My time here is coming to an end. Sally and I will be leaving in the next week or so. We’ll spend some time in Uganda and Egypt, and then back home. It is difficult to leave. I feel to some extent that I am abandoning some of the patients who have been here for a long time. I will miss the place, and the people who work here. So it goes.
The typhoid seems to have slowed down. There have been a few cases in the last few weeks, but nothing like before. I am waiting for the folks that were here from the CDC to share some of the specimen and culture info they brought back to Atlanta. The last perfs I worked on were 2 in one night, the night before Sally and I left for Bwindi 10 days ago.
Anyway, there are 31 beds in the surgical ward, with patients sometimes doubled up and often on the floor as well. I thought I would try to put a picture up of as many of them as I could….
The two below are a father and daughter combo. I worked on the daughter for a perf about a month ago, and the father the next day. The daughter got a primary closure, the dad an ostomy. He had to go back once for an abscess, but both are ok now and will go home soon. She is in bed 1 and he is in bed 18.
Typhoid perfs - Father and daughter
The girl below is Janet K. She had a bad typhoid perforation months ago. She got a resection and an ostomy but had another perf a couple of days later. She has gone back a few times since then for abscess and fascial dehissence. Her belly is a mess. I think she’ll live though. She is incredibly malnourished and has decubs on her hips and back. I feel terrible about leaving her. I’d like to try to put her back together but I won’t be around. I’ve used some of the funds folks have donated to buy her eggs and bread every day. She is a fighter. By the way she is 13 and looks like she is 8.
Janet K. - rough time with typhoid
The boy below had a typhoid perf and came in the day I left for Bwindi. He was septic and the bowel was dusky so I resected and gave an ostomy. He is doing well, and will go home soon.
Typhoid perf - doing well with an ostomy
The boy below came in with tenderness all over and a high fever. His spleen was very large, and I lapped him in case it was typhoid but there was nothing there. He was treated with antibiotics and antimalarials. He developed abscesses in his arms and axillae, and those were drained. Sally and I have been changing the dressings under ketamine on the ward and he slowly turning the corner. I am still not sure what his initial problem was.
The boy below had osteomyelitis. He got a sequestrectomy and then when it cleaned up he got a skin graft. I bought him the crutches with some of the money that was donated – $4.50. Happy as a clam, that one is.
Sequestrectomy for osteomyelitis - then a skin graft
The little one below had his ostomy from typhoid reversed last week. Happy as a clam part 2.
Ileostomy closed this week
The girl below had typhoid about a week ago. I closed her perf primarily but she had an obstruction. She had a small abscess when I opened her for LOA. She is ok now, but I am going to keep her and watch until I leave.
Had a typhoid perf primaily closed
The girl below from bed 5 had her ostomy from typhoid closed this week.
ileostomy closed this week
The guy below also had a typhoid perf. He is Rwandan and very tall (most Ugandans are short). His legs dangles over the OR table. Anyway, his bowel was dusky so I gave him an ostomy. His is ok and will go home this week, to be reversed by someone else in the future.
Had a typhoid perforation - doing well
Below is a picture of me Sally took in the breakroom….nice hat and gumboots, no?
In the breakroom
The guy below is in bed 25 and had a rectal prolapse with encaparesis. I told him there was nothing I could do, but he stuck around for a month so I did a perineal rectal resection and plasty. He was ok for few days but then complained of rectal pain. I examined him and he had a small abscess. I got nervous since I was leaving for Tanzania so I just diverted him – gave him a sigmoid colostomy. Anyway, I closed his colostomy this week and so far so good.
Sigmoid colostomy
Below is Sally getting ready to halp me with STS – surgical toilet and suturing.
Sally in theater
Below is the guy she helped me with…
Boda Boda trauma
After clean up…
Sewed back together
The woman below had a nasty skin condition all on her face. It has been there for 14 months. I did a biopsy and put her on steroids and antibiotics. It has really improved.
Skin excoriation
The boy below had 3 weeks of belly pain. Three weeks!! When I opened him there was a lot of pus, adhesions and badly perforated appendix. I did an appendectomy and washed him out. He is ok so far.
Bad perforate appendix
Below is Sally changing a burn dressing. The hospital has silvadene in stock, so that is really helpful. We usually give them ketamine on the ward to change the dressing.
Sally changing a burn dressing
The girl below is an epileptic and has been burned several times during siezures. She is basically shunned and is a charity case. Even though the fees the hospital charges are really minimal she can afford nothing. She has gotten carbamezapine which controls her siezures well, and gets food from the other attendents. I skin grafted her most recent burn on her foot last week. She stays on the floor because of the siezures.
Epileptic with burns
