|This baby never stopped smiling!|
Mission trips are expensive and we are currently spending 3-4 months in Nigeria. In addition to paying our transportation, we also pay for room and board. Many of us pay for surgery, chemotherapy or radiation therapy for indigent patients.
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I have a small stone collection from my patients in Nigeria. Stones can form in many parts of the body such as the gallbladder, kidney, bladder, appendix, tonsils, salivary glands etc. These stones can cause obstruction, pain, and infection, so many stones need to be removed.
The two stones in the lower left came from the distal urethra in a man. They were originally kidney stones that passed into the bladder and then into the urethra. They were too big to pass out and caused obstruction at the end of the penis, like a ball valve. In order to urinate, the patient had to push the stones proximally! They were easily removed with a small incision.
|Author at work|
This was a great trip! Of the eight team members, 4 were returning and 4 were there for the first time. Drs. Uche Nkeonye, Mike Enyinnah, Dabs Ngwu and Mishack Akunekwe and nurse anesthetist, Wilson Anyanwu, returned to help, as well.
We operated for 5.5 days and did 54 surgeries. Hundreds of other surgical patients were seen that will have surgery in September. Overall, it was a very successful trip.
In the following days I will show some other pictures from the trip.
The internet was terrible the last few days so the blog has been difficult. On 7/20/12, we did 9 cases. We had several big cases including a boy with a large ameloblastoma.
|Right hemimandible removed|
A mother brought her 1 month old baby in with abdominal distention. There baby had a large left sided mass. We did an exploratory laparotomy and found a large cystic kidney on the left and a much smaller cystic kidney on the right. There were megaureters and a massively distended bladder. We suspected some type of outlet obstruction. The left kidney was so large that we performed a nephrectomy. The specimen showed that there was almost no functioning kidney remaining. We also placed a suprapubic catheter to drain the massively distended bladder.
|Massively distended abdomen in a 1 month old|
We also did two hernia repairs, a modified radical mastectomy, a laparotomy for SBO, a toxic goiter, a BKA and drainage of a deep neck abscess.
Today has been quite a selection of surgeries. A ventral hernia repair, 2 toxic thyroids, 1 giant goiter, a maxillectomy, a rectopexy, a C-section, a debridement of a leg ulcer, and an excision of multiple skin cancers. We have completed 43 surgeries and have a bunch left for today.
|Intraopeerative picture-packing in sinus|
|Bladder Stone with suture in center|
The patient with rectal prolapse is quite interesting. She had a previous aginal prolapse repair and was complaining of sutures coming out of her vagina. At surgery, we found a giant stone in her bladder. In the center of the stone was a proline suture!
|Baby with jejunal atresia|
We had a wonderful surprise today when our baby with jejunal atresia came for a followup. We performed surgery about 2 months ago and the baby is doing great.
"Even a soul submerged in sleep is hard at work and helps make something of the world." Heraclitus of Ephesus
Three days-33 operations. Everyone is tired, especially me. We have 2 days left and the cases are starting to pour in to the hospital. Many will have to wait until the September Trip. Mr. Mike is with me today so we should be able to run two table and do many cases.
Today we had an interesting case. We came to the operating room and there was a young man waiting on a stretcher. He fell off his bicycle and landed on his machete. The wound penetrated his abdominal wall so we decided to operate. Once we got in the abdomen, we found there was a small amount of bleeding from behind the duodenum. All of a sudden, there was audible bleeding-the heart-stopping whoosh of blood pouring out of a large vein. The machete had lacerated the inferior vena cave just below the renal vein. There was a one inch hole in the sidewall of the cava.
We sewed up the laceration-then we changed our pants! The machete had practically skewered his entire body and there was also bleeding from the paraspinous muscles. We controlled all the remaining bleeding using FloSeal (Baxter) donated from Americares.
|Schematic showing access to the vena cava|
Doctors often depersonalize their patients-thus Mr. Jones becomes the gallbladder in room eight and Ms. Samuels becomes the mastectomy in room three. In Nigeria, I often refer to my patients by their diagnosis, rather than by their name since I can’t pronounce many of their names. We have nose girl, face boy, sarcoma lady, and albino man etc. In this day and age, such depersonalization is not considered politically correct. However, such characterizations are consistent with the way we think in medicine in terms of differential diagnosis. We spend our whole lives trying to categorize diseases and it is natural, in my opinion that we would think of our patients in terms of a diagnosis. I think this is fine as long as we remember that the diagnosis is attached to a real person.
Today's patients had many diagnoses:
Today's patients had many diagnoses:
We arrived at the Nigerian Christian Hospital on 7/15/12, after 48 hours of traveling. One hour after arriving we started out first case-a hernia followed by excision of giant skin cancers on an albino man and debridement of our main problem-the necrosed nose.
If you have followed the Blog, you are aware of our young girl with a probable fungal infection of the nose and maxilla. She has had a rough time. Her infection is controlled but she has necrosed half her nose and part of the maxillary bone. We debrided the wound and will do the first stage of reconstruction this trip-working on the lip and cheek. In September, we will do a forehead flap. Naturally, she is quite depressed. The first time I saw her smile is when I gave her this cap.
|Crowd horrified/fascinated by retroperitoneal liposarcoma|