Party!

My time here is rapidly ticking away. The morning started with a presentation at the hospital meeting. I had volunteered to share the experience of the Surgical Department activity during my time here. It was a really nice thing to do, summarising what we have achieved these last five months. Whilst I ensured that it was a balanced report ‘warts and all’, these were thankfully very few and it was certainly a report that I was proud to be sharing.

As I neared the end, I had a moment of hesitation. Caught completely of guard, my throat tightened as I praised the work of the local team and started to suggest some things to encourage a vision for the future. A slightly awkward period of silence ensued.  Evidently, I am very proud of what they have achieved. It will be hard to leave. It felt like an age to me (silently berating myself and imploring self-control and composure), but I managed to do so and finish strongly. I was rewarded with the most delightful applause – the hand rubbing, followed by some synchronised quick claps, building up to two large claps that they ‘throw’ at you. I smiled broadly.

After the meeting it was back to reality. The surgeon nun was visiting once again from Korogwe and we went to review the boy from yesterday. Disappointingly, he was more sore and we agreed to return later to decide if surgery was indeed required.

Operating on a little person

The operating list was in the obstetric ward theatre, which despite my initial reservations was a perfectly acceptable venue and actually worked out very well. We had an unexpectedly challenging paediatric hernia, which turned out to be a combination of hernia, maldescended testis and hydrocele (this means that the testicle had not migrated correctly into the scrotum on that side and was surrounded by a balloon of fluid). Far from the slick masterclass I had hoped, it was however perhaps excellent learning for all of us and went very well (herniotomy plus orchidopexy [fixation of testis in the scrotum]).

Further progress to our planned schedule was trumped by a C-section. My visiting friend was keen to get involved and I found myself happy to add to my experience of two.  We cracked on. It was a difficult procedure with the baby’s head wedged deep in the pelvis. It was also a hot and sweaty affair; the older air-conditioning was significantly less effective and we were both cursing the mandatory plastic aprons (without them we would have been soaked through with almost every body fluid though). One thing I won’t miss leaving Africa is the sweat pouring down my back and dripping off my forehead in such cases.  However, for all such things I am pleased to report that the baby came out safely and crying albeit with a funny shaped head (this is normal and resolves) – I am not sure if I will ever get used to obstetrics.

With that interlude completed, we were once again able to continue with our list. It was an exploratory laparotomy in a middle-aged man with chronic right lower tummy pain and an USS that suggested appendicitis! I was extremely sceptical, but like the handful of other such cases I have faced, the only option left available is to have a look inside the abdomen. Whilst certainly an invasive procedure, there is the potential to miss important mischief and no-one is yet to decline despite my cautionary counselling. Interestingly, all the previous cases (normal findings with routine appendicectomy) have remarkably reported full resolution of their symptoms.

Having successfully embraced the local teams request in the past, and despite my ongoing reservations, we conducted the procedure under spinal anaesthesia alone. In the UK this would be unheard of as we normally insist on general anaesthetic with full muscle relaxation to improve our access. Once again, embracing their practice was successful and it is certainly something that I might consider for very selected cases back in the UK in the future. After a brief flirtation with the ascending colon (initially we thought that there was a stricturing tumour – I initially got excited, but it turned out to be unusually pronounced muscle spasm of the colonic wall) it was indeed normal and we performed a routine appendicectomy before closing. Once again I smiled at the enthusiastic comments about the length of this worm like structure, but when you have seen over 500 of these things, I could confidently say it was within the normal spectrum.

On completion of that case, we had run out of time and concluded our operating for the day. We returned to see the young boy and all of us agreed that he needed surgery which we would schedule for the following morning. However, his mother was very reluctant to let us proceed despite gentle encouragement by the visiting surgeon nun. I cursed my decision to cancel him on the table yesterday. A most unsatisfactory situation, I hoped that things would be easier in the morning.

The evening was a fine affair. We had arranged and financed a party for 60 of the hospital staff that had worked most closely with us. Every single one came. Free drinks and a free meal were evidently ample encouragement. It was truly delightful and towards the end there were a few speeches followed by some gifts for us. They had had a dress made for my wife and a shirt for me. So lovely. And to compliment those, we were also given a few reams of beautiful African material which they paraded to us under the accompaniment of music and dancing and then wrapped these around our whole family. Twice – they are huge! There was a requirement for a vast number of photos and it felt like our wedding day, standing on show with various different combinations of the staff. The children were fantastic about it all, despite being tired and I am so glad because it clearly meant a lot to the staff.

It was then a very late night for a very tired Family Shim.

This picture is with the entre theatre department staff 22 in total