Operating!

The day started well as I dragged myself out of bed early to go for my first run of the trip. A ‘gentle’ 4k, being mindful of my rehabbing knee injury. Well done me! It was surprisingly tough in the heat of the morning (running any other time of the day would be madness I think!), but I’m sure it did me good.

Bad news however is that our water ran out yesterday. So ‘showers’ involve a jug and a cloth! Once a week the town’s water is turned on to refill the massive water tanks most residences have. Unfortunately, for some reason, ours did not fill. Whilst this is being looked into, the bottom line is no water out of the taps until at least next Tuesday (assuming the issue is resolved). Amazing what you take for granted back home – safe water out of a tap whenever you want it (we cannot drink the tap water here unless it has been boiled or specially filtered). The temporary solution is 8 massive buckets (not far off the size of an oil barrel) being delivered this evening and then being transferred into the house in an incredible one-man relay system using a jug and a smaller bucket. I was prohibited from helping and it is a testament to the African character that such as thing is ‘just normal’. One man, 8 big barrels, one jug, one smaller bucket, perseverance and time. But of course, it is special treatment for the ‘Mzungu(s)’ – technically in Kiswahili the pleural is ‘Wazungu’.

Anyhow, after the daily hospital meeting and brief surgical ward round, it was to theatre to do some operating. Today it was excision of a cyst on the leg of an 8 year old, adult strangulated inguinal hernia repair and adult hydrocelectomy (basically sorting out a massive balloon of fluid around a testicle – this one the size of a large avocado). It is surprisingly challenging operating away from the UK. So many things that one would usually take for granted…. I will spend more time unpicking this in the future, but for now imagine working with a team that you don’t really know that well, albeit very friendly, having no scrub nurse, no instrument count, no swab count, no WHO checklist, having to resurrect a diathermy machine and scrabble through a dark, cupboard to find a pair of forceps and pencil (sorry non-surgical readers) to use with said machine, having to re-sterilise these diathermy implements between cases in a dish of surgical spirit, having a set with some very dubious instruments (a knife handle that would not hold the blade properly, needle holders that don’t hold the needle…) and doing all that in a very warm operating theatre wearing a very heavy and slightly damp canvas gown! However, I did get to use catgut again (a suture material that is no longer used in the UK but is an artefact of legend) and ‘one’ discovers that ‘one’ can be surprisingly resourceful with what is on hand. The team were very happy with the standard of operating; they loved the diathermy machine (much less bleeding!), liked the site and size of my incisions and were particularly complimentary about my modified Jaboulay procedure for hydrocele (in the UK this operation would be done by a urologist, not a ‘general’ surgeon any longer and certainly not a ‘colorectal’ one!). Whilst it is my intention for this trip to take on a role strongly focused on training, today they wanted to see what I was all about.  I must say it was fun, very satisfying and probably very important in building up the relationships required for moving things along in a sustainable fashion.

Back at home, the older two girls seem to have had another successful day at school. They are making friends and seem to be enjoying the experience, albeit exhausted by it. Little Beth struggled again today with all the attention as well as the language barrier with the children she is with. We are going to have to be creative in making this work for her. Kate is getting to know the hospital and seems to be finding her feet very successfully working predominantly with the day hospice / palliative care team.

I cant wait for my jug of cold water and flannel wash in the morning 😊.