Hello again everyone. We officially started week 3 of our stay here in Nalerigu today. Monday is clinic day and we were quite busy with various complaints and diseases. Between Steve and me, with our translator, we saw 91 patients. The triage people were sort of running behind today so I am pretty sure we could have broken 100 if things would have been running smoothly. Our goal is to have an “over 100 day.” We saw various things including plenty of hypertension, general body pains, fever (usually malaria or typhoid), vomiting, waist pain (my personal favorite, as this is different from abdominal pain), multiple women in their third trimester of pregnancy with low abdominal and low back pain, and various other complaints.
I did attend to a younger gentleman who was involved in a RTA (Road Traffic Accident), although in his case it could also be called a Rural Tractor Accident because while he was out working in the field, his left chest and arm were run over by a tractor. Amazingly he did not appear to have any broken bones in the arm or shoulder area (maybe a few fractured ribs), had clear breath sounds (no pneumothorax) and was able to carry on a lucid conversation. I admitted him mostly for pain control and further observation, but I think he is going to recover well. He is very blessed the accident was not worse than it was.
Other admissions between Steve and myself were: concussion in a child who had fallen from a donkey cart (used to haul 55 gallon tubs of water), a snake bite, the RTA and a gentleman with atrial fibrillation with RVR.
After clinic we go to the theater for any small procedures which need to be performed on the waiting patients. Today I performed repeat incision and drainage on a young guy in his 20’s. We did an initial incision and drainage several days ago for large abscess along the muscle layers in the left thigh and right buttock. Despite cloxacillin and bactrim he continued to have fevers in the 103F range. We decided to take him back again today for additional incisions. We made the incision and got some pus out but did not really get back as much as we thought we would originally based on the Ultrasound we had performed. Please pray for him as he has a very serious infection and the antibiotics do not seem to be helping. Today I changed him to another antibiotic regimen, please pray this works for him and the abscesses would dry up and he would recover.
************Interruption for an update in Real Life in the ER, Nalerigu*********************
As I was typing this post the surgeon came to pick us up because Dr. Jim had called him from his night rounds saying there was a lorry (truck) accident and many people were hurt and needing suturing. By the time we arrived he had already triaged several of the patients and decided one of them would need a skin graft on her shoulder in the morning. Others were receiving stitches from some of the OR staff. The lady who was the most critical had a large chunk of flesh out of her left shoulder, mangled skin on her fingers and the top half of her left face was shredded. The pictures are much too graphic to share but we did take a few to hopefully compare before and after. It was a blessing that most of the bleeding was stopped and it really is a miracle her temporal artery was still intact. You could see it pulsating along its course on the side of her head. She had not received any pain medication because she had just eaten and the anesthesia tech was concerned about not having digested food and giving conscious sedation. We gave her Demerol and plenty of lidocaine locally prior to starting. I was in charge of the fingers and am not sure how it is going to turn out. I just reapproximated skin as best I could and cut off the pieces which were no longer viable. Dr. Joel started on the area of the face and placed a few sutures but then decided it would be best to wait until the morning and take a closer look in the OR. He then moved on to the shoulder and tried as best he could to sew the shreds back together after cleaning out the gravel and glass. I know I am being graphic but there really is no other way to describe it. She was all bandaged up and will have her dressings changed again tomorrow and we will take another look at her wounds. It took about an hour with the two of us sewing and Steve and Dr. Jim being our assistants/anesthesia administrators to get it finished. She will have a long road for recovery.
Please pray for her and the other ladies involved in the accident. They were actually patients here today and were on their way back home from their visits when the accident occurred. It really is sad to know how hard life is here on a daily basis and then an accident like this occurs. I know the Lord must have a plan for all of it but you still ask the question “why?” Please pray for their recovery and quick wound healing and that there would be no complications with wound infection. We’ll try to keep you updated on the outcomes over the next several days.
Love,
Jeremy
****Continuation from Steve***
I echo much of what Jeremy has written for today. I was on call yesterday and it was much easier than the previous call was. No major trauma, only a few snake bites which had to receive snake venom, albeit one was at 5am this morning, meaning I had to wake up to give it out, since we store here at the house during the night (pharmacy is only open during the daytime).
On the pediatric side of the world today, we had a little infant a few months old pass away after battling pneumonia and likely developed sepsis. It was just in such respiratory distress it didn’t have a good chance from the time it arrived. We placed it on oxygen, which is an interesting task here. We have no nasal cannulas here, so they take an NG feeding tube, insert it into the nose on one side just a little ways, then tape it down. They then tape this to the hose coming from the oxygen generator (a portable machine). The hospital is equipped for oxygen in the different areas, but for some reason does not have an oxygen supply or delivery is malfunctioned. This can be a real stress in the operating room, and also when trying to save a child’s life. I am not exactly sure what all was wrong with the kid, because I sort of took over on rounds, after the child had been admitted by a medical officer. I was worried yesterday she may not survive, and today she was still in significant distress on my exam (although the staff said she was “much” better today).
Another interesting case was in regards to circumcision, which is common in some groups here, and not common in others. We had a patient come in on Friday with parents requesting a redo of his circumcision. He is about 1 year old and had the initial one done at home soon after his birth. We brought him in on Saturday to do the procedure. After much hassle and examination, we determined that the child’s circumcision could not be redone because when they had performed the initial one they had actually removed the foreskin and the glans penis (the tip) which is termed glans penis amputation. So basically this child still has a lot of swelling and a little urethral opening to urinate through (amazingly has not closed off) and will be deformed all his life now. It was very sad to see this and to see his parents’ disappointment with the whole situation. A few of the children who have been here for the whole two weeks have actually been able to go home in the past couple days, so there is some good coming from the work with all the kids.
On a more positive note, we are expecting some new short term physicians over the next week or so. The first is supposed to arrive tomorrow. She is a pediatrician from Kansas City. We are looking forward to having more medical staff, and also to having more people to divide up the call schedule. I am not sure the dates, but I think a surgeon and a few others are coming in the following weeks.
We are all preparing for malaria to continue to increase in frequency. It is now rainy season, although here in Nalerigu we seem to be getting less than some of the surrounding areas. With the increase in water, comes more mosquitoes and hence more malaria. Currently on the peds ward there around 10-15 patients per day, but when this happens, the story is that there are usually around 2-3 patients per bed in the peds ward (which has 30+ beds). So, as you can imagine, it could get busy very quickly.
I think I will leave you with that for the day. I see this is already 3 pages long. Please keep praying for our work here, and for the patients now and after we have returned home. It is a situation that words and pictures will never be able to describe, but is filled with wonderful, happy people who love one another, and show us love for the work we are doing. We will post again soon.
Love,
Steve
No comments:
Post a Comment