Part 2 - Battery acid and buttocks.

We've had students from Cape Town. As you can see, it's all smiling faces in rural health care. On the far right is Dr Veldman and Dr Jimoh.



Happy students



As I mentioned, work has been busy. Each day has been filled with exc itement and a fair amount of head banging. The strikes are coming to a close and business is starting to resume as usual. However, with Christmas just around the corner everyone is going on  holiday – this includes the pharmaceutical depot and the outpatient department at our referral unit. Hence, we are still low on essential drugs and equipment. At the moment we are scrubbing for theatre with regular soap. To add to matters, our radiographer says the X-ray machine has broken down. It all seems a little too convenient – the machine stopped working last December. He took four weeks of “sick” leave due to his asthma, but refused to let us see him or get a referral to another hospital. In some ways I don’t blame him – he is on his own and has quite a heavy workload, but then so do we all. Unfortunately, Christmas is when an X-ray is vital – it’s the stabbing season.



This poor baby was born with a large vascular
 lesion where her bottom would usually be.
 It could possibly be a teratoma or dermoid
 cyst (remnant of an incomplete twin).
We referred her, but she didn't survive.



With all the excitement and goings on, I’ve written a list of some of the memorable moments from the past month:

-          I walked into the surgical unit one weekend to review someone. On my way through the ward I encountered one patient cutting the nails of another who was too sick to do it himself. I’ve noticed that patients look after one another on the wards – the ones that can walk fetch water for the ones that can’t and, from what it seems, even help out with a bit of podiatry.

-          I was reminded of the lady I saw last year who had used so many rectal enemas that her anus had almost closed up secondary to scarring. She came back to see me with similar problems. After receiving treatment (anal dilatation) at our referral unit, she continued to use the enemas again.  I’m pretty sure I told her last time that putting battery acid in ones rectum is probably a bad idea.

-          I called a colleague to assist me with a difficult delivery. With a bit of persuasion and some good pushing from the mother the baby started to come. We did a suction delivery, but the little one got its shoulders stuck – the head was outside the vagina and his body still in the womb: a shoulder dystocia. A few simple manoeuvres and out popped a very flat bubba. We successfully resuscitated him and then the nurse called me back to the Mum. She had a 3^rd degree tear – that’s when the laceration goes nearly all the way into the rectum. I’ve never dealt with one of these before, but knew the theory. So, there I was – head torch on, forceps and suture in hand and my trusty step by step obstetric book on my lap. I think I did a pretty good job. In hindsight, we should have done an episiotomy, which would have avoided the tear – but it slipped our minds in the heat of the moment.

-          It’s circumcision season. If you want a traditional one you need to be over 18, have parental permission and a nod from the local chief. A guy came in last Saturday night who was denied this opportunity by the chief. He was so desperate to lose his foreskin that he took a pair of scissors to his member and gave himself the snip. Might I add that he was stone cold sober. Good thing that, for he may have cut off more than intended. He did a rather good job and all I had to do was stop a bit of bleeding.

-          “Doctor, a cow fell on my leg.” Quite how this happened, I don’t know. The herder said he was giving the cow some treatment and then it toppled over – it must’ve been some pretty strong stuff. Turns out the guy is also made of tough material as his bones seemed fine.

 



One shouldn't really see this X-ray - this big mass in the pelvis is a gentleman's bladder. Unfortunately the admitting doctor missed the elephant in the room. The old chap drained almost 3 litres of urine once I catheterised him.



This gentleman presented with severe shortness of breath. The X-ray shows a gigantic, or "globular", heart. He had a massive pericardial effusion secondary to TB (TB pericarditis) that we drained, much to his relief.

Some seriously arthritic hands - guttering, ulna deviation

 and swan neck deformities.

I have chosen an exceptionally bad choice of facial hair after removing the beard. Sorry Mum.