Please note: If you’re squeamish, don’t read anything in [brackets.]
I didn’t really get a chance to talk in depth about the surgeries I saw yesterday because I had the internet and wanted to get it posted while I had the interent. To elaborate, I finished helping Mr. Swaray and had a quick lunch, and then joined the OR. Dr. ABD was about halfway through a hernia repair. It looked quite large to me, but he said it was a small one according to his standards. The repair went quickly and without complication. The next procedure Dr. ABD performed was for a woman who had a miscarriage at home, and then started to bleed. [When she came in, they determined that much of the afterbirth remained in her uterus. They decided to go in and remove it before it made her sick. I’ve never experienced anything like it, they used clamps the hold this woman’s vaginal canal open, and used metal rods of increasing width to widen her cervix enough to fit his tools in it. Then he used a thin metal rod with a loop on the end of it to basically scrap all the afterbirth out of her uterus. There was a LOT more than I expected, with lots of blood clots but also clear liquid.]
The next procedure was a quick cleaning of the man who had his testicle removed. They didn’t even put him under, which really surprised me. They pulled the gauze that they left inside the wound out, pushed on the incision a bit and prodded around to makes sure there was no puss or any infection starting, re-packed it, and sent him on his way. The final case was a young boy who came in with to severely injured arms. [One arm had a minor fracture near the wrist, which had originally been treated at home with traditional African medicine. They had poured boiling hot water with herbs in it on his arm, which melted away some of the skin and left the muscle exposed over the fracture. They had already reset the bone properly and cleaned the wound, so they were just checking on it and putting a new bandage on it. The other arm had been injured in the same accident, but his wrist was broken so badly that it was no longer attached to his arm, and his radius and ulna were showing. They had also tried traditional African medicine on that too, but because his bone was exposed when they treated it with their concoction, it melted away a lot of his skin and infected the skin and the bones had become necrotic. His hand was still sort of okay when they brought him in, but the lower are couldn’t be saved and they had amputated. Today they were supposed to do a routine cleaning, but while Dr. Erdi was removing some of the blood clots from the surface (“Bacteria love old blood, they eat it up, if you want infection just add some old blood and you’ll be all set” ~Dr. Erdi) they accidently cut a suture that was keeping a bleeder closed, which started a lot of bleeding. So they had to quick open up a kit and clean it out and sew it up, all while Dr. Erdi got covered in blood.]
After Dr. Erdi changed, she did one final cleaning of the man’s knee that had a cleaning yesterday. No infection today, and on Thursday if all is well Wednesday when they change his bandage and on Thursday when they open then they will put in some pins and start to close him up! I will definitely sit in on that one!
Anyway, this morning I got up at the normal time and had my regular breakfast, then went to Morning Handover. On Wednesday mornings, Dr. ABD, Dr. Erdi, and all the head nurses go on rounds together, but only see the patients that are extra interesting or were miss-diagnosed when they first arrived. It was very interesting, because all the patients you see on this round are the really really exceptional conditions. After Big Rounds, I followed Dr. Erdi on her rounds in the maternity and children’s wards, and by that time it was 14h00 (2:00pm) and time for a late lunch. After lunch, I noticed the lights where on, so I went to see if there was a surgery going on. Normally, the big generator for the whole compound is on from 11h00 to 13h00, and the small generator just for the houses in the back is on from 19h00 to 22h00, but you can always tell when they do a surgery or procedure because they turn on the big generator to power the OR, so all the lights come on. Despite having limited power, I haven’t once felt like I’m without electricity.
Anyway, so I zipped over to the OR, but they had just finished with the procedure, which was just a wound cleaning. So I went to find Dr. Erdi, who was doing ultrasounds in the maternity ward. One of the Creole words I’ve learned is Peecin, which means baby. During the scanning, the conversation goes something like this:
Dr. Erdi: Ha-low, how dee body? (Hello, how are you?)
Patient: Dee body fine, fine. (I’m doing well.)
Dr. Erdi: How long dee belly? (How far along in your pregnancy are you?)
Patient: ___ mont. (___ months.)
Dr. Erdi: How dee peecin? (How’s the baby doing?)
Patient: Dah peecin be fine, fine. (The baby is doing well.)
After a few, Dr. Erdi showed me how to do a physical examination of the fetus by feeling the abdomen, which can tell you about how far along the pregnancy is, and where the head is. Once the head is found, she normally starts by looking at it and using her ultrasound instrument to calculate how far along the pregnancy is based on how big the head and sometimes the femur is. She also looks at the heart, and if it’s beating fine she tells the mother, “Dah peecin be blow fine, fine,” which means that the fetal heartbeat is strong.
Some other Creole that I’ve learned:
“How dee sleep?” How did you sleep?
“How dee morning?” Good morning, how are you?
“Dah peecin be warm?” Does the baby/child have a fever?
“Small, small” A little. They use this a lot to mean a little or small or not much.
“Hum dee dee deedah.” I’m doing much better.
“Light head.” Headache.
“Dah peecin be eat?” Has the baby/child been eating?
“Dah peecin be toilet?” Has the baby/child had a BM today?
“Dah peecin be eatin dee fruit, for make dee toilet soft.” Feed the baby lots of fruits and soft foods to make their stool soft.
It’s just amazing what people just doing understand here as far as hygiene and child care that we find very important in the U.S. Mothers who bring their children into the Hospital are given classes daily about health and hygiene, and one thing that they stress every day is cleaning all eating utensils, bowls, and plants “fine, fine” (very well) before feeding the child out of them. They also pick children up here like they are sacks of rice. They grab them around the upper arm, near the arm pit, and with only one hand swing them onto their backs and secure them there with scarves. I’ll have to take some pictures. They also whip out their breast whenever they whimper just the littlest bit. And most nursing women don’t wear tops, because it’s too much of a hassle to take off their clothes to breast-feed.
Bo, one of the cats who live here with Dr. Erdi, had kittens about three weeks ago, but they never found the kittens. Today we found the only survivor living in one of the spare rooms here in the guesthouse. Unfortunately, Bo seems to have rejected it and will hiss at it if it is near. We don’t know what to do with it, so we might ask Dr. Abel, one of the other doctors who lives on the compound with his family, if his son Elliot would like to have it.
Other than that, it was a pretty quite day. It can be very frustrating being here, because you can see that you’re needed, but they don’t really know how to use you, so at times you can sit doing nothing because no one has anything for you to do.
Here is Sierra Leone, the female coming of age ritual is still widely practiced and includes anywhere between partial to full female castration. Many of the women working here have gone through the process. This post is dedicated to them.
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