June 8th and 9th - more adventures in the hospital

Pic: Guess which one I am.

On Thursday and Friday I was hanging out with the surgeons
again and saw some more surgeries, both minor and major. Of note,
there was a circumcision of a boy who we put under with ketamine.
Circumcisions are still a regular occurrence here, even while in
Canada, they are entirely elective and you have to pay for the
procedure out of pocket. I think it is a matter of hygiene here more
than anything else. In any case, it was a quick procedure, but it is
disconcerting to hear the child cry out in pain, even though they are
probably hallucinating and would never remember the experience. It's
been a rather common experience actually: unless there is a reason to
use a gas anesthetic, quick procedures only receive ketamine, and many
of the patients visibly grimace or try to move their limbs while
under. I guess that with the limitations on drugs, they don't have
much choice, but its hard to see.

More drug woes here today: All the anesthetic drugs are
depleted and elective surgeries have been cancelled. It's only the
C-sections that seem to be going, unless the procedure can be done
with local anesthetic. Maybe by Monday, they say. We'll see.

On Friday I attended the surgical department's meeting and
rounds, which was really interesting for me, because I hadn't seen the
wards in a Tanzanian hospital first hand. We visited many of the
surgical patients in the hospital, including those who were in the ICU
and paediatrics. It was a good exposure, not only to the typical
surgical case here (ortho!) but also to the dynamics of the hospital
(nurses play a different role here and the hierarchy is obvious). It
was also interesting to see the level of the residents here, compared
to Canada. It seems as if they are on par with Muhimbili, so perhaps
not as far along their training as I think we would be in Canada. It
also exposed me to a few cases that we'd never see in Canada: a hippo
bite (broke the skin and fractured the bones of his foot) and Maasai
spear wound (in the back, causing some neurological deficits).

Friday afternoon I spent with an Austrian doctor who is
volunteering his services here for 6 months. We reduced some fractures
and did some casting with plaster of paris. People have to pay for
their casts here… probably about 15$ CDN, a fair amount for many.
X-rays cost 10$, which is often equally prohibitive. They also carry
their own xrays around with them to the hospital and bring them home
with them, as they do with the official drug records and sometimes
even their charts. I find this somewhat bizarre, and I wonder how many
records get misplaced or forgotten about.