Some of the patients here are quite frustrating. And that's mostly because you just can't treat them the way that they need to be treated (medically speaking) because they don't want it. For starters, we are short-staffed and short-supplied, so that makes things difficult. Then on top of that, when you can do something, they refuse it. Sometimes it's because of money, which sure, sometimes they don't have the money to pay. But most things here are really cheap, and according to Wegner they'll try to barter and then usually just pull a wad of cash out and pay it when they realize they're losing the battle. But then you have our guy who broke is radius and ulna, and needs surgery, and won't do it because he wants massage instead. He's not even paying for it though because it's on the workman's comp thing, so we don't get it. It's really just bizarre. His arm is not going to work properly without the surgery, and none of us can figure it out. Then we had a lady today with a tubo-ovarian abscess that we were getting ready to drain.....and she just left the hospital. I guess she didn't want to pay for it, so she left.
We also dealt with another abortion type situation today. We had a woman who had severe lower abdominal pain, and not quite sure if she's pregnant or not, but we were having trouble getting how many abortions she's had in the past. We think she has 4-5 living children, and that she had 2 abortions after 4 months and a bunch of earlier abortions (not sure how many to count as real pregnancies or not). The husbands really force it on to them it seems, especially when the family units are one husband and up to four wives. A lot of this woman's abortions were just overdosing on medications, which is common. They take medications that are pretty harmful and just take a ton of them, hoping it will kill the baby.....not thinking about also the terrible things it will do to their bodies -- however, I'm sure many of them don't even have a choice. I hear that even the deacons in the church have been known to force their wives to have abortions. It's just one of those cultural things I guess that no one likes to discuss with movement towards change. Anyway, we'll see what happens with her, but it's tough when you can't get a full story.
Our guy that we started treating for TB meningitis (the one we thought maybe had Toxo) died today. We walked in and he was already dead, so we aren't sure for how long. But, we saw that coming. I think I mentioned before that he was a rebel in the army and then spent time in prison, where he acquired TB. He came in pretty late to us for treatment, so we didn't expect him to recover at this point. We also had a patient who had been beat up the night before, and I think they said they ultrasounded him and he had a laceration on his liver, but I kinda missed what they were saying. Anyway, he's recovering. Also had a patient who fell out of a tree and injured his spinal cord, and he's having urinary retention. He's got some movement and feeling coming back pretty good, so hopefully the rest clears up. We also thought initially that he had dislocated one of his ribs at the sternal junction, but now we are thinking that he fractured his sternum. Man, do I miss X-rays! We are hoping that they can fix the machine soon.....though I think that they also have a digital one that just no one has opened up and figured out how it works yet.
Sephora assisted Wegner with replacing that G-tube that I mentioned a while back. They had to re-open her up since we don't have a less invasive way of placing them here. Still working on that. I helped out in the Salles de Urgence with Amanda and then headed back to see if the next surgery was ready. We were supposed to skin graft the guy whom Kiong and I did the the necrotic resection on back on the first day. He had a pretty bad cellulitis and necrotizing fasciitis, so we had cut away all the dead tissue (which was a lot). We have been trying to do the skin graft for the past couple days I guess and the guy kept refusing to pay, so we've been waiting. We had him on the operating table and as we undressed the wound we realized that it was starting to look infected again. Wonderful pus and discharge....so we had to cancel the surgery. No point in grafting skin onto an infected area. So, I don't think I'll be able to finish that case as the next available day will likely be Friday, which is when I'm leaving. Sad sad day. I really wanted to see how they did that here. But, alas, some other time I'm sure.
That was it for the surgeries then, since our other lady absconded. Sarah Spear got lunch for me from the cafeteria, which was the "most local food available," which I was glad to eat. Fish, quanga, and some kind of spinachy-type stuff you dip the quanga in. The fish was a bit difficult to eat because you're basically trying to pull the meat off all the little bones, and trying not to swallow the little bones. But it did taste great. I also cut up an avocado and ate that, which I could just do with every meal no problem. It was also good to just chat with Sarah during lunch. She wanted to know more about Make a Change International, how it started, how I got here, etc. She's really incredible and has been working with these people for a long time, and has clearly devoted her life to serving others. It's a real privilege to talk with her and hear her views on things here and with my organization.
The rest of the work day I just worked in the Salles de Urgences with Amanda, checking on some of our kids, placing IVs, pushing some meds, etc. The good old bread and butter medicine that most doctors suck at, so it's nice to get practice. Especially with putting IVs in kids. Adults are much much easier, and usually it's hard to practice on kids in the US. But, here it's a little easier to get away with missing once and trying again. Chest tubes, laceration repairs, ultrasound, IVs, surgical procedures -- all stuff that has been tremendous to gain experience doing.
Anyway, it's 5:13pm here and our work day is ending. So we'll just see if anything crazy happens tonight (Dr. Kiong is really hoping no haha). Shorter post today, but I'm a bit tired. I'll post a bunch of pictures and stuff to make up for it when I'm back. Make sure to check out the other blogs at: www.makeachangeinternational.org/blogs
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