When We Come To It

It’s been a few days. Transitioning to a new team has been great. We’ve gotten Dr CAsey and her daughter Claire up to speed and I think they are adjusting well to “African time”

Monday was a slow day in the OR but we were able to get some teaching done and introduce everyone to Dr Casey. The residents here do not receive significant formal pediatric training so her presence has been a huge bonus. We comment often that the local residents want to discuss very esoteric and specific pediatric dilemmas but that really need to be return to the basics. Much like our earlier lectures, we try to mix in a few “expert level” thoughts with a bread and butter topic. We’ve covered club foot, hip dysplasia, and other congenital abnormalities. Important discussions (but met with less enthusiasm) has been pediatric infections and fracture care.

Dr Casey’s case list for the week has included spica casting for 2 femurs and osteoclasis for a incorrectly healing distal radius fracture. Today she is working on a dramatic presentation of an burned arm with significant scars and deformity. Sadly this child has a normal arm until the burns from about a year ago. We hope to release the skin contracture at the elbow to improve function. If successful, the hand contracture could be addressed at a later date. No one on the team is “an expert” at this surgery, but together we’ve talked through a plan (and gotten help from our colleagues back home!)

A grey cloud with a hopeful silver lining update. Our sweet girl returned to clinic this week and her skin covering the massive wound has faired very poorly. We knew that skin would be a risk from the beginning but it hits home pretty hard when the failure occurs. We were able to get her to the operating room last night and found that beneath the dead tissue some very robust and healthy wound tissue was found. The nerve repair remains intact. We were able to contact some wound care companies back in the United States and, of course, sent pictures for the girl’s wound and wonderful smile! They quickly agreed to Fed Ex wound care material to our final traveling surgeon – who lives for Tanzania on Friday. With luck, these biological dressing will help our young friend heal these wounds. Fingers crossed by all! Matt received a care package from his co-residents when Dr Casey arrived – we will donate our OREO supply to her this morning – which as you know will make everything better.

Natalie and I fixed a distal femur fracture. She did a great job getting the taller men to listen and follow advice! We taught them the “Swashbuckler” approach to the femur. It really gives a nice view of the joint and allows for plate fixation. The residents were very interested in this approach and I showed a teaching video today in morning report. Again, the stressed idea is respect of the soft tissues. Yes, we are here to fix the bone, but the tissues around the bone provide the blood flow and healing. Here’s a couple pics of our efforts – I think given the tools at hand it went quite well!

Matt and I worked on a distal tibia (pilon) fracture. Thanks fully, the articulate surface was largely uninvolved so we taught a percutaneous fixation technique (applying the plate and screws through very small incision. Again the stressed point was soft tissue respect. (Sensing a theme yet??). I felt the case went very well.

We journeyed to Mareguni falls over the weekend and took a COLD dip in the water and then enjoyed making coffee with a local village. Coffee is their main cash crop. Enjoying a fresh brew after grinding the beans with the local “machine” was a lot of fun.

To top off today’s stories, we obviously got some cases done yesterday. Unfortunately, the OR moves at a snail’s pace and we operated into the late evening. Dr Ali – one of the senior residents – took one look at Natalie and proclaimed we all needed to eat. This was about 7pm. Around 9pm our food arrived. The 4 of us had essentially 2 whole chicken and 4 servings of fries. Dr Ali set out the food and went down the hall to perform “check list” – sort of like our timeout procedure in the OR. He returned 5 minutes or so later to find that we had polished off 1 1/2 chickens already! I think he was most impressed with American eating ability!