Expectations

Friday I hoped I might get caught up on some things. We only had a few minor cases scheduled and I was hoping to spend some time thinking about how to  treat some of our patients that have been here for weeks, many with chronic wounds and patients with osteomyelitis(bone infection). 

Then I started rounds. My first encounter was a young man who had been beaten by thieves  and thrown off the side of a steep road two nights prior; he had not been discovered until the following day and finally made it to our hospital that night. His neck was broken and he was paralyzed from the neck down. After my evaluation, I found no other injuries to treat; I left his bedside greatly disturbed, there was little I could do to help.

Next patient: a man who had fallen over a tree and and began having abdominal pain and bloody urine. The story was unclear- my colleagues are from the nearby Congo and speak mostly French and Swahili not Kinyrwanda so, depending on the individual patient or nurse, the story may be difficult to obtain. However, I  could easily see his catheter output was almost purely blood and his abdominal exam indicated a need for an operation. I suspected a ruptured bladder but this was based on a history through two interpreters. Another issue here is that we can only get plain X-rays- no CAT scans or contrast studies are available so most of my decisions to operate are based purely on history and physical examination. While really old fashioned medicine, it sharpens your senses! (about our Xray technicians: they are excellent and are amazing at doing the best they can with what they have, very dedicated and bend over backwards to help!) 

We asked the crew to prepare for this man's case in the OR and in the minor surgery room next door we were doing some dressing changes. There came a knock at the door. When the door opened there was a group of men outside in the small corridor surrounding a young man on a stretcher. This is not uncommon that folks are sent to the surgery area to be seen like this; they usually will form a line on benches outside the surgery suite and patiently wait for hours until they can be evaluated, many requiring some minor operations like amputations or abscess drainage; often having the problem for days or even weeks.

However, this man was different- the initial impression was that of bloody muscle, bone and dirt; the next question I had after looking at this young man's face was whether he was even still alive. He had been working at an road excavation site when a tremendous boulder fell from a great height and crushed his right thigh against another rock, nearly severing it at mid thigh. It took ten strong large African men to move the rock away from his leg. The accident  occurred far way on an island in Lake Kivu which is actually part of the Congo but our hospital is the closest place to go; so they loaded this man onto a boat and for another  two hours he survived the trip to our hospital. His leg was hanging on by shreds and no telling how much blood loss. We immediately turned our attention to stopping any further bleeding, initially ignoring the dirt and grime. By the time we were finished with cleaning up and repairing what we could, he had lost the leg, but was alive and had a good blood pressure, mostly a tribute to his body's amazing resilience. 

After a short rest, we proceeded to operate and repair the man with the ruptured bladder; almost anticlimactic. Feeling pretty tired, we were about to call it a day when we noticed a young boy of 10 years of age who had been patiently waiting on the bench outside the OR all day with a bloody bandage on his hand. It turned out that a friend had accidentally partially amputated the long finger on his left hand with a machete a few days ago and now it was becoming infected. He was an orphan and lived far away. The patients at the hospital have to bring in their own food to eat and the children have to have a relative to take care of them while they are in the hospital and give consent for treatment. We ended up treating his wound without proper consent  and made him promise to spend the night at the hospital. Some other patients shared their food with him that night and later, my family brought him some more.

So much for a day to catch up on things! Of course, life anywhere is like this but here it seems more to happen frequently.  The lights go out in the middle of an operation, the equipment doesn't work or there may be a missing part; delays and complications are commonplace. Maybe  there are just less options to deal with the difficulties; maybe more needs; I laugh when my friends say: "TIA" (This Is Africa-Haha!). Even though I'm pretty exhausted, somehow there is a sense of peace. 

Thank you for your prayers!