OPD week mon tues half of wed
The OPD, out patient department is where every patient starts out in th hospital. It is mostly walk ins as ambulances are only used for motor accidents and transferring patients from clinics to hospitals or vies versa. Most patients are driving, taxi, walking, etc. the outpatient department has a admission desk and waiting area where you will be directed to the dr offices, dental, optics, OPD surgery, OPD obsentrics/gynaecology, skin disease ward, ctc(care treatment centre) for TB and HIV, or sent to the clinic for health insurance claims.
I started off with Dr.moses' office taking in patients.
Patient 1
Young male, a 4 week old arm injury previously X-ray and cast applied, however he removed the cast himself and is now back complaining of pain. Dr to send him for a new X-ray to compare to old, likely then discharged.
Patient2
Diabetic patient with lower limb and finger numbness, hasn't been taking her Medes for 2 weeks. Sent for blood glucose test and BP, new prescriptions given.
Patient 3
Older gentleman in wheelchair, has had CVA since 2010, complaining of pains, irritation, painful swallowing, cough, diarrhea, has a skin deformity on his arm.
Patient BP taken, prescribed antibiotics for infection and given a cream for skin irritation.
Patient 4
Patient coming in complaining of pains and weakness. Diagnosed soft tissue injuries, patient came with police report after being beaten. Dr fills out form describing findings, pain relief tablets given.
Patient 5
Child with club foot since birth, dr palpates, soft, tender, painful. Given some prescriptions, not sure exactly what for.
Patient 6
Older lady complaining of painful swallowing and hyper salivation, with visual inspection and palpating of neck sent to the dental ward. Depending of findings will be sent back to us.
Patient 7
Middle aged man with a lump on the lower right back, soft no tender palpation, also complains of painful urination. Sent to surgical ward to check and drain fluids from lump.
Patient 8
Middle aged,lady, complains of weakness, weight loss, sent to PITC (provider initiated counselling and testing) for HIV or similar testing.
Patient 9
Young male, history of pain in right foot and trauma throughout 2014, sent for X-ray of foot and ankle joint.
Patient 10
Child with difficulty breathing, seems like pneumonia, given 5 day course of antibiotics, with no improvement told to come back after course.
Patient 11
Baby, also pneumonia, admitted for 24hr with 1 day course of injected antibiotics, then to be discharged given a 5 day course with instructions to return.
Patient 12
Older lady, cough, sometimes bloody, sent for chest X-ray.
Was told I would be switching offices to join Dr.Mpena but her office was empty, instead I was lead out of the ward to the road out front with dr Mpena standing beside 2 pickup trucks. She told me to put on gloves and go into the first pickup truck. There was a blue grocery bag and she told me to expose what was inside. In the bag were 2 bloody shirts or large rags and I mostly expected to find some body part inside... However what I discovered was a aborted fetus maybe 8 inches long bloody and gooey it sort of look like some small alien, smelt horrible... Not quite what I was expecting after an hour in OPD............ After telling her what it was she sent me to the next pickup with a scene straight out of every mobster movie. A rolled up rug with what had to be a body inside. Again I was told to unwrap it and tell her what it was. So I exposed the body of an old man and told her it was a dead body. She then asked me how I would determine if it was dead. I explained I can check for verbal and physical responses if I expect unconsciousness and check breathing and circulation as well as for rigor mortis. She stared expecting lay at me so I did as I just explained going to check pulse and respiratory rates, or the absence there of. Instantly I felt how hard the body was and I realized why they call bodies stiffs, I really needed no more than that but I checked pulse breathing and determined death. So I touched a dead body, nothing I've done before, weird experience not sure how I felt about that. I then escorted the bodies to the morgue.
After my little adventure I went back for some more patients in the dr office.
Pt13
Old diabetic lady with swollen hands and a small cut on her pinky. Hands where non-soft and tender on palpation, sent to surgical ward for incision to drain pus, daily dressings, and to wait for her BGL to come down(currently 17.0 mmol/L)
Pt14
Patient presented with rough bumps starting at pelvis and getting sparser leading up to breasts, before we could finish the patient I was sent to the CTC, the ward for the immune compromised.
Was told dr would come back to me after a half hour, though she never did, I ended up staying we the dr in th CTC until he was out of patients.
The ward was explained to me, the reception desk acts as a bit of a triage/ distribution centre. Patients are sent to education seminars and counselling sessions for living with HIV every time they have to come to the CTC. Then they sent to drs for appointments to get their ARV drugs, antiretroviral. ARV must be taken at the same time every day for them to be effective. Adherence problems are the biggest cause of complications, with patients missing their doses, or patients taking them at wrong or different times. Patients come in frequently after thir diagnosis with HIV but the visits are made less frequent. Going from 1 week to 2 to 4 to 2 months to 6 months and th every 6 months. They are questioned about their health, symptoms and occasionally they get their CD4% rechecked. Cd4 being a certain measurement of their white blood cell levels. If cd4 isn't consistently rising each check the dr has to determine if this is due to immunological reasons, resistance development, or adherence problems.
Pt15
Diagnosis starting cd4 39%, after 6 month of ARV cd4 747% patient to be retested for current levels.
Pt16
Feb 2013, 247, June. 2013, 407 February 2014. 344
Checking current levels, will then question patient about adherence and possible testing about immunological changes.
Pt17
5yr ago 224
2.5 yr ago 209
Received counselling about drinking and drug use
Last year 481
Current 484
Pt18
May 2014 30
One month later 30
Checking current.
Pt 19
June 2008 cd4 6
2012 335
2014 394
Current 268
Lost 5kg in last couple months(~10% body weight) showing signs of TB and oth infections.
Pt 20
2011 cd4 41
2012 189
2013 272
2014 269
Based on his talks with the patient he expects poor adherence to be the main cause of no continued increase. Talks to patient frustratedly about importance and rig time of taking drug.
Pt21
No left leg, 2012 851
Current 913
Pt 22
2010 147
2011 121
2013 210
2014 187
I noticed a typo on his sheet where his age and eight were both listed as his age. Dr attributes patients cd4 problems to alcohol use causing missed doses.
Dr never showed up so I walked back to the offices in OPD.
Pt 23
Middle aged make, BP 160/80 sent to medical OPD ward.
Pt 24
Lower abdominal pain, genital skin rashes, diagnosed with PID and discharged with prescription antibiotics for PID
Pt25
Young middle aged man, has trouble keeping head up, subdued talking and responses, rapid respiratory and heart rates, pale, edemic. Possible heart/kidney disease/failure. Sent to internal medicine ward.
Pt26
Middle aged man with infertility. Long talk with dr, nothing really of note.
Pt27
Male 6 yo, malariA, sent for stool sample for other parasite checks.
28
Young girl can't straighten arm after falls down 2 days prior. Sent for X-ray.
29
Old lady with back pain, prominent spine disks, swelling, painful urination, sent for X-ray of lumbar spine.
End of the day, went home, no new students this week so Monday after no one was pretty free and relaxed.
Tuesday
Dr Moses gave me a lesson on diabetes. Was good, not goons write about it,though.
Pt1
Woman submitting a medical investigation form for someone else. Not sure what it entailed.
Pt 2
Woman in wheel chair, BP,test first thing as seems standard in OPD for chairs.
Recent HIV diagnosis, cd4 oct 181, early nov 110, current 181
Pepper white jaundice eyes, weightloss, frequent diarrhoea 7-8* a day! lower extremity pitting edema, heart failure! gradual onset of pain in legs increasing in severity over last 2 weeks. BP 100/60
6 different prescriptions given.
Pt3
Pain on left side, BP test 110/80 fever, throat pain, headache, median gastric pain, increases with hunger, most food relives pain but gassy foods increase pain. Expected peptic ulcer disease, given 4 prescriptions.
Pt4
Male in 40s timid low voice, slow to respond, red eyes, most questions met blankly. Has HIV taking ARV, vomiting and diarrhea, prescribed strong antibiotic and given a oral hydration solution. Told to stay on his ARV.
Pt5
Woman with lower abdominal pain, painful urination, 3 months no menstruation. Sent for a urinary pregnancy test. Came back negative, diagnosis urinary tract infection, given antibiotics.
Pt6
Mother with infant. Edema of right leg, painful on palpation sent for X-ray. Upon questioning the mother cause is found to be mother and father having a fight, mother tried to grab baby away from father and dropped him... When X-ray came back shown to have mid shaft femur fracture, to be admitted to surgical award.
Pt7
Male submitting a diagnostic investigation form for his pregnant wife who is in th dental clinic.
Pt8
17 year old woman in wheel chair. BP 110/80 can stand but slow and difficult, walks to examination table. History of lower abdominal pain, no clear and whitish vaginal discharge, on examination diagnosis is vaginal candidiasis. A fungal infection.
Pt9
20 year old female, history of lower abdominal pain, painful urination, PV discharge whitish recently turning red, on examination find red discharge and 2 small vaginal lacerations, urinary analysis ordered to check for syphilis and UTI. Syphilis comes back negative.
Pt10
Female history if lower abdominal pain, PV discharge, painful urination, on examination find coloured discharge and vaginal lacerations, dr diagnoses vaginal candidiasis and UTI.
Dr comments that it is like gynaecology day in OPD for some reason, i didn't expect so many vaginas until I was in obstetrics and gynaecology next week.
Pt11
Older lady in wheel chair, hemoglobin levels at 7.8 normal level 12.0 moderate anemia, large mass on pelvic X-ray, unsure of what it is, will go to surgical ward tomorrow for identification and possible surgery.
Pt12
Skinny oldish man, very distended abdomen, liver sclerosis, no pitting edema in legs, sent for abdominal ultrasound. Since there is only 2 ultrasound machines Iringa he will be transferred to one of,the clinics that has one, the hospital doesn't.
Pt13
Right ear pain, no abnormalities found on exam, diagnosis otitis media given a prescription.
Pt 14
Teenage male, pain of left arm after falling, sent for xray of wrist.
Pt15
Older couple, male has past of difficulty breathing, just in for a medical checkup, sent to medical OPD.
Pt16
Middle aged couple in, long discussion, secondary infertility(have had pregnancy, no longer able)
Pt17
Older lady in wheelchair, unable to walk. Pains of left hip joint starting 2 weeks prior, gradual onset increasing in severity, pain is localized and continuous with no aggravating or reliving factors. Patient is pail and jaundice, joint is swollen and tender, sent to surgical ward.
Pt18
Female in 20s, has typhoid, filling out a work sickness absentee sheet.
Pt19
Male brought in on stretcher, conscious but 0/4 alert and oriented, confused, erratic head movement, rapid blinking, no verbal responses, sent over from a health clinic, 6 hours ago he fell down and lost consciousness, BGL comes back in range, dr suspects severe malaria. Relative comes in and reports patient complained of weakness prior to event. BP comes in at 90/50, eyes jaundice, face pale, sent to internal medicine ward.
Sent to other dr as dr Moses needed lunch,
Pt20
63'year old male, complaining of pain of left side after falling down. On exam dr says the pain is to be expected, no signs of trauma, given some anti pain tablets.
Pt 21
The last case of the day was unfortunately a suspected rape case. Mother in with 14 year old daughter. Mother says daughter didn't come home the night before. Dr does a vaginal exam checking for broken hymen, bruising, bleeding, etc. based on the pain of the patient, some blood, and depth her finger went in that the patient had been a virgin before being raped. She then had a long talk with the mother and daughter and eventually father when he came in.
Tuesday finished
Given a lesson by dr impena on abdominal investigations. Visual inspection, palpation, percussion, and auscultation. Breaking down the sections of the abdominal into 9, General started ending points etc.
Pt 1
Middle aged woman, doctor does breast exam, checks eyes, and takes history. Diagnosis is a respiratory tract infection. Given antibiotics.
Pt2
Lady in wheel chair, patient complains of heartbeat awareness, hypertension, headache,weakness, difficulty breathing, and doctor comments that she looks quite visibly Ill. Admitted to icu.
Pt 3
20 yr old female complaining lower abdominal pain. Referred tqo different ward for further analysis.
Pt4
Baby, checked hands eyes feet tempura true(38C) do a malaria test. Palling, fever, vomiting, cries during urination, baby well until 2 days prior. Babies symptoms increase at night, baby seems weaker in the morning, frequent diarrhea. Dr suspects dehydration and other possibilities. When given water baby drinks very eagerly... Sunken and jaundiced eyes. Admitted to paediatric ward, to be administered 3 satchels of ORS, paediatric zinc, gentamicin injection, paracetamol syrup. Maybe another prescription or two.
I then headed to the OPD minor theatre. Child injured from motor accident, I was lead to believe it would be serious but ended up being quite minor when I arrived. Small abrasions on left knee, laceration above left eyebrow, abrasions across right leg, arm tied and squeezed for IV fluids, failed, switched arms. Success.
In the waiting room for the theatre was another patient. Middle aged man, sort of fat, quite big, covered in burns. Lots of lost and peeling skin. Looks like thin shrink wrap that's been warped and is no longer tight but peeling... Burns across legs up to groin including full thigh, burns across abdomen and arms and shoulders. Large saline IV. Man shudders with every breath and every action of the nurses but manages to never cry out or flinch too bad. Nurses cutting away and peeling off all the affected skin across the arms and shoulders, after peeling nurses unravelled dampened gauss and placed over the peeled arms and shoulders one piece at a time until completely covered by a couple layers. His shorts were pulled off and his underwear cut away, the peeled and cut the legs and left thigh of skin, repeating the process of watered down gaussing. The right thigh they kept the skin on after stretching it back over th thigh. They had to drain some fluid from the skin that had pooled underneath it before they pulled it over that thigh.
Antonio the Italian doctor/nurse came in and took over the show but not after knocking over the chair and some bottles of saline that were in front of th entrance. He seemed a little confused at the nurses using normal saline and seemed to want cooled or iced water. He brought some of his own gauss that was in a roll instead of in pads and used it to finish up the legs. He would gauss dry and then pour water over instead of soaking the gauss first. Once he had all burns wrapped a full bottle of saline was again poured over everything. He was then stood up and put on a dry blanket and wheelchaired himself out.
Tuesday, November 25, 2014
Wednesday, November 19, 2014
Final surgery ward runs.
Hints and stuff and stuff
Wednesday nove 12 surgery ward runs day 2
We started in th female ward, all the windows are open, but the screens aren't being used so there are flys everywhere. Sort of scary when the are open wounds and burns a plenty.
Patient 1
Patient sitting up, has abdominal pain, constipation, recently operated on hemmeroids, a intestinal block not sure if complete or partial, complete generally means no passing of stool or gas, fecal impaction, vitals were done.
Bp 80/40 blood glucose 7.6 mmol/L temp 37.8
IV inserted for fluid saline, after 2 attempts on left arm finally succeeded on right arm, all done with same needle. Patient to be monitored, block may need surgery.
Patient 2
Dental problems, switching wards
Patient 3
Femur fracture, 6 kg traction splint, will stay in ward up to 8 weeks.
Patient 4
Femur fracture, chest pain, displaced clavicle, HIV, at least one opportunistic infection, on a 2*4kg traction splint. To be in ward 6-10 weeks.
Patient 5
Young child, mid shaft femur fracture 2 kg traction for 6 weeks.
Patient 6
Patient was talked about in there morning briefing. Motor accident leading to open tib fracture above the ankle, between transportation on scene to a health clinic, and then transportation from the clinic to th hospital patients wound was not cleaned, no bandaged, and no fluids given. Patient arrived in hypo-volumetric shock with a dirt and gravel filled bleeding wound. Emergency operation scheduled but delayed, was the surgery discussed on my their surgery post.
Patient 7
Complaining of pain, has deformed foot and leg fracture, continued monitoring.
Patient 8
Girl whose arm fracture I helped set and cast on Tuesday theatre surgery, doing well and being discharge.
Patient 9
Femurs fracture 6 kg traction, 1 month in ward, 1 month to go. Some complications because of bedsores. Needs more consistent position changes, there do exist bless that don't get bed sores as explained by th doctor, but of course not affordable or convenient.
Patient 10
Young child, with X-Ray no fracture found, to be discharged.
Patient 11
Palpating suggests patient leg is not fractured, X-ray shows small foot dislocations/fractures, some small wounds from motor accident, dr hoping to be able to discharge by end of day.
Patient 12
Young child, motor accident
Eyes swollen shut, leg abrasions, no fractures found, waiting for swelling to come down so can be certain no problems are hidden. If nothing found will discharge.
Patient 13
Young child, facial and head burns dangerously close to eyes but thankfully not quite. Much improved since Monday, no longer constant vomiting nor dehydrated, looks much better, standing, eager to play, look around.
Patient 14
Young child with bone pain, hyper calcification, bone growth, leading to excess red blood cell production from the bone mass. I think was to be transferred to internal medicine ward, not certain.
Patient 15
Woman with extensive 2-3rd degree burns across back of legs and thighs. Looks somewhat improved since Monday, continue monitoring and staying in ward.
Patient 16
Smelly, lots of flys, patient has swollen labia and vulva gland from a bacterial infection. Has at least 1 STD, doctor notes poor hygiene, will require surgery.
Patient 17
Large neck abscess, has had it 20+ years, was drained last week according to older gap students. In ward for continued monitoring, cleaning, draining, changing dressings. Dr would use scissor clamps to insert a whole pad of gauss into the drain hole in the abscess and then would scrub around, get new gauss, repeat. after about a half dozen passes we moved on and a nurse changed the dressing.
Patient 18
Child with burns on legs hands and feet. Much improved since Monday, that or it just seemed better since I wasn't there when they were removing some gauss. Continued monitoring.
Patient 19
Child with burns on back of thighs, also looking improved since Monday.
Patient 20
Gangrenous surgery patient from Tuesday, continue monitoring and dressing changes.
Patient 21
Child with small swollen open sore under armpit. Minor surgery for Thursday then likely quick discharge.
Patient 22
Large breast lump, dr does examination, believes it to be non cancerous after feeling it.
Comments on ward runs day 2
I felt a lot better after day 2 relative to day 1. It seemed like patients were improving, I knew what to expect, I was more adjusted to the timeline, climate, sleep hours, what to expect in the ward, the smells... Maybe I had already grown a tolerance and steeled myself a bit, but I didn't feel like that, I felt more optimistic almost eager.
On Thursday theatre surgery I forgot to mention one surgery, mostly because we only viewed it briefly before moving back to another surgery room. S a patient from a motor accident, skull fracture, patient aggressive and confused, required sedatives.
Friday ward runs surgery
Today we went through the male ward for the first time, a bit quieter, more visitors, more people doings things rather that just laying around. Less burns, more fractures, people,on phones, reading papers...
Patient 1
Child with foreign body in ear for last 4 days before coming to hospital, to be sent for minor surgery today.
Patient 2
Sleeping, confused, refuses to let go of blankets, twisting and turning, yes never open long. Patient has head injury needs a ct scan of the left parietal. Slow steady recovery expected naturally. Considered mild severity, though not responding well with our check doctor explained that if he pursues the checks he will get verbal and physical responses as desired. Later during the day I saw sitting up and being fed by his friend/brother, even small amounts of talking.
Patient 3
Is a prisoner, has history of falling down and recently reported frothing at th mouth. Antiepilectics given.
Patient 4
Old man, constant shaking and mumbling. Can't pass urine thorough his urethra, his a catheter in through his supra pubis area for passing urine. doctor performs a rectal exam though extremely painful. Patient bridging on shoulders and feet screaming out and minor convulsions. Doctor reports his prostate extremely enlarged, hard, and rough. Malignant tumour of the prostate gland, patient had testies removed 2 years prior to reduce the tumor. Doctor notes the catheter is not working anymore and tries to insert a urethral catheter again to the extreme pain of the patient. However hr fails, says the urethra is completely blocked/shut. Surgery scheduled to removed and replace catheter.
Patient 5
Bike accident, chest injury, hypertensive, discharged with some anti-hypertensive drugs.
Patient 6
Bullet wound in hand, surgery from Thursday, I guess he's sticking around for awhile.
Patient 7
Needs nutritional support, has been in hospital for many months, had 4+surgeries just to remove infection and close stitching from original abdominal surgery months ago. Doctors and nurses don't like him draining resources, claiming he's,doing nothing to help himself, lays around all day doing nothing.
Patient 8
Anal fistula, opening between tissues, surgery hoped to be done yesterday but delayed due to time constraints.
Patient 9
A screw and wire in knee as seen from X-ray, not sure how it's proceeding, doctor with us stopped being so talkative or explaining anything after the old man...
Patient 10
Wound on top of head and back, dressings and monitoring.
Patient 11
Burns covering face and head, dressings and monitoring.
Patients 12-20
Femur fractures, traction splints, long ward stays.
Patient 21
2 feet in water bath, swollen, peeling, open sores, diabetes related complications. Lots of flys, horrible smell.
Patient 22
Long deep cut in leg above knee. Nurse cleaning it out with large syringe of aware and saline, dozens of repetitions, wrapped with antiseptic covered gauss.
Doctor sort of disappeared leaving us hanging. Later we got a long lesson on intestinal blockages from our mentor doctor.
Friday was a little different but there was little time for reflection as we were soon leaving for our safari.
Wednesday nove 12 surgery ward runs day 2
We started in th female ward, all the windows are open, but the screens aren't being used so there are flys everywhere. Sort of scary when the are open wounds and burns a plenty.
Patient 1
Patient sitting up, has abdominal pain, constipation, recently operated on hemmeroids, a intestinal block not sure if complete or partial, complete generally means no passing of stool or gas, fecal impaction, vitals were done.
Bp 80/40 blood glucose 7.6 mmol/L temp 37.8
IV inserted for fluid saline, after 2 attempts on left arm finally succeeded on right arm, all done with same needle. Patient to be monitored, block may need surgery.
Patient 2
Dental problems, switching wards
Patient 3
Femur fracture, 6 kg traction splint, will stay in ward up to 8 weeks.
Patient 4
Femur fracture, chest pain, displaced clavicle, HIV, at least one opportunistic infection, on a 2*4kg traction splint. To be in ward 6-10 weeks.
Patient 5
Young child, mid shaft femur fracture 2 kg traction for 6 weeks.
Patient 6
Patient was talked about in there morning briefing. Motor accident leading to open tib fracture above the ankle, between transportation on scene to a health clinic, and then transportation from the clinic to th hospital patients wound was not cleaned, no bandaged, and no fluids given. Patient arrived in hypo-volumetric shock with a dirt and gravel filled bleeding wound. Emergency operation scheduled but delayed, was the surgery discussed on my their surgery post.
Patient 7
Complaining of pain, has deformed foot and leg fracture, continued monitoring.
Patient 8
Girl whose arm fracture I helped set and cast on Tuesday theatre surgery, doing well and being discharge.
Patient 9
Femurs fracture 6 kg traction, 1 month in ward, 1 month to go. Some complications because of bedsores. Needs more consistent position changes, there do exist bless that don't get bed sores as explained by th doctor, but of course not affordable or convenient.
Patient 10
Young child, with X-Ray no fracture found, to be discharged.
Patient 11
Palpating suggests patient leg is not fractured, X-ray shows small foot dislocations/fractures, some small wounds from motor accident, dr hoping to be able to discharge by end of day.
Patient 12
Young child, motor accident
Eyes swollen shut, leg abrasions, no fractures found, waiting for swelling to come down so can be certain no problems are hidden. If nothing found will discharge.
Patient 13
Young child, facial and head burns dangerously close to eyes but thankfully not quite. Much improved since Monday, no longer constant vomiting nor dehydrated, looks much better, standing, eager to play, look around.
Patient 14
Young child with bone pain, hyper calcification, bone growth, leading to excess red blood cell production from the bone mass. I think was to be transferred to internal medicine ward, not certain.
Patient 15
Woman with extensive 2-3rd degree burns across back of legs and thighs. Looks somewhat improved since Monday, continue monitoring and staying in ward.
Patient 16
Smelly, lots of flys, patient has swollen labia and vulva gland from a bacterial infection. Has at least 1 STD, doctor notes poor hygiene, will require surgery.
Patient 17
Large neck abscess, has had it 20+ years, was drained last week according to older gap students. In ward for continued monitoring, cleaning, draining, changing dressings. Dr would use scissor clamps to insert a whole pad of gauss into the drain hole in the abscess and then would scrub around, get new gauss, repeat. after about a half dozen passes we moved on and a nurse changed the dressing.
Patient 18
Child with burns on legs hands and feet. Much improved since Monday, that or it just seemed better since I wasn't there when they were removing some gauss. Continued monitoring.
Patient 19
Child with burns on back of thighs, also looking improved since Monday.
Patient 20
Gangrenous surgery patient from Tuesday, continue monitoring and dressing changes.
Patient 21
Child with small swollen open sore under armpit. Minor surgery for Thursday then likely quick discharge.
Patient 22
Large breast lump, dr does examination, believes it to be non cancerous after feeling it.
Comments on ward runs day 2
I felt a lot better after day 2 relative to day 1. It seemed like patients were improving, I knew what to expect, I was more adjusted to the timeline, climate, sleep hours, what to expect in the ward, the smells... Maybe I had already grown a tolerance and steeled myself a bit, but I didn't feel like that, I felt more optimistic almost eager.
On Thursday theatre surgery I forgot to mention one surgery, mostly because we only viewed it briefly before moving back to another surgery room. S a patient from a motor accident, skull fracture, patient aggressive and confused, required sedatives.
Friday ward runs surgery
Today we went through the male ward for the first time, a bit quieter, more visitors, more people doings things rather that just laying around. Less burns, more fractures, people,on phones, reading papers...
Patient 1
Child with foreign body in ear for last 4 days before coming to hospital, to be sent for minor surgery today.
Patient 2
Sleeping, confused, refuses to let go of blankets, twisting and turning, yes never open long. Patient has head injury needs a ct scan of the left parietal. Slow steady recovery expected naturally. Considered mild severity, though not responding well with our check doctor explained that if he pursues the checks he will get verbal and physical responses as desired. Later during the day I saw sitting up and being fed by his friend/brother, even small amounts of talking.
Patient 3
Is a prisoner, has history of falling down and recently reported frothing at th mouth. Antiepilectics given.
Patient 4
Old man, constant shaking and mumbling. Can't pass urine thorough his urethra, his a catheter in through his supra pubis area for passing urine. doctor performs a rectal exam though extremely painful. Patient bridging on shoulders and feet screaming out and minor convulsions. Doctor reports his prostate extremely enlarged, hard, and rough. Malignant tumour of the prostate gland, patient had testies removed 2 years prior to reduce the tumor. Doctor notes the catheter is not working anymore and tries to insert a urethral catheter again to the extreme pain of the patient. However hr fails, says the urethra is completely blocked/shut. Surgery scheduled to removed and replace catheter.
Patient 5
Bike accident, chest injury, hypertensive, discharged with some anti-hypertensive drugs.
Patient 6
Bullet wound in hand, surgery from Thursday, I guess he's sticking around for awhile.
Patient 7
Needs nutritional support, has been in hospital for many months, had 4+surgeries just to remove infection and close stitching from original abdominal surgery months ago. Doctors and nurses don't like him draining resources, claiming he's,doing nothing to help himself, lays around all day doing nothing.
Patient 8
Anal fistula, opening between tissues, surgery hoped to be done yesterday but delayed due to time constraints.
Patient 9
A screw and wire in knee as seen from X-ray, not sure how it's proceeding, doctor with us stopped being so talkative or explaining anything after the old man...
Patient 10
Wound on top of head and back, dressings and monitoring.
Patient 11
Burns covering face and head, dressings and monitoring.
Patients 12-20
Femur fractures, traction splints, long ward stays.
Patient 21
2 feet in water bath, swollen, peeling, open sores, diabetes related complications. Lots of flys, horrible smell.
Patient 22
Long deep cut in leg above knee. Nurse cleaning it out with large syringe of aware and saline, dozens of repetitions, wrapped with antiseptic covered gauss.
Doctor sort of disappeared leaving us hanging. Later we got a long lesson on intestinal blockages from our mentor doctor.
Friday was a little different but there was little time for reflection as we were soon leaving for our safari.
Tuesday, November 18, 2014
Safari and stuff
Safari
7 of us went on Safari over the weekend. Unfortunately we were separated into 2 jeeps. On Friday after the hospital we had a quick lunch then headed off to the lodge. It was about a 2 hour drive, I spent the whole ride reading the book I nought on Wednesday. We arrived at the lodge greeted with wet towels and glasses of tamarind juice. The tamarind juice tasted like lemonade with not enough water. Very sweet very tart very thick. Most of the other didn't like it, it was good but drinking too much would definitely give heartburn... The lodge was a main building with a restaurant, bar, and deck. Across was a bathroom building with surprisingly the best toilet paper I've seen or used this whole trip. I really wanted to steal some..... There were about 15 cabins that housed 2-4 people each and we were split between 3 of them. They were small but comfortable, good beds and pillows, a small shower but hot and very high water pressure. After dropping off my bag I went down right away and read my book for another hour and a bit. After more than an hour a few of the others came down and we talked. Each of us giving a family background, brothers sisters parents jobs etc. The last 2 of us didn't come down for a few hours after that, just in time for dinner at 745. Food was okay, comparable with everything so far in Africa...
I kept reading some more but they shut off the lights pretty early. All the women went to bed soon but me and Stuart stayed up til about midnight talking and looking at the stars. Very clear, no light, but no Milky Way or visible satellites, just billions of bright stars. No real complaints, it was a good night. I did continue to read awhile in bed with a lantern in our room.
Saturday Safari day arrives. Up at 630 for breakfast and leaving at 7. Still in our 2 jeeps we headed off it was about an hour drive before we hit the national park boundary and on the way we saw only a couple impalas and a dikdik. Another 20 went by before we saw our first giraffe at a distance. A couple hours til we got some lions or elephants but by then it was constant. Never in big groups we saw hundreds and hundreds of impalas, dozens of all giraffes, elephants, baboons, monkeys, colourful land and flying birds.... Close up lions we saw 4, not too many ostriches, not really any water buffalo or hyena though... It was pretty incredible overall. We didn't get back to the lodge until about 5pm.
I finished my book, we did more stargazing and slept. Sunday we headed back but spent a couple hours touring through a Masai village. There were some scoffs, exclamations, and turned noses at some of what we saw, learned, and answered questions. They explained their traditional medicines, boiling some cow dung in water, cooling to warm, then drink it to cure stomach problems. Got malaria? Dig up the root of this tree and drink tea do it 5 days and nights and be cured for life. Other ailments? Pick and eat every unidentified plant you come across while ranging with the cows, if your haphazard munching cramps your stomach we've still got your cow dung. Our Masai guide claimed a life expectancy of 100-115, though he either didn't mean years or is mistaken/misleading a fact that was rebuked heavily at lunch when I explained as much at lunch that day... Apparently 1 persons claim is worth more than common sense, most the other students have seemed pretty gullible or a little dumb... I hate to say it but hearing them talk about water energy crystals, good and bad energies, or fruits only diets curing all ailments hurts my head a little.
After our tour done, our questions answered, we went to their little market where they are selling mostly paintings(the same one seems at every stall and corner in town) bead necklaces and wristbands, and simple carvings. They are pretty and relatively cheap, but every single one of the students REFUSE to barter... The women selling just started charging more and more every time someone bought something, it made me want to scream and also made it impossible for me to get anything for a decent price when they see all the students throwing money around like nothing... My suggestions of bartering, techniques, expected markup based on experience as well as multiple conversations with the staff and locals, or my cries that they were all being robbed blind, we're met villainous glares and it was suggested I was evil for wanting to deprive the Masai of money... It just seems like a disrespect of money and shortsightedness, maybe some arrogance. It reminded me of our bus ride to the orphanage, 8 of us went and it cost 60,000 shillings, none of us had change all of us had 10,000 bills only. We had plans of going to the club that night so I suggested putting the extra aside to pay for that such that change was split reasonably, or we could get change after the fact and split it up, or for the love of god we could donate that extra 20,000 to the orphanage where they are fed porridge rice and beans out of 1 pot a spoon at a time, no toys, old clothes..... Nope any of these suggestions were too difficult lets just tip the bus drivers 33% on 2 hours work where they were already making a weeks wages...
Back Sunday evening with a new department starting Monday, moving from surgery to the OPD out patient department.
I have patient by patient notes for my 2 unwritten surgery days and my now 2 OPD days, writing it all will be pretty extensive but it's all already there for me, will work on getting it posted, pictures might not come until after I'm home for the most part.
Thank you to everyone for your good wishes, thoughts, and for reading. If I don't reply to something or contact you keep in mind I haven't contacted anyone from back home since I left, I'm sort of useless like that.
7 of us went on Safari over the weekend. Unfortunately we were separated into 2 jeeps. On Friday after the hospital we had a quick lunch then headed off to the lodge. It was about a 2 hour drive, I spent the whole ride reading the book I nought on Wednesday. We arrived at the lodge greeted with wet towels and glasses of tamarind juice. The tamarind juice tasted like lemonade with not enough water. Very sweet very tart very thick. Most of the other didn't like it, it was good but drinking too much would definitely give heartburn... The lodge was a main building with a restaurant, bar, and deck. Across was a bathroom building with surprisingly the best toilet paper I've seen or used this whole trip. I really wanted to steal some..... There were about 15 cabins that housed 2-4 people each and we were split between 3 of them. They were small but comfortable, good beds and pillows, a small shower but hot and very high water pressure. After dropping off my bag I went down right away and read my book for another hour and a bit. After more than an hour a few of the others came down and we talked. Each of us giving a family background, brothers sisters parents jobs etc. The last 2 of us didn't come down for a few hours after that, just in time for dinner at 745. Food was okay, comparable with everything so far in Africa...
I kept reading some more but they shut off the lights pretty early. All the women went to bed soon but me and Stuart stayed up til about midnight talking and looking at the stars. Very clear, no light, but no Milky Way or visible satellites, just billions of bright stars. No real complaints, it was a good night. I did continue to read awhile in bed with a lantern in our room.
Saturday Safari day arrives. Up at 630 for breakfast and leaving at 7. Still in our 2 jeeps we headed off it was about an hour drive before we hit the national park boundary and on the way we saw only a couple impalas and a dikdik. Another 20 went by before we saw our first giraffe at a distance. A couple hours til we got some lions or elephants but by then it was constant. Never in big groups we saw hundreds and hundreds of impalas, dozens of all giraffes, elephants, baboons, monkeys, colourful land and flying birds.... Close up lions we saw 4, not too many ostriches, not really any water buffalo or hyena though... It was pretty incredible overall. We didn't get back to the lodge until about 5pm.
I finished my book, we did more stargazing and slept. Sunday we headed back but spent a couple hours touring through a Masai village. There were some scoffs, exclamations, and turned noses at some of what we saw, learned, and answered questions. They explained their traditional medicines, boiling some cow dung in water, cooling to warm, then drink it to cure stomach problems. Got malaria? Dig up the root of this tree and drink tea do it 5 days and nights and be cured for life. Other ailments? Pick and eat every unidentified plant you come across while ranging with the cows, if your haphazard munching cramps your stomach we've still got your cow dung. Our Masai guide claimed a life expectancy of 100-115, though he either didn't mean years or is mistaken/misleading a fact that was rebuked heavily at lunch when I explained as much at lunch that day... Apparently 1 persons claim is worth more than common sense, most the other students have seemed pretty gullible or a little dumb... I hate to say it but hearing them talk about water energy crystals, good and bad energies, or fruits only diets curing all ailments hurts my head a little.
After our tour done, our questions answered, we went to their little market where they are selling mostly paintings(the same one seems at every stall and corner in town) bead necklaces and wristbands, and simple carvings. They are pretty and relatively cheap, but every single one of the students REFUSE to barter... The women selling just started charging more and more every time someone bought something, it made me want to scream and also made it impossible for me to get anything for a decent price when they see all the students throwing money around like nothing... My suggestions of bartering, techniques, expected markup based on experience as well as multiple conversations with the staff and locals, or my cries that they were all being robbed blind, we're met villainous glares and it was suggested I was evil for wanting to deprive the Masai of money... It just seems like a disrespect of money and shortsightedness, maybe some arrogance. It reminded me of our bus ride to the orphanage, 8 of us went and it cost 60,000 shillings, none of us had change all of us had 10,000 bills only. We had plans of going to the club that night so I suggested putting the extra aside to pay for that such that change was split reasonably, or we could get change after the fact and split it up, or for the love of god we could donate that extra 20,000 to the orphanage where they are fed porridge rice and beans out of 1 pot a spoon at a time, no toys, old clothes..... Nope any of these suggestions were too difficult lets just tip the bus drivers 33% on 2 hours work where they were already making a weeks wages...
Back Sunday evening with a new department starting Monday, moving from surgery to the OPD out patient department.
I have patient by patient notes for my 2 unwritten surgery days and my now 2 OPD days, writing it all will be pretty extensive but it's all already there for me, will work on getting it posted, pictures might not come until after I'm home for the most part.
Thank you to everyone for your good wishes, thoughts, and for reading. If I don't reply to something or contact you keep in mind I haven't contacted anyone from back home since I left, I'm sort of useless like that.
Monday, November 17, 2014
Surgery theatre 1&2 Tuesday Thursday
Surgery theatre days 1&2
The days in the operating room were pretty crazy. Tuesday started off eith setting and casting a broken arm. Overall a pretty quick procedure. The doctor called me over and told me to put my hands just below the shoulder. I thought he just wantd me to feel something but suddenly he told me to pull when he pulled. He pulled down the hand as I held to the shoulder. There were 2 loud pops as he then had me hold the arm in position as he put a cast on.
Next we watched a surgery on a young boy with a enlarged scrotum. A loop of intestine had broken though the weakened perennial wall and descended. It was pretty delicate and tedious. Very small cuts though single membranes, then a larger, held open, then another very small cut, repeated many many times. Eventually the intestine was found and pushed aback into place and everything sealed up.
The last one was pretty gross. A lady with a gangrenous hand sized sore on her butt cheek. After the skin was cut off there was a lot of vigorous scrubbing with a lot of water and a lot of mortified flesh cut away. It looked gross, smelled grosser and in the end there was no skin graft so she'll have to lay on her front for a long time, and will have problems with the bathroom for up to 6 months.
Thursday was pretty interesting as we'll with one really long procedure to start it off. There was a open fracture of the Tibula with a couple closed fractures of the Fib. For the most part the closed fractures were minor and ignored. At one point while two of the staff were preparing a new saline bottle for washing the wound out they had pouring the remaining bottle into the wound while they scrubbed and cleaned it. The direction wasn't very clear just a point and a shout and a bottle put in my hands. At first I was pouring small amounts periodically until it was made more clear they wanted a steady pour. I obliged until the saline bottle was empty and retreated back to my corner with the other 2 students. After the cleaning was done they started scraping away at the insides of the bone with a Metal instrument before pulling then setting the bones together. At that point they had to screw in 4 bolts 2 on each side of the fracture and then tighten them together. This took a very long time as the drill did not at all seem strong enough to get though the bone. Over and over the bolt would lock and the drill head would spin and the doctor would have to try again, trying to find the balance between enough power to get through the bond without causing the drill to skip.
There was a bullet lodged in a mans hand that the doctors tried to find and remove but they could not get to the bullet. They told us that it was either lodged enough into the bone they couldn't remove it or that it would eventually pass on its own.
The last surgery we watched that day involved a woman with a fatty growth tumor in her leg/thigh. This surgery lasted a couple hours because as thy doctor said there was no capsule to the fatty pustules so they just manually removed them. Hundreds of little fatty balls and a few larger pieces of flesh, 2 different incisions were made before they cleared out enough to satisfy. The worst part of that procedure was that the patient was constantly waking up from drugs And they pain releases kept wearing off quickly. The doctors complained that she was a drug addict and ignored it but the lady was moaning, screaming, and writhing pretty much throughout.
The days in the operating room were pretty crazy. Tuesday started off eith setting and casting a broken arm. Overall a pretty quick procedure. The doctor called me over and told me to put my hands just below the shoulder. I thought he just wantd me to feel something but suddenly he told me to pull when he pulled. He pulled down the hand as I held to the shoulder. There were 2 loud pops as he then had me hold the arm in position as he put a cast on.
Next we watched a surgery on a young boy with a enlarged scrotum. A loop of intestine had broken though the weakened perennial wall and descended. It was pretty delicate and tedious. Very small cuts though single membranes, then a larger, held open, then another very small cut, repeated many many times. Eventually the intestine was found and pushed aback into place and everything sealed up.
The last one was pretty gross. A lady with a gangrenous hand sized sore on her butt cheek. After the skin was cut off there was a lot of vigorous scrubbing with a lot of water and a lot of mortified flesh cut away. It looked gross, smelled grosser and in the end there was no skin graft so she'll have to lay on her front for a long time, and will have problems with the bathroom for up to 6 months.
Thursday was pretty interesting as we'll with one really long procedure to start it off. There was a open fracture of the Tibula with a couple closed fractures of the Fib. For the most part the closed fractures were minor and ignored. At one point while two of the staff were preparing a new saline bottle for washing the wound out they had pouring the remaining bottle into the wound while they scrubbed and cleaned it. The direction wasn't very clear just a point and a shout and a bottle put in my hands. At first I was pouring small amounts periodically until it was made more clear they wanted a steady pour. I obliged until the saline bottle was empty and retreated back to my corner with the other 2 students. After the cleaning was done they started scraping away at the insides of the bone with a Metal instrument before pulling then setting the bones together. At that point they had to screw in 4 bolts 2 on each side of the fracture and then tighten them together. This took a very long time as the drill did not at all seem strong enough to get though the bone. Over and over the bolt would lock and the drill head would spin and the doctor would have to try again, trying to find the balance between enough power to get through the bond without causing the drill to skip.
There was a bullet lodged in a mans hand that the doctors tried to find and remove but they could not get to the bullet. They told us that it was either lodged enough into the bone they couldn't remove it or that it would eventually pass on its own.
The last surgery we watched that day involved a woman with a fatty growth tumor in her leg/thigh. This surgery lasted a couple hours because as thy doctor said there was no capsule to the fatty pustules so they just manually removed them. Hundreds of little fatty balls and a few larger pieces of flesh, 2 different incisions were made before they cleared out enough to satisfy. The worst part of that procedure was that the patient was constantly waking up from drugs And they pain releases kept wearing off quickly. The doctors complained that she was a drug addict and ignored it but the lady was moaning, screaming, and writhing pretty much throughout.
Thursday, November 13, 2014
Down time and stuff
Off time
After a stressful morning Monday we walked back to the house for a quick lunch. They make us a breakfast and supper but lunch is usually leftovers. Breakfast is hot porridge and one changing hot food, pancake one day, eggs, creeps, etc. other than that there is ample fresh fruit, bread for toast, cereal, jams spreads coffee tea etc. supper is usually 1 fresh salad, 1 meat dish, 2 starches usually rice and potatoe, and 3 different vegetable dishes. There Re always many gallons of fresh squeezed juice and a pantry of easily prep arable foods as well.
After our lunch we took a walking tour of th town, went to the atm(my card works woot) currency exchange, passed a f restaurants, book store, Mai market, meeting place for lost people, supermarket... We all stopped in the super market to see what it had. I bought a bottle of the,local liquor Konyagi for about 5 dollars. It's made of some fruit I have no clue about but it tastes just like triple sec/orange liquor. I mix it with the house juice they make and am very pleased. Everyone else thinks it tastes like nail polish mover but I think it's actually one of my favourite hard spirits I've had...
In the evening with any free time people mostly play cRds or are on their phones reading the internet and talking to friends. Tuesday Wednesday Thursday we have a 1 hour global health tutorial on a changing topic, malnutrition, HIV,emergencies and accidents, malaria etc. Tuesday and Wednesday they set up a volleyball net and we play for a few hours. On Tuesday night they brought in a local troupe of dancers and acrobats and they gave us a little show. Today(Thursday) we went to the orphanage this week it was 0-6 years old. They mostly didn't seem to interested in me but after awhile I had a whole group I was chasing around laughing. The final game that got the most of them in glee involved me picking one up, holding him or her under my arm straight as a log, and chasing the others around the yard. When I was finally to tired to continue and tried to sit I had a half dozen of them climbing on me and pulling my arms.
Tonight most of us will be heading to a local club for some drinking and dNcing, I hear most of the staff get involved as well and it's always a fun night.
On Friday after our hospital hours most of us will be leaving for a weekend safari.
After a stressful morning Monday we walked back to the house for a quick lunch. They make us a breakfast and supper but lunch is usually leftovers. Breakfast is hot porridge and one changing hot food, pancake one day, eggs, creeps, etc. other than that there is ample fresh fruit, bread for toast, cereal, jams spreads coffee tea etc. supper is usually 1 fresh salad, 1 meat dish, 2 starches usually rice and potatoe, and 3 different vegetable dishes. There Re always many gallons of fresh squeezed juice and a pantry of easily prep arable foods as well.
After our lunch we took a walking tour of th town, went to the atm(my card works woot) currency exchange, passed a f restaurants, book store, Mai market, meeting place for lost people, supermarket... We all stopped in the super market to see what it had. I bought a bottle of the,local liquor Konyagi for about 5 dollars. It's made of some fruit I have no clue about but it tastes just like triple sec/orange liquor. I mix it with the house juice they make and am very pleased. Everyone else thinks it tastes like nail polish mover but I think it's actually one of my favourite hard spirits I've had...
In the evening with any free time people mostly play cRds or are on their phones reading the internet and talking to friends. Tuesday Wednesday Thursday we have a 1 hour global health tutorial on a changing topic, malnutrition, HIV,emergencies and accidents, malaria etc. Tuesday and Wednesday they set up a volleyball net and we play for a few hours. On Tuesday night they brought in a local troupe of dancers and acrobats and they gave us a little show. Today(Thursday) we went to the orphanage this week it was 0-6 years old. They mostly didn't seem to interested in me but after awhile I had a whole group I was chasing around laughing. The final game that got the most of them in glee involved me picking one up, holding him or her under my arm straight as a log, and chasing the others around the yard. When I was finally to tired to continue and tried to sit I had a half dozen of them climbing on me and pulling my arms.
Tonight most of us will be heading to a local club for some drinking and dNcing, I hear most of the staff get involved as well and it's always a fun night.
On Friday after our hospital hours most of us will be leaving for a weekend safari.
Wednesday, November 12, 2014
Gap medic day -1,0,1
Up at 5am to catch our flights except today they aren't together. Mom is leaving to Paris and then home, I'm headed to DarEs Salaam to begin with gap medic. Mom goes to the washroom in the Dubai airport and the lineup was so long that her flight was boarding as she came out, our goodbye was cut short. A hug and she runs through her gate. Another long flight for me, I read my book, arrive, get my visa and meet up with our driver. 4 of us were on the flight from Dubai, 3 will continue on to Iringa. We stay that night in a hotel, collect a couple arrivals in the morning and take a van to a public bus and 9 hours later we arrive. There is 8 of us starting this week, current students leaving next week, and one long term student. We have an orientation, supper, and play some uno before heading to bed. Monday it begins.
I'm starting in the surgery department with Eenis and Toni. Me and Eenis are new and Toni on her last week is surprised we are starting in surgery, it is an intense way to start. Every morning once at the hospital starts with a meeting with the department you are in, the mentor head doctor a couple chiefs and a dozen or so nurses and trainees. Monday Wednesday and Friday we do rounds through the surgical wards, Tuesday and Thursday are for operations.
Day 1 Monday we start in the close care ward, the wards are all just single building separated by walkways, the first patient has a bullet in his cheek, he has had it for a couple days since he was shot we talk about is, plan to remove it on the next operations day. Another patient in that ward has flys around him, looks old and thin. He has a bowel obstruction, the doctor removes his blanket, and shoves a couple gloved lubed fingers in his rectum checking for stool, no stool thus complete blockage. Meanwhile the nurse is wiping thick yellow and red spit from his mouth, he has a couple lines of blood on his feet and body, the flys are almost only hovering around him.
The close care ward was pretty small and we soon moved to the female surgical ward. Over the next couple hours I was to cry, vomit, pass out, punch a wall until my hands are bleeding, and cry some more. Eenis has to leave a couple times for a few minutes then an hour feeling faint from the heat. There are babies and children with cages over them to keep their blankets off their burned bodies, open sores, scrapes, and cuts. Sometimes there is a little gauss, often there is nothing. A baby with her hands, feet and face covered in burns, screaming as a nurse removes some gauss from her foot, at the end the tip of her big toe and nails comes off with the bandage, she cried and cried. Another baby with abrasions covering her face, her nose ans ears missing skin, a fractured arm, vomiting everything she's been fed for over a day, they have to give her an IV so she can get some fluids to stop her worsening malnutrition and dehydration. The doctor ties a glove around her arm and spends 15 minutes over 3 attempts to get the vein.
Note at this point I'm using my iPad as a keyboard and not a text pad so I can type faster but I will be much more prone to missed spelling and grammar errors, especially due to the difficulty of making the auto correct not changing things I don't want changed. I only have so much fee time each day, and little of it with internet...
We came across next a middle aged woman with burns from a fire, the back oaf both legs anus to angles were covered in second and third degree burns, again a burn cage and blanket covering her. Next a woman with a neck abscess who has had it for 15+years! the size somewhere between a soft and baseball. Last week she came to the hospital and had it drained. Today it was cleaned , it has a looney sized hole, the doctor using a pair of tongs would soak some gauss in water and stick it inside scrape pull out and repeat. After a half dozen to a dozen blood and puss covered swabs a new bandage is placed and taped around her neck. Next s woman who 4 days prior had started feeling pain in her lower pelvic area, 2 days later it started to swell and within that day burst. She came to the hospital and is certain to have gangrene, that's where we are now with a palm sized area of deD tissue and puss, surgery scheduled for Tuesday.
The rest are a couple of constipation patients to be discharged that day, and a few femur fractures with crude traction splints with nothing but day to day monitoring happening. Average time in bed is 6-10 weeks before the bones set and reveal enough for discharge, that time is cut down to 24 or 72 hours if surgery can be done inserting rods and screws, but due to limited operating rooms, equipment, surgeons, money... Most. Re stuck eating the weeks. If the patient or family has the money, or if it is an emgergency there is often a small delay for surgery.
The traction splints are usually just a wrapping around the knee to under the foot attached by rings of gauss and tight wrappings around the leg. Then a rope attached from the knee wrap is placed over a small divet on the end of the bed and tied to a circular weight.they then spend the full time to recovery in a bed in the ward. Maybe a 1/4 of the female ward beds were taken by femur and pelvic fractures with traction splints simply waiting.
When it was fresh and raw I had more to write and was much more disparity than I am now, but damn one in the hospital ended by 1pm and the rest of the day was very relaxing and fun. By the end of the day I was in a much better state of mind, and by today(Wednesday) I am enjoying most every moment. I'll look to finish the rest of day one, and update my first surgery day, and ward runs day 2 tomorrow. Now that I've remembered to bring a pen in and not just my notebook I have notes on every patient examined so writing on them will be much better and easier, and I'll have more space in my mind to write about my other 12 waking hours And not only my 6 in the hospital.
I'm starting in the surgery department with Eenis and Toni. Me and Eenis are new and Toni on her last week is surprised we are starting in surgery, it is an intense way to start. Every morning once at the hospital starts with a meeting with the department you are in, the mentor head doctor a couple chiefs and a dozen or so nurses and trainees. Monday Wednesday and Friday we do rounds through the surgical wards, Tuesday and Thursday are for operations.
Day 1 Monday we start in the close care ward, the wards are all just single building separated by walkways, the first patient has a bullet in his cheek, he has had it for a couple days since he was shot we talk about is, plan to remove it on the next operations day. Another patient in that ward has flys around him, looks old and thin. He has a bowel obstruction, the doctor removes his blanket, and shoves a couple gloved lubed fingers in his rectum checking for stool, no stool thus complete blockage. Meanwhile the nurse is wiping thick yellow and red spit from his mouth, he has a couple lines of blood on his feet and body, the flys are almost only hovering around him.
The close care ward was pretty small and we soon moved to the female surgical ward. Over the next couple hours I was to cry, vomit, pass out, punch a wall until my hands are bleeding, and cry some more. Eenis has to leave a couple times for a few minutes then an hour feeling faint from the heat. There are babies and children with cages over them to keep their blankets off their burned bodies, open sores, scrapes, and cuts. Sometimes there is a little gauss, often there is nothing. A baby with her hands, feet and face covered in burns, screaming as a nurse removes some gauss from her foot, at the end the tip of her big toe and nails comes off with the bandage, she cried and cried. Another baby with abrasions covering her face, her nose ans ears missing skin, a fractured arm, vomiting everything she's been fed for over a day, they have to give her an IV so she can get some fluids to stop her worsening malnutrition and dehydration. The doctor ties a glove around her arm and spends 15 minutes over 3 attempts to get the vein.
Note at this point I'm using my iPad as a keyboard and not a text pad so I can type faster but I will be much more prone to missed spelling and grammar errors, especially due to the difficulty of making the auto correct not changing things I don't want changed. I only have so much fee time each day, and little of it with internet...
We came across next a middle aged woman with burns from a fire, the back oaf both legs anus to angles were covered in second and third degree burns, again a burn cage and blanket covering her. Next a woman with a neck abscess who has had it for 15+years! the size somewhere between a soft and baseball. Last week she came to the hospital and had it drained. Today it was cleaned , it has a looney sized hole, the doctor using a pair of tongs would soak some gauss in water and stick it inside scrape pull out and repeat. After a half dozen to a dozen blood and puss covered swabs a new bandage is placed and taped around her neck. Next s woman who 4 days prior had started feeling pain in her lower pelvic area, 2 days later it started to swell and within that day burst. She came to the hospital and is certain to have gangrene, that's where we are now with a palm sized area of deD tissue and puss, surgery scheduled for Tuesday.
The rest are a couple of constipation patients to be discharged that day, and a few femur fractures with crude traction splints with nothing but day to day monitoring happening. Average time in bed is 6-10 weeks before the bones set and reveal enough for discharge, that time is cut down to 24 or 72 hours if surgery can be done inserting rods and screws, but due to limited operating rooms, equipment, surgeons, money... Most. Re stuck eating the weeks. If the patient or family has the money, or if it is an emgergency there is often a small delay for surgery.
The traction splints are usually just a wrapping around the knee to under the foot attached by rings of gauss and tight wrappings around the leg. Then a rope attached from the knee wrap is placed over a small divet on the end of the bed and tied to a circular weight.they then spend the full time to recovery in a bed in the ward. Maybe a 1/4 of the female ward beds were taken by femur and pelvic fractures with traction splints simply waiting.
When it was fresh and raw I had more to write and was much more disparity than I am now, but damn one in the hospital ended by 1pm and the rest of the day was very relaxing and fun. By the end of the day I was in a much better state of mind, and by today(Wednesday) I am enjoying most every moment. I'll look to finish the rest of day one, and update my first surgery day, and ward runs day 2 tomorrow. Now that I've remembered to bring a pen in and not just my notebook I have notes on every patient examined so writing on them will be much better and easier, and I'll have more space in my mind to write about my other 12 waking hours And not only my 6 in the hospital.
Sunday, November 9, 2014
Foodie Heaven? Mais oui!
So after writing the last blog at 4 am this morning, I took a long hot shower, read my book for awhile, and decided to head out for coffee, eventhough it was still dark. What a shock! The bussling streets that looked so trendy yesterday afternoon, were a shambles!! The first thing I saw was an old drunk pissing on the wall of the hotel, then some vomit on the sidewalk, then a small group of people across the street sharing the contents of a brown paper bag. It was dark, and I suddenly felt extremely vulnerable. Paris looks different in the dark! There was garbage everywhere and although it was 6:30 am the streets were deserted, except for the drunks, and to my dismay, even the Starbucks was closed...so I hurried back to my hotel and went back to bed. A few hours later, I reemmerged to deserted, but cleaned streets. The drunks had gone to bed.
It was about a 2.5 km walk to where my food tour was to begin, and I enjoyed the buildings and sights along the way. I was surprised by the number of homeless people I saw camped out in the doorways. Being Sunday, all the shops and restaurants were closed, and it was 10 am before I could find a cup of coffee. But, it was worth the wait! What a great latte it was. It was 4 Euros, so I skipped breakfast and drank two.
The foodie tour took us through the Jewish district, because things there are open on Sundays. We went to some award winning bakeries, charcuteries, and cheese shops. I learned about the difference between "ordinary" French bread and croissants, and "traditional" ones. You could really taste the difference! We ate 8 different cheeses and several pates(my gall bladder is going to hate me), and washed them down with 3 different wines...from...get this...boxes!!! YES it is true...a new trend here is good wine in a box. The store that started the concept is called Bibo and the boxes are all pink, with the cellars' labels on the boxes. The guy got a bunch of good well known wineries to agree to this new environmentally friendly wine storage concept, and he sells from a small storefront near the market. "Natural" wine is also big here: wines made with natural yeast...much like sourdough bread is made.
Then we went to an award winning chocolatier and OMG it was amazing. I bought some to give as gifts at Christmas...they are sooooo good!!
Afterwards, I walked back slowly, enjoying a new route (to avoid the homeless dudes who I figured would all be awake), one that led me past high end shops that were all closed, providing an interesting backdrop to the hookers that lined the street. At that point I realized that I obviosly am just staying in a rather rough part of Paris. How was I to know? The hotel ads don't exactly say, "stay here, we feature drunks and prostitutes for your evening pleasure". Oh well...it is a cool old building with an elevator so small, if Nick were still with me, he would have had to take the stairs!
By the time I got back to the hotel it was quite dark out, eventhough it was barely 4pm, and I was so full of bread and cheese that the thought of going out for supper is too much. I had hoped to take in a nice meal at some famous place, but frankly, all my clothes are dirty, my hair is a mess, and I look like an Oakie from Maskokie compared to all these Parisians! Today, eventhough it was cold out, I did not see one ski jacket like what I was wearing. People wore warm coats and scarves, but they were all very fashionable. When they looked at me I got the impression they thought I just fell off a turnip truck returning from the ski hill! Sigh.
So, instead of heading out on the town, this frump girl is going to bed at 7 pm to watch bad French sitcoms, hoping to not wake up to pee in the night because my room does not have a toilet...it's down the hall. I guess that should have been the first clue that this was not the best part of Paris, eh?
All in all, it was a good trip, but I am so happy to be coming home tomorrow! All my boys have now had an extended trip with me, I have seen over 40 countries, experienced many different and wonderful cultures, seen some of the best scenery in the world, including many world heritage sights and some of the natural wonders, but, in the end, one of the biggest lessons I have learned from all this travel is, there is no place like home.
It was about a 2.5 km walk to where my food tour was to begin, and I enjoyed the buildings and sights along the way. I was surprised by the number of homeless people I saw camped out in the doorways. Being Sunday, all the shops and restaurants were closed, and it was 10 am before I could find a cup of coffee. But, it was worth the wait! What a great latte it was. It was 4 Euros, so I skipped breakfast and drank two.
The foodie tour took us through the Jewish district, because things there are open on Sundays. We went to some award winning bakeries, charcuteries, and cheese shops. I learned about the difference between "ordinary" French bread and croissants, and "traditional" ones. You could really taste the difference! We ate 8 different cheeses and several pates(my gall bladder is going to hate me), and washed them down with 3 different wines...from...get this...boxes!!! YES it is true...a new trend here is good wine in a box. The store that started the concept is called Bibo and the boxes are all pink, with the cellars' labels on the boxes. The guy got a bunch of good well known wineries to agree to this new environmentally friendly wine storage concept, and he sells from a small storefront near the market. "Natural" wine is also big here: wines made with natural yeast...much like sourdough bread is made.
Then we went to an award winning chocolatier and OMG it was amazing. I bought some to give as gifts at Christmas...they are sooooo good!!
Afterwards, I walked back slowly, enjoying a new route (to avoid the homeless dudes who I figured would all be awake), one that led me past high end shops that were all closed, providing an interesting backdrop to the hookers that lined the street. At that point I realized that I obviosly am just staying in a rather rough part of Paris. How was I to know? The hotel ads don't exactly say, "stay here, we feature drunks and prostitutes for your evening pleasure". Oh well...it is a cool old building with an elevator so small, if Nick were still with me, he would have had to take the stairs!
By the time I got back to the hotel it was quite dark out, eventhough it was barely 4pm, and I was so full of bread and cheese that the thought of going out for supper is too much. I had hoped to take in a nice meal at some famous place, but frankly, all my clothes are dirty, my hair is a mess, and I look like an Oakie from Maskokie compared to all these Parisians! Today, eventhough it was cold out, I did not see one ski jacket like what I was wearing. People wore warm coats and scarves, but they were all very fashionable. When they looked at me I got the impression they thought I just fell off a turnip truck returning from the ski hill! Sigh.
So, instead of heading out on the town, this frump girl is going to bed at 7 pm to watch bad French sitcoms, hoping to not wake up to pee in the night because my room does not have a toilet...it's down the hall. I guess that should have been the first clue that this was not the best part of Paris, eh?
All in all, it was a good trip, but I am so happy to be coming home tomorrow! All my boys have now had an extended trip with me, I have seen over 40 countries, experienced many different and wonderful cultures, seen some of the best scenery in the world, including many world heritage sights and some of the natural wonders, but, in the end, one of the biggest lessons I have learned from all this travel is, there is no place like home.
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