Kumi: week 2

This week Christine and I wandered onto the hospital campus with one of the doctors who is staying in the guest house with us (he’s sort of like an intern, and will start a masters program for orthopedics at Makarere in the fall) and ended up rounding with his mentor “hard core doctor” as we call him, a fantastic orthopedic surgeon who handles literally 15 – 20 cases per day in the OR. During rounds he would approach each bed for an average of 30 seconds, check the wound, talk to the patient in their native tongue, snap orders at the nurses, make a joke and then move on. It was awesome. I could tell he was not someone to trifle with, but that I could learn a lot from him.
On Tuesday of this week I shadowed HCD in the OR from 8am until 4pm and we did….guess how many…19 freaking surgeries! I was about ready to fall on my face at the end of the day. I, having learned the germ theory of disease from a young age (which made me a total freak for a number of years, but primed me to be a bad-ass in the OR) was in charge of tying on the surgical gowns of the two surgeons, adjusting their goggles and keeping their supplies of sterile normal saline and alcohol topped off while HCD shot questions at me and then explained to me why my answers were wrong. He would sometimes tell me the correct answer, but more often than not would set topics for me to study that evening via the painfully slow internet connection in town.
I have learned so much. Some of the procedures I’ve seen are:
--club foot correction: severing the Achilles and then setting the feet in casts for rehab.
--hip replacement and repair.
--limb amputation: mainly in patients with leprosy or diabetes who have severe progressing sores on their feet and legs, but also in cases of malignant melanoma.
--sequestrectomy: this is my shiny new word of the day, it is the term for the removal/cleaning of dead and infected bone in patients who have osteomyelitis, a condition that you rarely see in the states which usually results from a systemic bacterial infection that gets caught up in growing bone and then flourishes for a long period of time. It is usually seen in kids because A: their immune systems are not quite as developed, and B: their bones are still growing fast and contain little twisty systems of capillary beds that are easily clogged up with bacteria (usually staph aureus) if it happens to be flowing through the blood. It is very sad to see, but as long as there is a portion of living healthy bone to leave behind in the limb, the prognosis for recovery is quite good.
--Debreidment: removal of dead or infected (often gangrenous) tissue
--Bone stetting: we had a patient today with an open fracture whose tibia was completely snapped in two. Another reminder not to ride the boda bodas (motorbikes)

I have concluded that orthopedic surgeons have very strong stomachs and are pretty darned awesome.