Wednesday September 12, 2012

The day started with breakfast at Fishmarket, the President's house. The 2 other heart volunteers, Michael Politka, the 2 Chevron doctors, Dr. McDonald, Dr. Johnson, Jonathan, and myself all gathered in the palava hut and then we were joined by Madame President and later by Aunt Jennie. She was as usual very warm and kind and friendly. At one point there was silence, so I said " So how is the governing thing going for you?" She laughed, and talked a little about the difficulties, like trying to build roads in a country where in rainy season amazing amounts of rain fall on the country, washing away even the best built roads. ( as I write this on Wednesday evening, the skies have opened up once again. The noise of the rain on the roof is deafening!) Anyway, our discussion with the President moved to health care, and we continued to discuss that after she excused herself to go to work. After that we went to the hospital. Dr. Golikai was doing a hernia, so we went to the ward and made rounds with Dr. Kiiza and one of the interns. Happily, all patients are doing well, though ileostomy man from a few days ago remains weak and uninterested in getting out of bed. Eventually they were ready upstairs, so we went up and first did a cervical node biopsy in a friend of Percillar. Then we took a look at Victoria, but found that her low rectal anastomosis was strictured severely and could not be dilated, and we think she still has a defect in her posterior vaginal wall. I called Santiago in Indiana to tell him; because she was having a lot of trouble with her ileostomy, which had retracted to below skin level, Jonathan felt the wise thing to do would be to close the ileostomy and give her a colostomy. It was disappointing that we couldn't put her back together, but the stricture was not an unexpected finding and she understood that. So we opened her up and found a huge left ovarian cyst, which we removed, and then we closed her ileostomy and did her colostomy. The next patient was a woman that Jonathan had seen at Phebe last February who had developed a rectovaginal fistula as a result of a complicated delivery, and had a Hartmann's procedure done. They had tried to hook her back up at Phebe after the fistula healed, but they backed out feeling it was too complicated. This patient also had a big ovarian cyst inn the way, but we were able to identify her rectal stump, and after taking down her colostomy, we put her back together using an EEA stapler. Assuming she does well, I think we can feel very good about that one ! The last case was a fistula-in-ano which was pretty simple and superficial. Tomorrow is our last full day of operating, but I think it is entirely possible that we will do a case or two on Friday morning. As has often been the case, we are leaving some patients undone, but I imagine that would probably happen if we were here for 2 months rather than just 2 weeks. There are so many hurdles to get over in planning, scheduling, admitting, and doing surgery; sometimes I think it is a wonder we can as much done as we do ! I have finished today's blog, and it is still pouring rain. The electricity went out for a while but now it is back; however the Internet went out and has not returned. Speaking of electricity, I learned from Weltee that this compound has its own generator to provide a reliable sourcenofnpower to the occupants of the apartments, most of whom are ex-pats. But they turn off the generator between 9am and 5pm, so I guess if you live here you better have a day job