished with a patient in the office that had a small rectal prolapse, I went to check on her and found her walking towards me. In the ER was an old guy who said he was peeing blood and was obviously hurting. So I thought it’s most likeluy a bladder cancer or a bladder stone. So I got out my butterfly ultrasound and attached it to my phone and then looked in his abdomen with the ultrasound. I found what looked like a huge irregular prostate and irregular stuff filling the bladder- blood. Cancer! He wanted immediately to try and go pee again. But as blood clots won’t come out the penis, he feels the need to constantly evacuate but can’t and the bladder stays full of blood and clots. I sent him to pay for a suprapubic catheter placement. It was 300,000 FG which was about $35. He went to the toilet and his brother and wife went to the cashier. I went and called the other surgeon to find out how to get the OR crew for this surgery. He called the person who has the key (the scrub nurse) and the anesthetist. Fortunately both were still here otherwise I guess we don’t do surgeries in the night or weekends- if I understand correctly. I guess the staff live in town 15km away. So the anesthetist the other surgeon and I took the patient in to the OR and as I didn’t want to wait for fluid loading and a spinal anesthetic, the patient got ketamine for the operation, which I later regretted. We prepped after collecting all the material we needed. Then opened the lower abdomen and went down to the bladder which was huge up to the belly button. We opened it and sucked out a lot of blood and clots, I’d say nearly a liter. I felt around and felt a huge prostate but no obvious cancer even though that’s what I had expected. We put in the large foley catheter put some sutures in the bladder to close up around the foley. It was quite hard as we were working in a small hole and the patient kept tightening his abdomen. We closed up the other layers on the way out, leaving a drain in place in case the bladder leaked. We wheeled him to a room and found his wife to take care of him. We told her when she could give him water and food and left an irrigation drip running, which she will pour bottled water in to throughout the night. I left to go home and the other surgeon went to fill out governmental paperwork from the days clinic patients. (Lots of redundant paperwork here)
At home Audrey met me with the good news that the person who is cooking for us while we are in the hospital, had made spaghetti without our prompting. Spaghetti is our family Friday night tradition, since living in Cameroon. We were both pleased!