Wednesday March 5

Wednesday March 5

      We had quite a day today ! We did 9 cases, which might be a record for us! Yuk and I started with a large pediatric hernia and hydrocele, and then did Emil who had an incisional hernia.
      One of the pediatricians, Dr. Shankar, had messaged me on Facebook that he had a friend who had a large incisional hernia which needed repair, probably with mesh. I was reluctant to put in synthetic mesh because of the risk of infection, so I told him I would try to get a piece of biological mesh, which is less likely to get infected. I spoke to the rep from Cook Medical, Alyssa, who then gave me the email address for their mission donation program. I filled out the application, and shortly before we left they emailed me to say it had been approved; soon thereafter I received 4 large pieces of mesh! This was an incredibly generous donation as the product is very expensive; I am extremely grateful to Cook Medical. We used one of the pieces for the repair of Emil's hernia today, and the operation went very well.  
      The next case was an acute abdomen from the ED which Santiago and Rakesh did, and which proved to be an ideal perforation from typhoid. Then we removed a large round keloid from the neck of a young man who had been referred to us by Aunt Jenny while the other tools care of another melanoma of the heel with palpable groin nodes.
      Next we all worked on an unfortunate 6 year old girl who received bad body burns from boiling water spilled on her. She has no IV access, and so they asked us to help. I tried a saphenous vein cutdown, but she is so dehydrated that proved impossible; we tried a cephalic vein cutdown which was also unsuccessful; finally Santiago put in an IJ line. We changed her dressings under anesthesia; her burns look and smell infected, and I suspect she will not survive, but we shall see.
        Then we did a couple of hernias: Rakesh and I did the biggest inguinal- scrotal hernia I have ever seen. It was truly an African hernia, which the scrotum filled with bowel and extending more than halfway to his knee. It was a difficult but interesting experience fixing it, as the anatomy was totally distorted by the size of the hernia, and the fact that this was a recurrence from a repair previously made in the late 1990s. We finally finished it, and in the meantime Santiago had been called about another acute abdomen in the ER; that one turned out to be a perforated gastric ulcer which he repaired. We finally finished around 10:30, went to the dorm for a quick bite to eat, and then to the apartments for bed. It was a long, but productive and rewarding day !