Amazingly enough we have entered our last week at the hospital. I was hoping to be in surgical clinic on Monday but couldn't find dr lee, so I decided to spend a bit more time in the labor ward. It's always interesting being inthere because you're never really sure what's going on or who's closest to giving birth. Many of the women scream and moan for hours on end before they actually give birth and others wander in and give birth as they're setting up their bed without saying a word. On this morning it was fairly quiet except for one loud and exuberant youger woman and after morning rounds there were two women who started giving birth one right after the next. I was able to help get supplies ready and got to carry the baby into the newborn room where they get weighed and then just snuggle under a blanket. The first mom did quite well and was up and walking within a half hour of delivering but the second mom seemed to be suffering from post partum hemorrhage. Several of the nurses gathered around to get an IV into her and start pushing fluids. Once she had been given a full IV bottle, they started to help her up to take her in a wheelchair down to the postnatal ward. As she tried to move from the bed to the wheelchair, she collapsed on the groud at the nurse's feet completely weak from losing so much blood. They put in another IV line and drew some blood to check her hemoglobin count to see if she needed a transfusion. Once she was in the wheelchair and blood had been drawn, I got to help carry her newborn baby girl down to the postnatal ward as one of the nurses wheeled her down. After that, there seemed to be very little going on and the nurses didn't seem very happy to have me there so I headed on over to casualties (aka the ER).
Just after I walked in to the casualties area, a woman was wheeled in looking barely conscious. 4 of us medical students gathered around trying to get vitals on her. We couldn't get a blood pressure and could barely find brachial and carotid pulses. One of the British medical students wandered over to the supply cupboard to find some fluids which then drew the attention of one of the doctors. As she came over, we explained that we couldn't get an accurate blood pressure because it appeared to be so low and we could barely get pulses. She then helped Lindsay to start an IV and push fluids into her as fast as they would go. "This is a resuscitation!" in the words of Dr Janet. Then, of course, when her first course finished, we went to get more normal saline to continue to boost her blood volume, there was no more. So instead of normal saline, we used ringer's lactate, which, fortunately, is a perfectly acceptable substitute.
Tuesday is surgery day. We walked in, changed into our appropriate scrubs and rain boots and got ready to see what was on the schedule for the day. A scar repair and 2 amputations. Sweet.
As the woman came, prepped to get the scar removed from her face, one of the other surgeons came in and started discussing alternative options with Dr Lee. Why wasn't this discussed prior to her laying on the operating table you might ask? Good question. We're still wondering the same thing. She ended up walking out of the OR with the plan of simply getting a steroid injection. Of the other 2 operations that were scheduled, one refused surgery and the other was postponed until Thursday. So we spent the day watching many broken bone reductions and casting.
One of the more involved ones included an older man who has apparently been in some type of motor vehicle accident and suffered a fracture of the calcaneus which is the main weight bearing bone in the foot. The injury was such that there were two huge flaps of skin even though he was now 10 days post accident. Also, the way that the bone broke the Achilles tendon is pulling up on the bone putting it at a suboptimal angle for weight bearing and also decreasing the function of the achilles tendon. Normally, a surgeon would have put a pin through the two halves of the broken calcaneus to stabilize the fracture but alas, this is Africa and mt meru is a government run hospital that is out of supplies.
I spent today rounding with the surgical team and saw one example after the next of decries that need surgery to heal properly but they are out of rods to stabilize femur fractures. There were no less than 50 patients, all with severe breaks that will likely heal well enough but definitely not back to optimal function. One of the patients was being seen for a proximal tibial fracture and had a cast on but he had also suffered a fracture of the radius which also resulted in a dislocates elbow. The complication is that he also had a prior fracture that twisted the bone and didn't heal right. There is really nothing that they can do now as the repair would be a lenghty complicates surgery that they do not have the supplies nor the staff for. It has been A very eye opening experience to see the extent to which seemingly simple fractures can interrupt and ruin someone's life here and I hope that there are things that we'll be able to do in the future to help a bit more.
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