Today was a landmark day for Alison Hemenway in Sierra Leone. Not only was it my first day in the hospital, but this morning, while I was sleeping, I felt cold. Not like I’m-shivering-it’s-so-cold-right-now kind of cold, but I felt chilled. Enough to pull my sheet over me while I was sleeping. So before I even woke up, I knew it was going to be a big day.
This morning I woke up at about 7h00 (7:00am) and had a breakfast of half a loaf of bread with peanut butter. The loafs of bread here look a bit like a short baguette, about ten or twelve inches long with a crisp outside and very soft inside. They aren’t very thick, but having half a loaf of bread is about the equivalent of a medium to large bagel. They are very delicious actually. What people normally have to drink is hot coco…even though it’s hotter here than the warmest day in Michigan. But everyone thinks it’s cold so they have hot coco, and because I was chilled (Yay for being used to the heat!) I tried it. It’s very different from U.S. hot coco, but still very good.
Each morning at 8h00 (8:00am) they have a meeting with all the head night shift nurses and the new nursing staff that’s coming in for the day shit called Morning Handover. They basically review what has happened over the night as far as beds full, beds empty, number of patients, if anyone was discharged or passed away during the night, and so on. Then they have nurse presentations. Each nurse takes a turn researching a topic and presenting what he or she find to the rest of the nurses. Today a nurse presented on the different parts of the abdomen and what organs are there. It is really helpful to know because you can diagnose why people have abdominal pain if you know what organs are in the area where the pain is. After he finished his presentation, Dr. Erdi introduced Tanis, Elizabeth, and I to the nurses.
We decided after Morning Handover that I would follow Dr. ABD, Elizabeth would follow Dr. Erdi, and Tanis would hang out with Nicole in the Therapeutic Feeding Center (TFC). I started to follow Dr. ABD but he kept getting distracted by people asking for help, so he told me and his nurses aid, Alpha, to go to the Male Ward and start rounds and that he would catch up. Before we barely started Alpha asked me if I wanted to do the writing in the charts. I told him I might try it tomorrow. About ten minutes later her asked if I would marry him, and I told him that I didn’t think that would work out. Then he asked if I would be his friend, and I told him that I would, and he seemed pleased.
We went around, and I saw so many things that I have never seen before, and would never see in the U.S. There were two men who had sections of their intestines removed because typhoid had absolutely destroyed it. One man was diagnosed (by me, whoa!) with tuberculosis and I got to listen to his lung sounds. There were two men who had strokes, one man who they had no idea what was wrong with him, and one man that they thought might have diabetes. Lots of men recovering from severe malaria and typhoid. Another couple had recently had operations to repair hernias. One man came in with leg pain, and an X-ray relieved server osteomyelitis, or bone rot, in the upper section of his tibia. Dr. ABD decided to remove it and operated to do so three months ago. Most doctors in the US would have just amputated the leg, on the rare possibility that a doctor in the U.S. were to see any injury the progressed for the first time.
There was also a man in the male ward that had cardiomyopathy, who’s heart was severely enlarged and so was his liver and spleen. I believe Dr. ABD told me that there was fluid building in his lungs and abdomen, and you could see the ripple of the heart beat down into the chest cavity. Dr. ABD let me feel the enlarged liver and spleen. The man also had conjunctivitis, and I think malaria too. He will be treated for malaria and conjunctivitis, and given medication for his heart, but odds are he wont last long because they can’t really do anything about it here.
In the female ward, Dr. ABD saw a woman who’s spleen was severely enlarged, so much so that you didn’t even have to touch her stomach and feel for the spleen to know, it was so large it was protruding and could be seen through the wall of her abdomen. She also had very swollen legs. In the States, a specialist would be called in for an emergency spleen-ectomy (spleen removal surgery), but here it is a very tricky operation that they wont do until they have no other choice. They will treat her for malaria (which she also has) and see if that improves things.
Almost everyone who comes into the hospital, even if they come in because their leg is hurting, has malaria. And odds are if a male patient comes in for leg pain, he hurt himself falling out of a mango tree. And odds are they tried traditional African medicine first before coming to MCH, which consists of pouring a solution of boiling hot water and herbs onto it, which melts the skin away and causes infection, making the situation much worse than it needs to be.
So after I followed Dr. ABD on his rounds, he had a meeting with Marcel so I went to have lunch. Lunch consists of the same bread from breakfast, the topping of your choice, and whatever you brought from home. So after bread, a cheese stick, and a piece of beef jerky, I went to find Dr. ABD, but he wasn’t back in his office yet so I found Dr. Erdi about to start giving ultrasounds to pregnant women. Sierra Leone has a government operation that has been attempting to encourage family planning, good fetal care, and HIV testing during pregnancy. After about three, Marcel came in to ask Dr. Erdi for help and told me that Dr. ABD was back in his office, so I went to find him. When he finally emerged from his office, I asked if I could keep following him and his said of course and took off. I followed him and before I knew it I was being told to put on scrubs and get ready to go into the OR.
The first procedure was just supposed to be a dressing change for the patient I mentioned earlier that had part of his bone taken out. When they started to remove his dressings, they found maggots, but Dr. ABD wasn’t concerned because they were just on the surface, and maggots only eat dead flesh anyway. They removed all the old dressing, or so I’d thought, when they started pulling a tremendous amount of gauze out of the wound. I had no idea that must gauze could fit in a knee! The man had a large incision on the right side of his left knee starting about mid knee and extending down about four inches, an incision below his knee on the left side about one inch long, and another incision above his knee on the left about two inches long. Dr. ABD let me get really close and see where they’d removed a section of bone, and it was very cool. Part of the remaining bone still didn’t look so good, and he said they might have to remove more later. When they began to clean the incision above his knew on the left side, they found an infection above the incision inside the leg, because when they pushed on the leg above the incision pus came out. I’ve never seen any procedure so invasive. Dr. ABD stuck his finger in any hole he could find, and fished around like crazy. In attempt to get the infection out of the incision that had the pus, he stuck his finger up in the patient’s leg as far as it would go and made another incision at the end of his finger so that he could flush the area out with iodine. After the procedure he told me that while most doctors in developed countries would have just amputated, he sees value in saving as much of the leg as he can. To me it seems like they could avoid a lot of potential infection by amputating, but he’s in charge so I didn’t say anything.
The second procedure was actually an emergency operation on a man who originally came in for a hernia, which was prepared, and then some bleeding complications that required emergency surgery. And after all that, Dr. ABD found out that one of his testis was necrotic (dead or infected) and should be removed. And can you believe he could tell that by how it smelled!?! So the patient was re-opened where his original incision was, which was a two or three inch vertical incision across the middle of the abdomen about four inches below the belly button. Dr. ABD also made another incision downward from the middle of the original incision about four or five inches, and had his assistant use metal tong like things to hold the incision wide open while got like both hands inside this guy. After a while, he pulled out the necrotic testi and removed it. One of the nurses, Abby, had trained herself in her spare time in some of the elementary anesthesiology involved in surgery, and she started giving me things to do, which was awesome!
One things I was totally not prepared for was the amount of surgeries that they keep the patient open afterward. Both with the man’s leg and with the testi-ectomy (testi removal surgery) Dr. ABD packed the wound with gauze and intends to go back in on Wednesday if everything looks good during rounds tomorrow morning and clean it again. Later in the day Dr. Erdi told me that this is common with patients who have an infection, but not so for patients who have regularly scheduled surgeries.
Once the two procedures where over, Dr. ABD had another meeting to go to so I went in to observe as Dr. Abel saw patients in the OPD (out patient department). All patients start in the OPD and if they are severe enough are admitted but most of the time are sent home with medications. One woman was found to be pregnant, with malaria and typhoid. She was pleased because she only has one other child. The malaria medication is not a problem to take when pregnant, but most typhoid drugs are not recommended for pregnant women. Luckily there happened to be some typhoid drugs on hand that doesn’t have any warnings for pregnant women. Another patient, male, was found to have syphilis and severe typhoid, but his main concern was his sex drive. He kept asking if the drugs were going to help him get is libido back, and I’m pretty sure that the nurse eventually lied and told him the typhoid drugs where to get it back.
Thinking that exciting part of the day was over, we sat down to dinner and swapped the stories for that day over a wonderful meal of very spicy pasta with sausage, some sort of beef that had been fried with onions, fried plantains with sugar on them, fruit salad, and salad. We were all sort of chillaxing, doing our own thing, and I was in my room when a bat flew in. While Tanis was in the shower. And it flew around all menacing and I barely got away. We finally got it out into the common room, and we’re pretty sure it’s out of the house, but we’re keeping our bedroom door closed tonight just in case. And now it’s time to fall asleep to rain on a tin roof.
When I first arrived here, I met a little boy named Abulay. His mother brought him here to the TFC a year and half ago, and left him here while he was getting treatment to pick something up at the market and never came back. He has been living here as an orphan since, and always has a smile on his face even though the workers yell at him and treat him poorly. Today I found out that he’s very sick, they think he has malaria. This post is dedicated to him.
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