16.08.2011 Surgery in Africa
Today I assisted Dr. Julius with two surgeries. It was him, one local nurse, and me in the operating room. I was doing the job of what a surgical tech would do in the USA. I held his tools, handed him what he needed, and at one point, had my hand inside of the patient’s abdominal cavity to stop a small bleed. The first surgery was an appendectomy, old school. I have only seen laparoscopic appendectomies. He taught me how to determine where to cut, and how deep. He pulled a portion of the intestines out of the incision, and found where the small intestines met the large. He removed the appendix, and then sowed the patient up. During the entire procedure, the local nurse was sitting at the head of the patient, not doing much. The patient’s BP, HR, respirations, and LOC was not being assessed at all during the surgery. I would look at him, and try to count respirations. I would ask the nurse to check his heart rate, and she would grudgingly do it. I asked if there was any way we could get a pulse ox on a finger. I couldn’t believe the differences between surgeries here versus at home. At one point, I looked up and realized I could see people walking and cows grazing through the open window. The wind was blowing inside of the operating room, where our open patient was. I asked them to close the window, but they kept the curtains open for light. After the surgery was complete, the nurse rolled the patient out. Dr. Julius and I stayed in the OR cleaning up a bit, removing our sterile clothes, and talking about the surgery. When we walked out of the OR, we saw the patient on the bed, alone. Nobody was accompanying her, and her side rails were down. I went to her side, raised the rails, and stayed by her side until she was taken into the ward. She began to wake up the same time she was being rolled away to the general ward. PACUs don’t exist at this hospital, and the “ICU” is just a private room, so the general ward was probably her best bet for proper health care. I left her with a nurse, and then joined Dr. Julius for our second surgery.
The second surgery I assisted Dr. Julius with was a hydrocele. The man’s testicles were about four times the normal size, and the skin pulled tight. I have never helped with one of these in the States, but I think they are accomplished by putting a needle in the testicular sack and removing the liquid that way. Here, local anesthetic is given, and then a large incision is made to the testicles. As soon as the blade reached the hydrocele, yellow liquid squirted everywhere. We drained it completely, and then he was sown back up. During the procedure, he was squinting and moaning from the pain. The local anesthetic may have helped numb the area a bit, but this man was still feeling pain. I was informed that whenever possible, local anesthetic is used rather than general because general anesthetic is more expensive, and the patients will require a bed, which the hospital has a short supply of.
I am so grateful for the experience of volunteering in Africa, and seeing these surgeries. I am learning a lot. Nonetheless, assisting with surgery here makes me extremely grateful for everything I have at home. Often, we find that certain things are due to us, like proper health care. It is true; everyone should have access to great health care. However, it’s easy to forget about the people who don’t when they are half a world away.
