Chad 2022 #7

Greg Uncatergorized No Comments

How did my day go you may wonder?  Here is a summary:

-worship at the hospital at 7AM

-about 8 lightning rounds on the surgical ward with the nurse Emmanuel who knows all the patients and tells me any of their problems

-A neck dissection for a salivary gland tumor with enlarged lymph node near by

-removal of a dental mass in the gums displacing the front incisors and removal of a couple of dead teeth

-surgical consultations that wait outside the OR- saw a necrotic/dying foot in a diabetic that needed amputation- he refused

-ER consultation for a burned girl who was burned about a week before

-prostatectomy

-more surgical consultations

Ended about 9pm

Ive realized some things about myself this trip.  The tedious surgeries that take many hours are less enjoyable to me than the faster surgeries that take a couple hours or less.  Thats a new realization.  Doing the thyroid excision the other day and the neck dissection yesterday, they were interesting for a while- but after a couple hours I wish i were doing a different surgery.  

Ill explain more now the dental mass.  It was challenging to me and i did enjoy that.  Ive not resected a dental mass like this before, in that location.  But it was up to me to fix.  A picture of the woman is down below.  I know if you get to the marrow of a bond that granulation tissue can start from there.  That’s how we fixed a child with exposed skull before in Cameroon.  Expose the marrow and it granulated and covered the area.  I wish i had a way to talk to my dental friends and get advise, but I didn’t.

She was brought into the OR and a visiting anesthesiologist from the US and parent of one of the missionaries did a nasal intubation.  After that I placed a gauze in the back of the mouth to catch blood and started removal.  After excising the mass and the involved two front teeth I had difficulty deciding closure.  I created a mucosal flap and rotated it into the area to cover the exposed bone.  I figured since the marrow was exposed it would probably granulate, but since I couldn’t confirm this with my dental friends, I created the flap.  hopefully I will see today if my flap survives.

Chad 2022 #6

Greg Uncatergorized No Comments

TYPHOID!!  I’m in the operating room doing my first case of the day which is another bladder stone (I think i did three different patients with stones yesterday). Andrew did surgical rounds, and he sends the lady back to me that Ive already operated on twice for typhoid perforations.  She was the one with the dead bowel in two sections.  last time i operated on her i left a drain so I would know quickly if she perforated again, meaning that stool would come out the drain and tell me things were bad.  So he was rounding and saw that she had a distended abdomen and that there was stool coming out the site where i had left a sterile glove finger hanging out as a drain.

I feel sad as we get her to the OR and sit her up for the spinal.  Liquid yellow stool gushes from her drain and incision pooling around her then flows over the OR table side and waterfalls down to the floor making a large pool growing pool on the floor.  Im guessing that more than a gallon has leaked on to the floor before the spinal anesthetic is in and she is laid back down on the operating table.  One of the nurses, David, cleans up the floor and the patient and places a urinary catheter, then cleans the abdomen.  in the mean time I rush back to the place we are staying to use the bathroom, then back to the OR.  She was prepped with betadine and I scrub my hands at the sink and put on my cloth surgical gown.  I know this will likely be wet with the patients stool down to my skin- yuck!  But this is what we have to wear here.  They are washable and reusable.  It is 10AM and the OR temperature is already 85 deg F inside.  HOT with all the surgical gab on.  (It will get up to about 98 later on in the day).  We pray for her and us and this operation, then I remove my previous skin stitches and take out the glove drain and open the fascia stitch.  We suck out a couple more liters of liquid yellow stool out of her abdomen.

As I look around the intestines don’t seem stuck together as I expected.  She must be to malnourished to be healing that fast.  Not a good sign.  I look and there are two small 2mm holes in the intestine about 3 inches apart from each-other.  Then i find another.  TYPHOID has made these holes.  We’ve been treating her all along for typhoid but it appears to continue to wreak its havoc.  I choose a piece of intestine to take out that includes all three holes and is about 6 inches long and cut it out.  I tie all the vessels off that went to that section so they don’t bleed.  Then with silk suture, I reconnect the intestine back together.  It takes me about 

45 minutes to hand sew this anastomosis.  With staplers in the US it would take about 5-10 min. I wash out her abdomen with liters of fluid and eventually it becomes clear.  There is residual stuff stuck to the intestine that wont come off.  I close the fascia and leave the skin open as it will become infected if I close it.

In the other OR room Papa and Lazaar, the two fix it guys, are trying to get one of the 4 AC units in the ORs working.  They replace some wires and turn it on.  one runs and cools but then the electrical cord and the one feeding the plug get warm and they turn it off.  We sure need a knowledgeable handyman here!  There are endless things to fix.

Chad 2022 #5

Audrey Uncatergorized No Comments

Shanksteps Chad 2022 #5

Hi, Aud here. Usually Greg writes the Shanksteps because his surgeries are just so interesting. I’ll write today to give you a little taste of what this part of Africa is like. Today is Saturday, the Sabbath, and we make this a day of rest. Last evening, we had a fantastic vespers at Megan and Andrew’s home. All the missionaries on this campus got together for dinner, singing and discussion. The food was amazing, the singing was fun, and the discussion was definitely thought provoking. We discussed missionary/physician burnout and working to fatigue, and where do you place the boundaries, or do you place boundaries. Jesus worked until he was exhausted, BUT didn’t turn people away when he was tired, because he had Compassion. See Matthew 14:8-14.  It was a very interesting discussion. 

This morning, we went to the “bush church” under the mango tree. Some of the missionaries  piled into the 4-Runner, while Greg and I took a motorcycle. About half-way there, the Toyota picked up a bunch of kids who were also headed to the bush church. It was a wonderful experience, and church the way I believe “church” should be; a bunch of Jesus lovers meeting under a mango tree, singing songs and hearing the stories about Jesus’ love. 

After church, Greg and I took a detour back to the compound, stopping at “foret du singe” (monkey forest).  We weren’t able to get close to any monkeys, but probably saw 8-10` leaping through the forest. They tell me they are protected in that forest.   

After church and a visit to the monkeys, we came back to the hospital for Greg to see a couple of patients. Soon after, we left (again via moto) for the river. All the missionaries, including some from a nearby village, all brought food for potluck lunch and we spread mats under the trees next to the river. The food was fantastic and so was the company. After eating, we went for a dip in the river. Boy did that water feel great in the 100 degree heat. The name of the river is the Tendjile river, but we have always referred to it has Hippo River due to seeing hippos bathing, and hearing of people being bitten by the hippos over the years. Today no hippos were present. I have been to Bere, Chad many times, but this is was my first time to the river.  I guarantee it won’t be the last.   

Greg and I left the river early to see a couple patients and get ready for surgery. On the way back, the moto ran out of gas about halfway home. So Greg pushed that moto about a mile back in 100 degree heat. 

Now we are back at the hospital compound and getting ready to do an appendectomy.

Chad 2022 #4

Greg Uncatergorized No Comments

Chad 2022 #4

Have you ever heard of the proverbial taking a load off your back expression? I saw it teenage boy yesterday with a significant load on his back. He was born with a little red nodule on his back. Apparently at the age of five he developed a growing mass on his back. It has there since then and has gradually gotten bigger and bigger. It has leaks clear fluid at times.  He denies any pus coming out of it or any blood. He says it weaps the liquid at the bottom of this thing on his back. I evaluated him sitting on the bench and as he sits on the bench the mass trails off behind him. I’ve never seen anything like this. Have you? Look at the picture below. He was sent up to the capital Ndjamena last week to get a CAT scan to figure out what this was. Instead, whoever he saw ordered lab work and did not get a cat. Since they did not know what they needed, they did a lab work and came back with it. They were ready to have the operation. Unfortunately they did not get a CAT scan. Any of you who are medical, I would be happy to have your guesses as to what it is! It seems firm to the touch has some large vessels in it.  It is very sad to see things like this. I hope that it is not attached to his spinal cord like a meningomyelocele.

One of the interesting operations I did was a woman who gave birth a week or so ago to a baby and then developed abdominal pain. She came to the hospital for abdominal pain. She was a evaluated by Dr. Andrew and thought that she should be operated on. He thought that she probably had an intestinal perforation. So he brought her to the operating room first thing and we operated on her together. We opened her up and she had a lot of stool throughout her abdomen. Everything was stuck; intestine attached to intestine and Intestines to the abdominal wall.  Poop everywhere!  This woman didn’t look as sick as she actually was. As we dissected out the various parts of the intestine, some holes were made in the serosa (covering of the intestines). It was a disaster.  There were two pieces of intestine that had died and completely gone to mush.  There was a large hole where the live intestine was open and then a space of white nothingness, and then the other hole where the other piece continued.  And there were two sections like this.  I have no idea how long it takes to look that way, but im very surprised she is still alive to get here.  Eventually we found and dissected out all the small intestine and emptied all the pockets of poop and pus.  She had obvious areas where intestine was ulcerated and doing poorly.  We connected things back together after taking out the bad pieces and hand suturing them back together.  We considered bringing out an ostomy and decided that would give her short intestine syndrome.  While we are working on her abdomen.  She has two rotten teeth that need to come out and have given her a rooten tooth and abscess and mandible.  So as we are working on the abdomen the visiting anesthesiologist and local anesthetist get the dental tools and pry and take out two molars that are deeply impacted and one is broken off at the gum line. Today, she says her teeth dont hurt her any more! Apparently today she passed some gas.  Which is a good,  but I’m not sure I believe it yet as the sign the intestines are working.

God please heal her!