A ‘normal’ day?!

The striking thing about today is that it has felt like one of the more ‘normal’ days I’ve had here. Whilst this leaves me a little stumped to know what to write about, it is perhaps, in itself notable. Maybe another step taken on the ‘settling in’ ladder.  

Before

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Today we did four procedures on three patients. Firstly, a large paediatric umbilical hernia. Whilst only two years of age (quite young to repair such things) hers was large and it seemed prudent to get on with the repair. As it turned out the neck was certainly tight compared with the contents (caecum and appendix) and I am glad we repaired it. Then it was excision of a large groin lipoma in an older lady (the size of a standard UK mango [a mango of that size would be considered small here]), which I guided one of the local surgeon’s through. To finish, it was repair of an epigastric hernia and lower midline recurrent incisional hernia in the same patient, both with mesh. 

After

The cases today couldn’t have gone much better really, and I am enjoying where we have got to as a team. We are also now up to 22 cases with ‘mosquito’ mesh and approaching the sort of numbers that provides meaningful evidence that what we are doing is safe.  Fingers crossed that the current good run continues. (Proof reading this I think it is important to clarify that I do not use mesh in the children)

My efforts with the pencil diathermy (electrocautery – modern version of a red hot poker) have also had another breakthrough. We have three in circulation currently (with three spares I think), but after 16 cycles through the lower temperature autoclave, the buttons on ‘pencil 1’ are becoming temperamental. Especially the button we use the most (blue, coagulation). To be honest I am delighted that it has lasted so well. A single use instrument has been reused 16 times! But, desperate to extend the lifespan of these instruments even further, I had a moment that was either going to be genius or whimsical experimentation. I wondered if we could activate the pencil using the foot pedals usually used with the forceps diathermy instruments. It worked! Brilliant. So we have given these pencils yet another new lease of life. Perhaps dramatically.

On the home front, I’m sorry to report that things were a little tiring. For some reason, conflict was the mood of the day with lots of grievances from most parties about something. I have never been one to enjoy such things, and here most of the problems seemed very ‘western’ issues. No-one in the household had died or was in the process of doing so, no one was starving (literally) and most of the trouble seemed to be around invasion of territory or property (of which, in my opinion we all have too much). So, perhaps a very normal day by western standards then!

(For clarity, I think as a family we do pretty well. On the whole, we get on with each other as well as any family does, I believe. It’s just that being here, you see such a stark contrast to western reality. It is normal for children to grow up without one or both parents (many a child is attended in hospital by a grandparent or aunt/uncle), or to have siblings who have died, or for parents to have lost one or more children. HIV is also the reality for many. And some go hungry. Being immersed so richly in the reality of this by working in the hospital leaves me little sympathy for what can seem the triviality of ‘western complaints’. But of course, these complaints are the important reality of our lives and must be given the attention that they require. Perspective develops with time and experience. It is however a wearing journey as any parent will know. But on the other hand, how privileged we are to be in such a position.)