Today was another hot day. So humid, it is like living in an incubator.. great for infectious bugs…We have so much to learn and we think our modern way is the best way… well these people have done and continue to do OK with their method of therapy. The surgeon that is present at the hospital is originally from France and has been working here for greater than 30 years. It was interesting to hear that he has a greater level of infection for the surgery that are greater than 1.5 hrs, anything less time even with his dirty area, he has a minimal level of infection… true not true.. he seems to have a good reputation in the area.
We had 2 nights ago a young women that a still birth, she presented to the hospital in the morning bleeding, she was advised to go home and continue compresses.. she returned at night where she was seen by our gynecologist where at night, he took her to the OR for a curettage to find out she was very week, and needed further treatment and coagulation evaluation, she was transferred to the bigger city where she passed away. It was frustrating for the team to try to get information, 3-4 different stories, no one will ever know what really happened.
The next morning, we were suppose to do a surgery on a young 7 month old girl, (picture included) she was diagnosed with polydactolie (6 fingers on both hands, and extra toe on each foot) as well as epigastric hernia, this was an routine case for the pediatric surgeon. we began to put her to sleep when she vomited and aspirated breast milk, after a decrease in saturation, we cleaned her lungs the best we could with what we had…she went into cardiac arrest, recovered, and her saturation improved…no aerosol so we tried and invented a way to give her some humidity…remember no ICU, no sat O2 outside the OR… We obtained an xray, very poor quality, showed nothing obvious, but it was early. Kept her for few hours with us and she seemed OK, advised the staff and the parents took her to the room. We found out this morning that this young girl passed away…. No one came to get us, to advised us that she may have had problems… even at late rounds she seemed OK, sleeping. AT 12:00 she passed away… spoke to the mother during the day and explained to her that the baby was suppose to be fasting before the OR, which we all thought she was, the mother said “but when she is hungry she needs food, I have to give her food” we told her how dangerous it was, and she again said “yes but she was crying and hungry, I had to feed her….” Such a sad day!!!!
After all of this when we talked to the surgeon, he told us that babies here are never fasting… they need to eat!!!!!… wow … also epigastric hernia, umbellical hernia have a frequency of 1 in 2, .. now all we see is kids that have those… so we do not operate those anymore… they only get treated if they cause obstruction…We all feel so so bad. It would have been nice to know ahead of time…..
We also found out that the surgeon here treated a 70 year old lady that needed a hysterectomy but had also a large mass, spleen was enlarged. We advised the surgeon that we did not feel she should be done in this hospital with these conditions, he said he was only going to do the hysterectomy because it was descended and within her vagina. He does not do vaginal access to perform his hysterectomy, so opened her up and this large mass did not allow any access to the uterus, so rather than closing the belly, he tried to remove it, the spleen weighed 10 lbs….she unfortunately passed away lather in the evening due to lost of blood.
So do we know more than they do,?? do we need our fancy things to help people….yes.. does it make a difference, no question… do we take our fancy tings for granted…
Out of another 14 hour day, we still did some great changes to these people, good cleft surgery, good hernia, repair, large breast surgery with latimus dorsi surgery reconstruction… we the present conditions, we have so much to learn from them and I think we are doing some great differences for these people… but … we know so little in the large scheme of things…. Very humbling…