Week 1 in Review

Sorry that I have been somewhat negligent in posting on the blog. It was very familiar to return to the OR this week on Deck 3. I have been assigned to Theatre 4, working with Dr. Gary Parker perform daily lists of maxillo-facial procedures. There have been small infants for cleft lip and/or palate operations; adults with very large parotid (facial) tumors and even some plastic surgery reconstruction on a 9 year old girl that suffered severe burns as a toddler.

Tani had lost her nose, the sight from her right eye, most of her right ear and several fingers form her right hand and yet despite living for years with an incredible deformity, she remained an engaged, energetic, playful child. This is a tremendous testimony to her parents, who despite her appearance, have let her know that she is loved and valued as a person. Several weeks earlier, Dr. Tertius had constructed a "tube flap" from skin from her scalp and attached a rolled up portion of this scalp tissue to the place where her nose had been. Now three weeks later, we came to see if this graft had found a blood supply in its new site, and the host graft disconnected and reattached to her scalp. Burned skin behaves differently often with poor perfusion, and there was some concern that Tani would not yet be ready for this stage.We were all encouraged to see that the graft had found a new source of supply, and could be detached. A "new nose" was fashioned and the "borrowed" scalp tissue was returned to its original location. We are not yet finished, but have been able to move her several steps ahead in her physical recovery.

Patient histories sometimes produce unexpected responses yet provide insight into life in Africa. when asked if a lady ever gets "short of breath" she responded, "When carrying 50kg bundles I do get short of breath after several miles". Despite this limitation, I still deemed her fit for surgery. ;-)

Gary Parker has often partnered with local physicians while in each port. In Lome, the only maxillo-facial surgeon in the country has spent most of the week with us, not only learning a few new techniques  but providing valuable assistance and help in covering the volume of surgical cases. this friendship has matured over many years and several visits. Tonight, the OR staff have been invited to his home for a dinner. 30 of us will join him tonight and I will post some of this event on a blog later.

VVF surgery has begun this week. Not only are we providing care for 80-100 women, but surgeons from Rwanda, Uganda and Benin have come to learn these techniques so that they may be able to take these skills home with them. Much of the communication has to occur through translators. It may get a little exciting as Steve tries to warn his African colleagues of impending misadventure. There is lots of expression and celebration in theatre 3.

A bladder catheter with a marked with a balloon  volume of 20 ml had inadvertently been filled with 25 ml. There was some concern in the OR that this overfilled ballon might burst. To solve the dilemma, Steve offered a game of "Russian Roulette". After explaining what the original game of Russian Roulette entailed, each of the surgeon took a catheter and in turn injected 10 ml of water to the catheter before passing it around the circle to his colleague. The game grew louder and more excited as the balloon grew. I am not sure which surgeon got wet when the catheter balloon broke at 116 ml, but am sure that no one in the room will forget this illustration.

Gary