Back on track...

Now that's what I'm talkin' bout!  Awesome day today!! OR ran very smoothly and all the cases were hot and went well!  I was very pleased.  I ended up doing 4 surgeries today-a couple of which were new for me.  I did an amputation of this lady's arm who had a severe burn after being trapped in a house fire some time ago.  Her arm was so badly burned that it ended up getting infected and it had tracked way up into her arm so I had to take the amputation quite high.  The second was a guy who was in a RTA (road traffic accident-Liberian acronym for ya'll!) last week and had a busted femur fracture.  We don't have the advanced instrumentation here to fix it so I ended up using a Kuntscher intramedullary nail-I've always heard of it, but have never seen one before: TIA-This Is Africa!  They got one here-why not?!!  It went well too!  I had to approach the surgery differently than I was used to; particularly b/c I didn't have an xray machine in the OR!  The next case was a skin graft for a guy who had a bad ankle ulcer.  And the last one was real awesome-this lady had an old subtalar dislocation and had a really bad ankle deformity.  Her bone was almost poking through her skin.  I ended up removing her entire talus which was dead and fused her tibia to her calcaneus!  Fortunately I was able to get the drill here fixed on Monday so we had a drill that worked finally as opposed to the manual one.  I had to dig through screws to find the appropriate size to use.  It was a great variety of cases-I love the challenge of coming up with stuff and working with what we have here to make things work.  It's such a learning experience.  And so far things are working out well; at least the patients like me thus far. 

In response to your comment/question Marc, I'd say that 90% of my patients come in as acute trauma seondary to RTA's (either car crashes, being hit by cars, or motorcycle accidents-everyone rides a "pam-pam"; Liberian for motorcycle).  Remember there are no traffic signs here at all!  The other 10% come in through the clinic as "cold trauma"-they've had some injury awhile ago and are left with either some crazy deformity or post-traumatic pain or something-like the ankle fusion I did today.  That was an elective case even though she had a trauma some time ago.  Occasionally I will need to do a minor procedure in the clinic-like that finger amputation I just did.  I've even had people bring traumas into my office that I've had to send straight to the ER.  (Man two people just came in carrying their family member unconscious into my office last week after being in an accident the day before-I was like...you guys should carry her to the ER ya think?!)  Included in all of that is alot of infections.  Remember how I mentioned earlier that many people will sign out AMA from the ER and go to "county doc" or the "herbalist" (who actually has a radio ad here!) for treatment?!  They end up coming back infected and needing an amputation b/c ol' country doc told them to drink some nonsense for there minor finger infection or open fracture and it just gets exponentially worse and then they are brought in weeks later with a smelly rotten extremity.  I think I mentioned a lady that came in last week after being hit by a car and had a really bad pelvic injury and hip fracture-well her family came to take her from the ER to be treated by country doc and signed out AMA!!  She'll be back...probably my last week here.

You're second question is a very good and provoking one.  I have thought about that alot during my time here.  It is by far too much to answer in one entry.  I will answer it for you as I continue to journal.  Thank you for your interest in my experiences and growth.  My man...

We have a new medical student this week.  She's seems eager to learn and I think she had a great experience today as well.  I gave her a couple of reading assignments so that we can talk about a few things in the morning.  She's pretty excited to be doing Orthopaedics.  So one memorable thing that happened today: I was talking to everyone today in the OR about the surgeries as we were doing them and they were asking about how we do things back in the states and I kept saying "well, back home we do xyz..." or "You can do it like this, but back home we do this..."  At one point this old anesthesia guy at the head of the bed interrupted me and says, "stop saying 'back home' son, this is your home."  He just got quiet and stared at me through his mask for a minute after saying it.  It was a very memorable moment to say the least.

So around mid-day I get a call from the local radio station inviting me to do an interview and talk about HIV/AIDS!!  I'm like dang yo, how these people know I'm here like that?!!!  So tomorrow I may be doing the interview at 3pm-will let you know.  I have to inform the general administrator; I think there may be some politics behind it all.  Not sure yet.

All in all it was a much better day.  I left work at a reasonable hour and was able to go get some good Liberian food at some friends' house. Cassava leaf is great!!  I think I'm going to sleep with my mosquito net down tonite-they tore me up last nite :-/