June 29/30 - How is that even possible?

In this post: Late night on the streets of Dar, You call that a tumour?

The mitral valve repair got bumped this morning: they didn't have
enough blood in the bank for this size of operation. It doesn't happen
too often apparently, but they rely heavily on the patient's relatives
coming in to donate if they are going in for surgery and this time it
didn't work out. I got to sit in on a peripheral venous stasis repair
though, which was interesting. The guy had apparently had a pretty bad
ulcer on his ankle, which someone had put a skin graft on 10 times
before they realized that there was a bigger problem with the veins.
They managed to get him all patched up pretty quickly and I had an
early day.

Later that night, Jeff and I met up with one of the interns
that Jeff had met in the hospital to go to a local bar and watch some
football: Spain v. Portugal. He brought his brother and cousin along
and we had a great time chatting about culture, football and language.
It was very interesting walking back from the bar late at night in
Dar. I felt comfortable because we were with some locals and it was
great because I got to see a side of the streets that I hadn't yet
experienced… quiet. It was almost eerie after the bustle of the day.
There were a few people sleeping out on the street, but they were far
out-numbered by the security guards sleeping in their chairs outside
of almost every business (Econolodge has 2-3 guards with Billy clubs
at night… some guards around the city are sitting around picking their
noses with shotguns. Scary).

On Wednesday we met up with the intern again for breakfast at the
hospital because we wanted us to try cassava. It is the root of a
local plant, that when cooked becomes somewhat sweet. It is served
with a spicy chilli sauce, which is a different experience for me that
early in the morning. It was pretty decent though, and I could
envision becoming accustomed to eating it, just maybe not while eggs
are still an option.

Today I switched to the General Surgery service and got to watch 4 or
5 operations throughout the day. The first was a doozie: She was a 60
year old woman who probably weighed maybe 110 pounds… a full 15 or 20
of which was abdominal tumour. When it came out, it was the size of an
American football. I guess part of the reason that cancer can get so
big here is the lack of screening, coupled with the belief that
traditional healing can reverse the course, added to the fact that so
much of the population is rural. It was unbelievable how fast they got
the thing out though. The majority of the operation was then spent
repairing the abdominal structures that had been compromised by the
tumour. I wish I had a camera, but I doubt many readers would want to
see it anyway. Your stomachs are probably already turning as is.
Sorry.

The rest of the surgeries were a mix bag, ending with an HIV positive
lady with an opportunistic infection that had turned into a large
ulcer on her face that needed to be surgically removed. She was lucky
that she didn't lose her eye but she is currently recovering with a
good chunk of cheek bone exposed to the air. It was a sad case to
witness because her prognosis is so poor.