Bonjour!
I am now on my second week here in Mango. During my brief stay I’ve been reminded very
acutely of why I decided to go into medicine (and surgery) in the first place:
to help people who are suffering and in need of medical attention, serving them
where nobody else is giving care.
Nonmedical highlights of the past week:
- a going away party for Kyle heading back to the States, complete with homemade doughnuts
- watercolor night
- working on a puzzle at the guesthouse
- sharing many meals with Sarah, an ED attending from Atlanta, and Heidi, a midwife from Washington
- dessert at the DeKruyger household followed by a victory in Settlers!
- Fellowship meeting on Sunday night
- Finding a place to live in Ypsilanti! My Mom and Dad and Aunt Lynne and Uncle Kevin were instrumental in helping me find a condominium on Ford Lake! What a blessing!
For the first time I’ve decided not to include a photo
essay. Currently my phone is dead and
loading pictures takes a considerable amount of time. I will be good about taking photos of my
various adventures and promise to include an extended montage next week.
12PM- 3PM of 15/4/2015.
Following a mildly chaotic morning that included an
amputation for a bleeding leg status post washout in a cirrhotic man in
hemorrhagic shock and a chest tube for a girl with a parapneumonic effusion, a
man came into the reanimation (the ER) with a complaint of sudden onset chest
pain (what was really bothering him) and abdominal pain that started this
morning when eating his porridge. His
history was difficult to gather as we had to go through two translators and he
was in quite a bit of pain – it was a bit unclear as to what was going on.
We (Dr. Nathan Huber - a general surgeon from Indiana who has been phenomenal to work with over the past two weeks and myself) sent off labs (CBC, HIV, Malaria) and brought him down to
radiology where we performed an upright Chest X-Ray. Right off the bat we saw air under his right
diaphragm: he needed an operation.
Our incision extended from his xiphoid process down to just
above his belly button. We entered into
the belly safely and shortly thereafter found pus. After clearing out the pus
with suction we looked around until we found a small hole in the first part of
the intestine, the duodenum. Three
sutures later and a patch of abdominal fat, the omentum (a Graham patch) the
man’s abdominal problems were solved.
This is the kind of case that makes me love general
surgery: a bit of uncertainty in the
beginning, an efficient diagnosis, definitive one-step (we pray) surgical
therapy, a young person without other serious comorbidities, and an excellent
prognosis.
Following this operation we saw in clinic a woman from the
Ivory Coast (quite a distance from Mango) who had some sort of intraabdominal
catastrophe resulting in an ostomy and two places where her stool was draining
through the skin complaining of nausea, sweating, and vomiting. She is evidently not succeeding with
outpatient therapy. She needs an
operation to close her EC fistulas, but prior to that time she needs to become
nutritionally replete: she appears like
a living skeleton. An X-ray did not show blockage of her intestines and her
electrolytes were within normal limits.
We thought that she is likely dehydrated and we are giving her fluids
and seeing how she does; we will check on her in the morning. She has a very bad problem.
After this clinic visit we had to go back to the operating
room to help a woman pass the remainder of her placenta – this happened
uneventfully. While we were finishing up
alarms for the medical gases started going off.
What was happening was that the oxygen compressor (a very expensive
machine) had overheated and there were only two bottles of oxygen left for the
entire hospital. In short, a disaster.
Todd (an immensely talented and experienced surgical PA who
functions as a general and orthopaedic surgeon here at Mango) and Sarah (my ED
Attending friend who I share meals with) went around the hospital seeing if
people really, really, really needed the oxygen. If prognosis was poor, the oxygen was
discontinued. I sat while the walked
around and just prayed – there was nothing else I could do.
We had another case going back to the OR – a septic hip in a
baby – and Todd expressed his frustration to me: he had spent over one year
raising support for L’Hopital d’Esperance and this hospital has been a calling
for the past fifteen years. For
something as critical as the oxygen machine to go down during the first two
months of operation of the hospital was disastrous and maddening and
discouraging.
In the OR we found pus in the baby’s hip and were finishing
the case following leaving in two drains to let the pus evacuate from the joint. I walked out into the recovery room and
didn’t hear the sound of the alarms indicating that the oxygen was low. I went to Todd to let him know that the
numbers looked better – we didn’t get our hopes up. While walking back to the nurse’s station I
saw one of the maintenance men, Allain, who reported that they were able to fix
the oxygen compressor (the dust of the Sahara clogged the air filters more
rapidly than the U.S. manuals would predicted – the filters were changed and
everything started working), meaning that we wouldn’t have to deliver the hard
news that we just did not have oxygen with which to support people with limited
pulmonary function, from newborns with bad lungs to people who are recovering
from their operation. I started shouting
(literally) and still have a big smile plastered on my face.
This is just a slice of what happens every day at L’Hopital
d’Esperance, just at the surgical department.
Countless other happenings occur
in pediatrics and in medicine.
What happens is a mixture of good and bad; disheartening and
nearly indescribably joyous. More than
anything, there are answers to prayer.
The heart of the people who work here is truly awe-inspiring. Everyone has left friends and family to serve
in the heat here in Mango. And one finds
that every single person has such a critical role to keeping a major part of
the Mission’s work here at Mango, from the maintenance men to the nurses to the
financial gurus to the physicians. More
than anything this reminds me of the body of Christ, which is the church: many
parts doing their role to serve collectively as the hands and feet of Christ to
a very needy, hurting, and broken world.
L'Éternel te bénisse et
te garde!
L'Éternel fasse luire sa
face sur toi et te fasse grâce!
L'Éternel tourne sa face
vers toi et te donne la paix!
(Numbers 6:24-26, in French)
John Donkersloot
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