Today is the first official day we are working in the L'hospital Evangelique a Impfondo. The weekend was fairly light, so other than that surgery I mentioned, Jason and I didn't do any other surgical cases. There were a couple cases that came in, but they weren't urgent enough for that day. We headed over to the Chapel at 7am, where they start their day with singing a few hymns and doing short devotional (in Lingala). Dr. Harvey and Wegner introduced and welcomed us to serve in the hospital. From there we headed to the administration building for the morning report, which is exactly what it sounds like....a report in the morning of all that happened/is going on. There were some updates regarding the maternity ward and a few of the pediatric cases of malaria. Malaria here is a pretty big deal, and really common.....and really bad. Hemoglobins drop lower and seizures are common occurrences (and could be from fever, hypoglycemia, or cerebral malaria).
So anyway, after morning report we headed to do a hospital orientation with Dr. Wegner, who showed us around everything and gave a run through on how things work and the expectations for us while we are here. Basically, have fun, learn a lot, help as much as you can, and try not to get (too) sick. We then headed over to meet with Anna Wegner, who gave us a rundown on the cultural things to know about the Congolese, which was great. From there we headed over to catch up on rounds on all the patients. We followed Dr. Keon, who has been on call and is most familiar with most of the cases that have come in. We saw post-operative patients who had gotten hernia repairs, eye surgery, and incision and drainage (I&D) of lots and lots of pus. If there's one thing the Congolese seem to have an abundance of, it's pus. And it's the good kind of pus. You know, the kind that runs, spills, smells, sticks, gets everywhere.....and kills you if you don't get it out. So we drain it. We drain lots of pus. Pus in the belly. Pus in the leg. Pus in the face. You name it, pus will go there and we will drain it. So we checked on a few post-drain-pus-patients and decided if we had to re-drain, discharge home, watch for another day, etc. We also saw our intussusception guy from Friday, who's healing quite well.....we are just going to watch him another day and see how his bowels start working.
One big problem they have here in the Congo is related to abortions. Abortion is not something that really seems to be accepted as okay, so men will pay for their wives to have them done in mud huts for example, and then come to the doctor afterwards when there has been a nasty infection (hey, pus again) that develops, and then lie about what happened. We can tell though. The docs here then have to do a D&C and clean out the uterus of all the infection. Sometimes the abortions are spontaneous and end up being septic and.....yep, you bet.....pus. So there's a lot of gyne type pus surgeries going on is the point. I think you've heard enough about pus for a moment.
We then headed over to the pediatric units, which has a bunch of the kids being treated for malaria. One of them we weren't quite sure, but his neck was stiff so we did a spinal tap there and will start on antibiotics. They have one incubator and they had a very small 36 week preterm baby boy in there. 1 week old and I think at about 1500g. So they do have some medical equipment for stuff like that, but other things they have are just broken and it makes it difficult. There seems to be a lot of babies being born and most women are on their like 8th child that we've seen....so the birthing process is super quick for the most part. From what I hear, they moan a bit but if they scream, then their mothers (baby's grandmothers) usually yell at them and tell them to hush. I'm sure we'll see a couple babies born here. There was a one woman who came in this morning who we were going to induce....she was at 42 weeks. Not sure if she had the baby yet.....but I'd guess yes.
We rounded for a couple hours and went through the medicine areas, surgical patients, ER/ICU patients, and pediatrics. Then I headed over with Dr. Keon to get started on a surgery. The guy was young, probably late 20s early 30s, and he had gone to a local witch/voodoo doctor who had basically stabbed him in the foot to "drain out evil spirits." Not sure why he was trying to get rid of evil spirits, but they are really into some of that stuff here. I guess if the witch doctor tells you that you have cancer because of your uncle, then they might go try to kill the uncle, for instance. Or, stab your foot to drain out evil spirits. So, this guy was stabbed in the top of the foot and as a result developed infection, cellulitis and.....yeah we are back to pus again. Basically on the lateral side of his right ankle was a whole bunch of necrotic tissue, and on the medical side was some more with deep pockets of pus. So we took him into surgery to debride it all. We cut out all the dead skin, which was a lot, and scraped the underlying tissue to make sure it bled and was viable. He'll need a skin graft at the end of the week....we took off more than the size of my palm....and it's about a centimeter or two deep. On the medial side we took out about half the size but made deep incisions to find the abscesses, which tracked up behind his calf muscle. Truly disgusting but fairly satisfying to drain and cut away. This is a great example though of the difficulties that we run into when modern medicine clashes with their "medicine." Please don't take my cynicism for cultural insensitivity, as I don't mean to be. However, when something like this causes so much unneeded harm to someone, it's really just sad. These people are so trapped into believing that these "doctors" are trying to help them, but now this guy is going to be in the hospital recovering for quite a while, undergoing surgeries and skin grafts trying to save his leg, which is at the moment filled with pus and dying. Throughout medical school we have looked at situations like this and discussed the "right" ways to approach them, and I don't think there is a right way, we just do the best we can.
After the surgery I headed over to catch up with the rest of the group and Dr. Wegner. We hung out in his office and saw patients for the remainder of the afternoon. He's really an amazing guy and a great teacher as well. Today he wanted to teach us a bit about ultrasound, and they do have a portable machine that they use to diagnose.....well everything. I think they sometimes have an X-ray, but other than that, anything we might use a CT, MRI, Xray for....let's try an ultrasound and see what we see. He gave us a basic review and the next several patient's we saw he had each of us do a full abdominal/chest ultrasound on them for practice. Make me excited to get started in my residency and start learning a lot more about utilizing ultrasound, and becoming an expert in time. Dr. Wegner believes that it will be the new stethoscope in medicine......I'm inclined to agree with him.....or maybe it's just that I really hope that it happens. I want to creat an iPad app that has a bluetooth attachment....even more portable. I'm not technologically smart enough though and I'm sure it's being created.
After we finished up with all the patients I headed over to the Chapel to help with the worship practice. After last night, playing the piano for those hymns during their "Sunday Night Live" (forgot to tell you that's what they call it), Joyce really wants me to play with them while I'm here now. Which, I'm happy to do....any excuse to play the piano works for me. Dr. Wegner came over to play the acoustic guitar, a medical student from France played the flute, Joyce's daughter (Cherissa) played the violin, and Henri pounded the drum. They have a bit of a problem staying in a rhythm, but their hearts are in the right place, so it's enjoyable. I gave them some pointers on starting songs and how to try to play more together along with the drums. They've got some work to do, but like I said, their hearts are in the right place. I would try to lead them more but they sing a lot of the songs in French, and I pretty much just can't sing in French at all. Hopefully the rest of the time I'm here I can sit in on their practices and try to help give some pointers for improvement. Joyce also asked if I could give her some piano lessons, which I'll definitely make time to do.
That's about it for events of the day. I went back to Albany (house I'm staying in) and made some dinner. We got a phone now so they can call us if anything goes down during the night. Thanks again for reading!
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