Spine in Mbingo

So it was like being gone on a long holiday and we have picked up right where we left off last summer.  Cases are coming in every day.  Dr Nana (Cameroonian Ortho Dr) had several spines waiting for my arrival.  We started Tuesday with our first one. A T5-6 fracture/dislocation from about 2 weeks ago. Very unlikely to get him to walk, but at least make him better able to transfer and receive care.  Was a good safe case to do out of the gate to make sure they were ready to do spine surgery again.

Blue line represents spinal canal.

There is also plenty of clinic and patients to see.  It amazes  me they come from 6-8 hours away going fast, probably 12-15 hours by common taxi/bus, they see us for 4 minutes, get told they have a problem we can't fix, don't have equipment to fix or doesn't need fixing.  They get some medicine and they smile (most of the time) feeling treated and cared for and "head to the house"  It's frustrating that so many of them could be so much better treated with a little bit of  the resources we burn through in the US.

Even if they have a problem that is treatable here, they are given a date in January 2013 for surgery, no matter how bad or urgent the outpatient problem is.  Motorcycles in the last few years have completely changed the landscape here and the wards are full, full, full of motorcycle trauma that ties up the resources (Staff, wards, equipment, most importantly time.)  Even the open tibia fractures wait, days and days to be treated.  It is one of my frustrations here, I just want them to give me two operating rooms and staff for one day and let me clean up the wards, get people treated and on with their lives.  But as a guest, I can only push so much and need to understand, that when I leave more people will break on motos and if we became more efficient at treating them, word would get out and more people would come for treatment.

I am learning how to finagle the system a bit though, I have a very good rapport with all the general surgery residents who have more OR time and staff.  I saw a cased of a contracted Achilles tendon after a tibia fracture.  The man couldn't walk or sit to use toilet, or provide for his family because he couldn't put his foot down.  Answer is, pay the money we will put you on list for January 2013, keep living with it till then. The residents and I agreed that wasn't a good enough answer.  I convinced the residents, that there was no bone involved in treating this problem, only a "soft tissue thing" so it really should fall under general surgery and we should do it together some afternoon and I would staff it.  He's on the books for the last week of June :)

You know your operating in Africa When....

1) There's cardboard taped up partially covering a broken window in the OR.

2) You hear your scrub clap his hands real loud, not because your doing exceptionally

well, but to kill flying insects.

Amy told you of our hike on Tuesday, more of those to come.  All work, makes the Ipsen's dull so we are getting out some. 

Planking for AB, SW and KV!!!

Wednesday brought another spine, a L1 burst fracture, with para-paresis, about 10 days old.  Again I wasn't to optimistic about return of function, but wanted to be able to mobilize the patient, and bracing out here is almost unheard of.

I saw him this morning...he lifted both legs off the bed!!  He and I were both pretty excited.  It's hard to fathom how much we changed his future, and it happens every day in a big way to alot of the people we touch.

So it would surprise many of you that know me to find out that after that case, I got a little impatient about how they were going to treat this 8 year old boy with a very bad elbow fracture, (Type 3 supracondylar for those that know)  He was put at the bottom of the list,  4,5,7,9 days from now to be fixed, already 5 days when he came.  I insisted that they let me have 20 minutes and him in a OR that day.  I thought I was going to pull a fast one and look like a hero, because the only x-ray machine they have even close to the OR is a small little machine for hands, but figured it would work fine on an 8 year old's elbow....  That would be if it still worked, which they didn't tell me until after he was already asleep and ready to go..Not that it would have changed much, still needed to be done.

Before

So we went ahead, did it blind and its better to be lucky (or blessed depending on your view) than good and we had a perfect shot, with a very good reduction.  He went home today, doing great.

After

Sign of advice for everyone entering the surgery clinic.

Finally, today brought Susan's surgery.  She is the daughter of Pastor Mendeh from Gambia, who works with Cindy at Open Doors Foundation, whom I went to Senegal with last year.  His daughter has pretty involved scoliosis and has continued to worsen.  Her surgery almost got cancelled this morning as we continued to struggle to find blood for her.  Thankfully, the man who's spine I fixed yesterday was a match, and the blood donated for him, he didn't need so they reserved it for her...which was a blessing as we needed some of it for her in the OR today.

Susan's back pre-op

Susan's xray

It went well, she didn't make it easy, she had a very stiff curve that wasn't easy to straighten.  Without spinal monitoring during the case I was hesitant to push for too much, so I took what GOD gave and know I improved her and will keep her from getting worse.  I'm anxious to see how much we got her corrected. During the case I wanted to grump at my instrument reps but they were no where to be found, as I couldn't find any sagittal or coronal benders ( help to do the final straightening touches)  But again, I have to accept that we got her treated safely, well and likely better than she otherwise every would have been... The impatient, type A in me just needs to put a number/measurement on how well we did today, so waiting a day or two for an xray post-op will drive me crazy.  She is doing well, post-op, sleepy which is better than hurting.

Everything else is good, fast approaching the weekend, another burst fracture tomorrow to do, and a complex elbow fracture that I was given after the child's elbow went well, they decided I'm an upper extremity specialist also.  Then it will be June the 9th, for a second year in a row here Africa, and should be great...37 I think, getting to old to remember.

Sorry so long a post, I will try to be more frequent or at least directed in my stories from now on, but had alot to get out over the last 4 days+.


BI