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First full day in Togo

May 3, 2010

A little bit of medical detail for today…nothing to make your squeamish though.

Crazy Monday OR Day

Drinking from the fire hose today for both of us. It’s fun being back at Togo as a surgery resident compared to when I was a medical student. Now I get to operate all the time, but each time I operate it’s always something new. Today we did five cases in about 4 and ½ hours. It’s great when the room turnover after an operation is less than 10 minutes. Some were simple obstetrics procedures, others were more complicated such as delivering a near term baby in transverse lay (baby’s head is pointing to the side instead of pointing down into the pelvis) via cesarean section in less then 2 minutes because the mother was a paraplegic, and couldn’t risk general anesthesia or spinal anesthesia. Even the hernias we did were extremely challenging in terms of chronically inflamed hernia sacs that were difficult to dissect off the cord. We also do not use mesh to close hernias in Togo for various reasons (in America the usual standard of care is a tension free mesh repair). Probably the most poignant case though was an elderly gentleman in a poor state of health who had an incarcerated ventral hernia (the bowel is trapped in hole in the abdominal wall and eventually dies if not put back into the abdomen). When I saw him on rounds in the AM, I knew we were in trouble. True to form likely elderly patients in the states, it was difficult to obtain a reliable physical exam on him. But my previous experiences in Africa have taught me that if I think someone needs an urgent operation, don’t hesitate. Nevertheless, he died before we could the operating room. (Cultural tidbit—in French we say this as “aller au bloc” pronounced alley-oh-block”). At least this time I didn’t make the same mistake I did in Tenwek. I talked with the man and his family on rounds about the potential for death during the operation and prayed with them. What a joy to know that he was saved before he came to the hospital. Indeed the family was so grateful for all that we had tried to do for him and that he was in heaven. It’s rare to experience what some call the purity of medicine—where you care for the patient and their family without the overwhelming worry about the overwhelming spectrum of reduced reimbursements, malpractice costs etc. While we can’t always provide the highest standard of care as in the developed world, we can practice medicine with far greater intimacy than in the states. This is an incredible experience that I think no doctor would regret.

Ginnie was equally overwhelmed…well probably more overwhelmed since she can’t speak French

Tough living watching satellite TV in the Ghana Guest House

and pediatric residency didn’t cover cereberal malaria and all its complications (and man there are a lot—low blood counts, seizures etc). She did a bunch of adult and pediatrics echos today as well. But she’s still pretty nervous about being the on-call doc tomorrow. I can’t say I blame her. I’m on call for the reminder of my time here as well for surgery. So your prayers would be appreciated! We heard from the kids’ adopted grandparents. It sounds like they are doing well and loving to spend time with Yvonne and Cico. What a blessing to know that God knew that we would need help from the great body of Christ, and he provided these two wonderful folks at just the right time. It’s late so I’m off to prepare a devotion in French for the OR guys in the bloc in the morning. More to come!

Ghana Guest House Porch--tough African living--ok it's a little hot!

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