Rahul for Elective Africa

Ho-ly crap (of a different kind) – the broken a/c in one of the minor surgery theaters was blowing air (not cold, but still…). Amazing, it felt real nice especially cuz today was super hot. Did a lot of stuff today. First case I had was to take a biopsy sample (which means take it out really..) of a mass on this prisoner’s groin area. This is not remarkable in itself expect that he was actively dying from mets to the brain throughout the whole procedure (wtf…). The mass was quite gross, probably another met with necrosis…it smelled and had black gung coming out of it. It was pretty big mass too, probably 2×3 inches circular shit. That black shit spilled everywhere. Also another first for me: stopping active bleeding with suturing (in US we cauterize). Its actually quite blind procedure. Want more? Another first: disarticulation of this lady’s ring finger. On presentation she came in with a finger with just bone sticking out the last phalangeal joint. It was decently healed proximal to it but looked necrosed. I ask what happened and I shit you not she said, “an animal called ‘insect’ bit her.” ….wtf you talking about lady? Anyway, I took it off to the proximal joint intersection. Thats, that. And what day is complete without human bite – not this one. This one actually sucks. It was a dude that was trying to break up a fight and one of the fighter’s bite his ear (apparently he had just watched Mike Tyson re-runs). But this was worse than what Mike did, that shit was like 1/3 gone. Not much to do for it in minor surgery, just dressed it and sent for ENT referral.

Monday blues. Same shit, different toilet. Removed a breast lump, did some suturing for minor wounds – yet another human bite. Saw (blatant) ascites for the first time, did drainage (also a first for me). Interesting case though, the lady (~50 y/o)  had elevated LFTs but no history of alcohol, chemical exposure and negative serologies…odd. She is going to another hospital for CT scan !

Saw sunrise at Nyali Beach at 6:03 am this morning. Had to walk a couple miles and get lost a couple times before I got there (took me ~1 hour)…it was worth it.

It was raining almost all day today. This is interesting for two reasons: 1) it does not rain for more than an hour here in Mombasa normally and 2) (more relevantly) people here are quite chill, with it raining outside people have become EXCESSIVELY chill. I came to hospital around normal time only to find essentially no patients at A & E AND there was no tools in minor surgery. Yes folks, the guy that delivers suturing supplies and basic tools decided to call off today – d/t rain. So didn’t do much to the patients that weren’t there in the hospital. Thats all for today…

Went to beach party at night…Happy Deepwali

More ho-ly crap. So I find out today that the head laceration guy from yesterday just left after he we finished stitching him up. Man that sucks. He for sure has an infection and seriously is going to die without antibiotics and proper observation. Even if he comes in after a day or too with a “bad headache” its going to be too late. Shit. Hope finishing that duel was worth it friend…

So removing lipomas is relatively routine in minor surgery, I’ve done a couple already. Not really a big deal, takes about an hour or less. I hope you can see where this is going. Today we had a seemingly similar case. 53 y/o F with (premused?) lipoma on right way lateral side of her chest (between lower ribs and flank?), she says its been there for about 5 years, no symptoms. I was leading the surgery (the resident was doing another at the time), and was assisted by two other med students, because I was the only one of the three that had done the procedure before. So anyway I was cutting away and trying to separate the mofo, and after like ½ hour, I’m like this is way too hard. It’s not supposed to be this deep or this difficult. It was almost like it was adhering to the ribs. I keep trying for a bit longer and realized this is above me. I wait for the resident to finish his case and take over. He works on it for a while but that thing feels like it getting bigger as we keep separating it out. We make a larger incision (the third extension by this time). About a 1.5 hours has passed, good amount of blood loss, patient is in obvious distress. Other students set up a line and starting pushing some saline. Also at this time the patient stops moaning (which she’s been doing the whole time). We’re like crap…hope she’s not in shock. But vitals are holding. Separated most of that shit out but the superior aspect is (you guessed it) stuck to the on the rib or pleura. We decide to just cut as close to the attachment as possible inside of trying to getting the whole thing out and risk pleural injury. That shit was big, probably 7.5×6 inches, sent for biopsy. It did look like fat tissue (it was yellow on the inside!). Closed her up, going to admit because that surgery was not too minor. Whole thing probably took couple of hours. Geez could have used a CT scan…

Ho-ly crap. There was a guy, in a motorcycle accident, with a scalp laceration, and open skull fracture, I can see his brain. He does not appear to be in any pain or distress. No loss of consciousness. He just comes in casually with head wrapped in a (probably dirty) cloth and asks us to stitch it. The story is kinda weird actually: he has no other injuries or bruises but a single, well defined ~4.5 inch long deep cut on his scalp from a motorcycle injury? I was discussing this with my colleagues, our consensus was that his was in fact sword fighting (whether he was on the motorcycle at the time was not determined). We had some debate with the resident whether or not this a minor surgery situation (I know in the States, this is immediate neurosurgery referral, but there are no neurosurgeons at this hospital). Some senior physicians came to assess the situation. It was decided to close the wound and admit for acute meningitis (which by this time that shit is for sure infected). First time I used bone wax. It’s a moldable substance that conforms to whatever shape and hardens to cover gaps in the bone, pretty sweet stuff. We believe that it’s made from concentrated strips of pre-chewed un-dyed gum, hot glue, and magic. It can in fact repair any wound but this would drive the medical community out of business so we keep it on the low. So we bone waxed the skull, put a couple layers of stitching, and shipped him to the wards to be admitted for his likely infection. Did other stuff today too, but because this was so interesting, I forgot about the rest. Sucks for you, I guess you’ll just have to come down here and see crazy shit for yourself.

As you may have noticed I’m blogging a lot more casually because frankly I don’t care anymore. Elective Africa “makes” (i.e. highly suggests/endorses/recommends/naggs) us blog to give other potentially participants an idea of what its like. And that’s fine, I really do think it is a great program, and certainly a unique opportunity for medical students to get some incredible firsthand experience in a novel environment. So if this is what you are looking for (and are not squeamish) I thing you should definitely check it out. You will have more opportunity to do procedures here than you would back at home I assure you and this is lifetime chance to broaden your perspective on the world (perhaps the more important reason). So just let your gonads descend and do it. Its worth it, even if you have to blog.

I actually didn’t go to work today because I still feel at little drained from the food poisoning and lacking proper sustenance for the past ~30 hours. I went around Mombasa and the hospital with Bjorn though taking pics for him because it’s his last day here. Came back, chilled and watched the game at Mikeye…and had some somosas and chicken kebab (ya damn right). Man that chicken is so tender and delicious, I can’t explain it; they have chickens around in our complex, I swear I think they literally take them out after we order (because it takes like ~ 1 hour to make).

Safari to Masai Mara: amazing. Lions, hippos, elephants, giraffes, zebras, crocodiles, warthogs, other animals I don’t know the names of, breath-taking sunsets, rolling lands, lone trees. Here are some facts I learned: lions sleep ~20 hours a day and feed about every other day; hippos are the real kings; elephants I already know a lot about; zebras are mad cool because they are always chilling with whoever: elephants, wildabeasts, giraffes, impalas; giraffes will protect the dead carcass of their young so it won’t be eaten. Also when they open their mouth to speak it comes out as “giirraaffe?,” no matter what the context (even when mating, that’s how they set the mood). They are quite inquisitive animals. We stayed in tent lodgings. I say lodging because these are by far the sweetest tents I’ve been in. I mean they have shower, toilet, power outlets (albeit only from 6pm-10pm, but still that’s crazy). The Masai are the native folk there; unique because they have “preserved culture.” It’s in quotes because although they without a doubt live a lifestyle that I could not begin to fathom, it’s just interesting to see the subtleties of creeping ‘modern’ influence. For example about 30-40% wear digital watches. Also be careful when you buy stuff from them, they are formidable bargainers (among the best), start your bid <50% of their asking price.

We went with a few people that were not from Elective Africa. I really enjoyed their company. I big shout out to them (you know who you are – the gringas, the kid, the good doctor). I’m always amazed and humbled by the fact that random strangers from around the world can become friends if you just confine them to a moving vehicle for just a few hours. It is testament to how much we really are social creatures, and (at least I’d like to think) that the world is in fact for the most part full of good people (random sampling right?). Anyway, many thanks goes to them for making it such a memorable experience. I wish you the best of luck on your life journeys and hope to meet with you again.

Enough of the mushy stuff. The last day I got food poisoning. Probably toxin: started shortly after breakfast, lasted maybe 24 hours. I ate a total of 3 biscuits the whole day (my tummy hurt). Tummy hurts with nausea are the worst. Felt a little better about time I got back to Mombasa, had a beer and good food.

Just to give you an idea of total travel time: [Mombasa to Nairobi (9 hours bus) + Nairobi to Masai Mara (6 hours van)] x 2 trips (back and forth) = 30 hours. Maybe that chick with respiratory distress went to Masai Mara too (see above post on Oct 25^th). Oh and giraffes don’t actually make audible noise (I hope you didn’t actually believe me before).

I forgot to add something: the night we arrived in Nairobi the day before safari, Edwin (Elective Africa coordinator) took us to restaurant called Carnivore where they serve exotic game meat. Crazy shit man. It’s kinda like Brazilian BBQ where they bring around all types of meat. They have the standard: poultry, beef, pork; and more exotic stuff: crocodile, ostrisch. Croc tastes something between fish and poultry (not a big fan, but Bjorn really enjoyed it); ostrisch meatballs however are ridiculously good, I mean Fken ridiculous.

Belgians are timid folk I think. I like ‘em, they’re good people, just timid. So the lack of plentiful basic and advanced medical resources is really starting to dawn on me now. Yesterday was the (not) CT Scan. Today I will top that. We waited about ½ hour for sterile gauze. Yes you heard me correctly – no gauze in the entire emergency department. After this initial situation, the rest of the day was pretty smooth until about 2pm when the lights went out in minor surgery whilst I was working on an open wound. It’s all good because the students pooled their cell phone lights and we got the job done. On the bright side (pardon the not-pun) it was much cooler in the minor surgery theater. Had some classic cases today: gallstone (fat, female, forties!), bowel obstruction (s/p appendectomy 3 years ago), a tourist with fever/chills/fatigue/body-ache and a ton of mosquito bites(can you guess it…malaria). Always, always, always take proper prophylaxis Imzungu (you can look up this word, consider it a Swahili lesson bonus blog).

There are some Belgium students here I found out, not through elective Africa. I think from their school probably, they’ve been in Kenya for 2 months (wow). Routine stuff in minor surgery today: suturing, dressing, catheter-ing. Had a weird case of respiratory distress in a 26 y/o female: past 6 hours, sudden onset, no cough/fever, no trauma, didn’t swallow anything, no past history, had recently travelled for ~10 hours (but seriously PE in a 26 y/o??…maybe a coagulopathy), no meds, had some retractions, diminished breathe sounds LLL, O2 sats were ok, clean CXR. Sounds like a job for CT Thorax – oh that’s right there is no CT scan in the hospital. The patient was given two choices: admit for observation or travel to the nearest private hospital for more diagnostics. I don’t know which she picked, probably the former (since the latter is unfortunately very expensive).