Our time in the hospital started off with surgery the morning after we got off the train. It was a fairly routine surgery until we realized the anesthesia was never routine. Patients rarely would be put under full sedation (gas, muscular blockade, IV medication). Our patient was given a lot of IV medication to compensate. Unfortunately her airway was not kept open and she had copoius secretions with no suction. She proceeded to desaturate until her oxygen levels were next to nothing when we had to take over to get her breathing again. This was our induction to surgery in Africa.
We have had several patients who have groaned during operations; some more than others. Although, with the medication they are on they will likely never remember the pain of surgery watching the patients experience the pain in an altered state is still unsettling.
We have seen an extraordinary amount of children with burns; sometimes extensive. Kids often play near fires with little to no supervision as a way of life. The struggle is not the surgery to repair such wounds with skin grafting, etc; the struggle is with wound care management and physical therapy. We round everyday often changing wound dressings with children in agonizing pain. Even with proper managment many of these children will lose function in the hands, arms, legs, etc.
Many children also come in with serious fractures often dirty and old. Many kids develop osteomylelitis (bone infection). When this happens you can treat with antibiotics. They have access to some antibiotics here but not the IV variety they have in the states. So many children are left with multiple operations to remove the infected bone as their only alternative.
We also have seen an good deal of patients related to 'motos.' Motos are essentially taxi motorcycles. Courtney and I experienced an accident on the way to town one day. We performed a basic trauma survey on the side of the road. We had a man stabbed multiple times from someone attempting to steal his moto. Most recently we saw an accident with 3 people on a small motorcycle being struck by a large bus.
Many OB/GYN cases also have bad outcomes. The infant mortality rate here is still very high here; with approximately 5 of our last 10 C sections resulting in dead children. There is little to no prenatal care and often women wait until it is much too late. Compounding many of these problems is the reliance on 'traditional' medicine before seeking 'western' medical care.
Lastly, is a case that will stay with us for the remainder of our careers. Pt X was a 30 year old female who was a UN recognized refugee living in CAR (Central African Republic). She came in with a large mass in her abdomen for an unknown amount of time. The history we got was anywhere from 6 months to two years. We obtained an ultrasound and a pregnancy test. The pregnancy test was negative and the ultrasound confirmed a mass outside the uterus. We were truly confused. She had also developed an abscess with pus draning from her abdomen. She complained of constant itching until a hole opened in her skin. We decided we had to explore and remove whatever was causing this problem. Brent was lucky enough or unlucky enough to have scrubbed in on the surgery. Pus drained profusely as we opened the wound. Then fragments of hair and bone were seen; typical of a dermoid cyst (cyst with hair, tooth and nails; fairly common). We continue to remove debris until we noticed a femur, pelvis, and a horrific smell. We were removing a dead child. The child was either an ectopic abdominal pregnancy or her uterus ruptured and she recovered quickly enough to not bleed out. The child had been dead so long her pregnancy test was now negative. As we grimly removed her unborn deceased child she never knew she had, Courtney was asked to document what we had seen here. She did her best to contain her emotions and her stomach as she took pictures. The whole situation made you want to cry.
I write about these situations not for shock value or as a condemnation on what goes on at a hospital just trying to save whatever lives they can with the resources they have. I write this as a reminder as to how lucky we are to being living in the US where we have access to great care in virtually ever walk of life. I also write this as a plea to continue to keep in your thoughts and prayers the disparity in the quality of life here.
-Brent Brown
That's so moving ... we are all thinking of you guys <3
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