Friday, August 28, 2009

Is that patient on our unit?

The surgical patients are divided into two units. Two or three surgeons are part of a unit, and each patient is assigned to either Unit 1 or Unit 2, depending on who performed their surgery. The patients are not sorted by unit in the wards, and I don’t yet understand how the rounding surgeons know which patients they need to see. There is no master list of patients, as far as I can tell. Rounds occur only Tuesday, Thursday and Saturday, which means these are the only days a surgeon examines the patients and updates their plan of care. Two nurses are responsible for fifty patients. Things get missed.

Walking into the women’s surgical floor this morning, we passed a grey-haired woman curled on her side in bed. “Is that patient on our unit?” Jon asked the nurse. Instead of answering, she felt for a pulse. The patient was dead. A woman I assumed was her guardian sat on the adjacent bed weeping quietly. The nurse put a screen in front of the dead woman’s bed and we continued rounds.

Later, we came to a woman eight days out from surgery to repair a perforation in her small intestine, a relatively common result of typhoid infection here. The patient unwrapped the dirty cloth – not gauze, but the colorful fabric the women here wear as skirts – from her abdomen to show us a baseball-sized opening in her belly. Her surgical wound had opened and her small intestine was open to the air. No surgeon had seen her on Saturday rounds, perhaps she was walking around when they passed by, or maybe she got overlooked by the busy physicians. The patient told us it had been open for a week. Even though here “a week” can mean between two and twenty days, the last time she had been examined was five days ago. She was scheduled to return to the operating theatre to repair the wound, but it did not happen today. Hopefully tomorrow.

Saturday, August 15, 2009









DFO

I was very excited to join the American surgeon, Jon, on surgical rounds and call today. It would be my first time on the wards at Kamuzu Central Hospital. I planned to round on the surgery patients in the morning, then join Jon in the OR (called the operating theatre, here) for any emergency cases.
First, Jon gave me a tour of the wards. I had never seen a hospital in a developing country, and KHC was basically what I expected. There are about forty beds in a room, and a family member accompanies each patient to provide basic care and food. The beds look dirty, the patients look sad, and flies are everywhere. Today, the wards were all but deserted, and families gathered in the central, open-air courtyard to enjoy the clear, dry morning.
The first patient we saw on rounds had an infection on his leg and was waiting for a skin graft. Elective cases are only scheduled Monday, Wednesday and Friday, so he might wait a few more days. Jon encouraged him to try to walk, or even move his legs while in bed; no physical therapist would come daily here to help him maintain his strength. The second patient had been burned on his leg in 1999, and his wound never fully healed. In the States, a complicated surgery might spare his limb, but here he was scheduled for amputation. I had seen some dirty wounds on my surgery rotation, but nothing compared to the smell coming from this fellow's gangrenous leg...
I felt a little dizzy, and the next thing I knew, I was being carried down the hall. I had passed out. I have a nice bump on my head and I broke my nose, but Jon cracked it back into place.
What an introduction.

Tuesday, August 11, 2009

It's a long way to Lilongwe!

Here I am. Figuring out this blog thing.... I think I can only post between 10pm and 7am. Hmm.. Let's be patient and I'll soon tell you all you ever wanted to know about my life here.