So yesterday was just sad. We started the day with three pediatric cases. Two were suspected malignancies and one was a young boy who had fallen from a tree (a common occurrence since many children pick fruit here). One of the first things that struck me about the kids is how much younger they look than kids the same age in the states. I assume it is from malnourishment and it is really saddening. Dr. Shores and the ENT Clinical Officer (Southern African occupation which I would say is a similar profession to a Physician's Assistant in the US) did biopsies on the suspected malignancies of the two children. One was just a baby. One was fourteen. He looked like he was 8 or 9. If the results return saying that the tumors are some type of lymphoma, the cancer may be treated and cured with chemotherapy, which I will try and cling to as a glimmer of hope. Realistically, these are very bad situations. The child who suffered the fall trauma will probably need to wait for a pediatric ENT surgeon to have the operation to fix his tracheal stenosis. For now, he will leave the hospital breathing through his stoma, but will hopefully be a perfect candidate for future surgery.
Today, Dr. Shores had a schedule chock-full of meetings so went to "Theatre" (OR) with the new Chief of Surgery. We saw several colostomy operations, repair of an inguinal hernia, and a child with Hirschprung's disease for a biopsy. I scrubbed in on an operation with an Australian Orthopaedist re-setting an improperly healed femur fracture. Orthopaedics really is like carpentry (and has similar tools). Overall, today felt better. There was more 'quality of life' value in the surgeries I saw or scrubbed on today. A mere hernia repair, considered a minutia of a surgery in the US, is really a preventative measure to life threatening illness here. A reset limb may provide ambulation, self esteem, and greatly improved quality of life.
Amblessed and I have been talking about what life would be like choosing surgery as a career. I think that it is important to remember that in this resource poor, medically underserved country, most people do not see doctors regularly for routine check-ups or small complaint visits, which are often the impetus for further medical treatment. Thus, many people coming to the hospital are very, very ill and require serious attention and many of the surgeries are very serious and may be less helpful than if the patient presented earlier. I don't this it is quite like that back home, especially for all of the specialist surgeons, who complete the same few operations all of the time. Overall, I think surgery could be very hard and very rewarding. Sounds like all of medicine. Kinda sounds like all of life.
Lastly, a nice couple just moved into our house for the week. They are working on a documentary about obstetric fistula repair at Bwaila hospital in Lilongwe. I might try and go over there to hang out for a day during my time here. There is a UNC doctor who is spearheading the program. The couple was also talking to me about the idea of starting a school for the fistula patients (ages 12-80). Sounds pretty amazing and transformative.
Our house at UNC Project is really wonderful. I love hearing everyone's stories from clinic or work when we all return home. I also really enjoy the American treats coming out of our kitchen, including rice crispy treats last night and the promise of cinnamon rolls tomorrow morning...