After an amazing safari and break from the hospital,
we were all eager to get back to Coast General. Right away in the morning we
headed up to Major Theatre, where all of the surgeries take place. There are
four operating rooms – all containing the bare minimum. The surgery we observed
was a 15 month old boy with hypospadias. Hypospadias is a birth defect in the male
urethra in which the opening is abnormally placed. This wasnt a very servere case, but the doctor began tediously cutting and suturing. I can’t
imagine how hard it was operating on such a small area! But the surgery went
well with no complications – other than the cautery machine not working. And
quite frankly, I was impressed the hospital even owned one to begin with.
After that procedure, we went back down to good old
minor and casualty. In minor we did a lot of dressing changes, and I saw one of
the worst wounds since I’ve been here. A man was at work when an iron sheet
fell and cut his foot. Since he couldn’t afford to go to the hospital, he
ignored the cut and kept working. After some time, the foot became severely
infected and as of now, there are two spots the size of my hand where no skin remains.
The pits were about a half an inch deep and covered in puss and infected flesh.
The only treatment he can afford is debridement and redressing, so that’s what
we did, and prescribed some antibiotics. Let’s just say this was one case where
I wish I didn’t have a sense of smell!
After minor I wondered over to casualty where I
found Dr. Abdul Hussein. He is another physician, originally from Russia, who
has been very helpful to us students. The first patient I examined with him was
a “mob justice” victim. Basically, this man had stolen from someone, and in
Kenya, the punishment includes being nearly beaten to death by the people in
the streets. When Dr. Hussein explained this to me, and after I saw this man’s
condition, I nearly threw up. This is just one of the corrupt aspects of
Africa. Anyway, police eventually break up the fight and bring the victims to
the hospital – but even they show the victims no mercy. This man was severely
beaten and the cops threw him around and slapped him in the face when he was
unable to move. I cringed every time. The victim ended up having a cracked
skull, broken wrist, and exposed bones from deep gashes. I was even able to
feel this man’s malleolus (ankle bone). There were obviously internal wounds
and bleeding, but since the man couldn’t afford an ultrasound, Dr. Hussein took
a syringe and stuck it straight down into the man’s abdomen and aspirated the
syringe to see if any blood was present. It’s quite gruesome to say the least.
Upon completion of the examination, the patient was to be sent for X-rays and
then to minor for suturing. Dr. Hussein asked that I do the sutures, but after
nearly 2 hours later, the patient had yet to have X-rays, and was near death
when my shift was over. No matter how long you nag the nurses and doctors,
nothing is done in an urgent fashion – even if a life is on the line.
The next patient I actually diagnosed on my own, and
Dr. Hussein was very impressed – even gave me a high five! J
The elderly woman had a mass in her right atrium which was blocking the blood
flow to the rest of her heart and body. Since the heart is a muscle, and it was
in overtime trying to compensate for the lack of blood supply, the woman
developed cardiomegaly, or enlargement of the heart. This was all previously diagnosed, but today
the woman came in complaining of severe pain in her legs. They were severely
swollen due to a lack of circulation and buildup of fluid, and her upper thigh was
very tender, red and inflamed. The diagnosis was edema and cellulitis.
It was a very stressful, gut retching, and educational
day. A lot of mixed emotions, that’s for sure, but its days like this that make
me more appreciative of the small things. And more eager than ever to be a
compassionate and empathetic physician someday.
Much love from Kenya!
No comments:
Post a Comment