Rubber in Lungs

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It is Friday afternoon. The morning has been quite busy at the clinic, 22 patients. Especially since Maria has been teaching our nursing auxiliary class most of the morning. So besides being the doctor that does the consultations (the CHO is out due to family issues, said he would be back today, but not seen yet), I also covered the pharmacy. Luckily Morlai, our nursing aid was there to help me!
A father comes in with his 5-year-old son, Amadu. The boy was playing with a small piece of a toy, like a small rubber. He was trying to whistle with it, when it suddenly got in his throat. He had been coughing. It just happened this afternoon.

The boy is sitting next to his father and we are able to take his vital sings. He coughs once or twice. When I check his lungs, they are clear. We are hoping it is stuck in his oesophagus, so Maria gives him some biscuits and water. After observing him for some time, he seems to be fine.
His mother, who is one of the nursing auxiliary students, comes out of the class, as the lesson has finished. The whole family goes home, with instruction (if cough continues or fever come, do come back).

On Monday Amadu and his father come back. He is coughing a lot and sometime makes a whistling sound when breathing. When I check him I confirm what the father tells me.

That means the rubber went to his lungs. It can course a lot of problems there, and is difficult to get out.
Under anaesthesia I do give it a try, but I do not see the rubber. But this makes him cough even more, unfortunately not coughing up the rubber ☹.
 I contact the bigger hospitals in the capital city (Children’s hospital and Emergency hospital, but neither have a bronchoscope), maybe the government hospital in Freetown. So I tell them to go there tomorrow and write a small note.
When he is fully awake, the classes are over and Amadu and his parents go home.
We clean up the last things in the hospital, when a motorbike comes. It is Amadu’s father. With a big smile he shows a matches box with in it…. The rubber.
 At home Amadu coughed again after drinking and it came out. He will be fine!

Best Wishes for 2012!

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Weer eens tijd en energie om jullie een verhaaltje te schrijven

Allereerst over een patiënt die zwanger was, maar de buik niet goed mee groeide en erg veel buikpijn had. Met de echo gekeken en daaruit bleek dat ze een buitenbaarmoederlijk zwangerschap had die gebarsten was en bloedde in de buik. (Een normale zwangerschap nestelt zich in de baarmoeder, die zeer goed in staat is mee te groeien en voeding aan de foetus te leveren, een buiten baarmoederlijke zwangerschap nestelt zich elders in de buik, vaak in de eileider, die niet geschikt is om mee te groeien. Wanneer de foetus dan toch groeit, barst de eileider en gaat (veel) bloeden in de buik).

Dit hebben we uitgelegd aan de vrouw en haar man en verteld dat ze een operatie nodig had. Ze leken dit te hebben begrepen, maar weigerde de operatie even later. Ook haar man weigerde, hij was bang voor zijn schoonfamilie en de vrouw zelf was ook bang. Ze komen uit een dorp nog verder in de middle-of-nowhere dan Masanga. Na veel praten wilden ze het advies van de nursing aid die hen als eerst had ontvangen in het ziekenhuis. Hij kwam en probeerde hen gerust te stellen, dat leek te werken, maar later toch weer twijfels. Ik wilde het bijna opgeven, omdat ik zonder hun toestemming niet kan opereren (nee, ook hier niet!), maar zonder operatie zou ze kunnen dood bloeden..
Na nog meer pogingen lukte het om hen te overtuigen. Gelukkig!

Met dr Alex en de STP (Surgigal Training Program= HBO-artsen in chirurgisch training) haar toch nog diezelfde avond geopereerd. Bijna 3 unit bloed uit haar buik kunnen terug geven en de bloeding kunnen stoppen. Na de operatie knapte ze goed op en was ze erg dankbaar. Ook de nursing aid, die geen familie was, bleef erg betrokken bij deze patient en was blij dat ze het zo goed deed.
Tja, als je in een dorp woont ver weg van alles, lagere school waarschijnlijk niet afgemaakt, een rivier hebt waar je water vandaan komt, woont in een hut, ect. Dan kan ik me wel voorstellen dat wanneer een blanke dokter zegt dat de zwangerschap in je buik niet goed is en je geopereerd moet worden, dat wel erg eng is…. Toch goed dat ze wel naar het ziekenhuis gekomen is.
Er is hier nog veel verbetering mogelijk, zelfs met simpele dingen als mensen leren lezen en schrijven.

Nog enkele fotootjes:

 

Story from Africa

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Dear all,
As you might know I am working in Masanga Hospital since the beginning of this month. Masanga Hospital has about 105 beds, divided over a surgical ward, male and female side (but here also the medical cases are being admitted), paediatric ward, stabilisation centre (for malnourished children), and a maternity ward (were also the waiting mothers are staying). There is an OPD, under-five clinic with antenatal care, a laboratory, dispensary/pharmacy, X-ray department and …. of course a theatre.

I would like to try to send you a short story from Africa once in a while.
Just before I left Makeni, the bigger town, I wanted to convert my driver licence into a Sierra Leonean one. I was lucky as one of the drivers of Magbenteh could join me, as I did not know exactly where the road traffic department is. We drove into the road and asked, as the driver was also not sure. Some men under a tree were friendly and pointed out that it was just a little further down the road. There we found it, but there were several offices, most closed. After being directed to the road traffic office, I was told by the young men that the officer (in change of the driver’s licences) is out, so I should come back later. When I told the driver that he told me that that officer is the one that showed us the way… So we went back to the tree and explained what we came for and then the man would come with us. As I had inquired before I had all the required items (passport picture, copy of driver licence and passport with work permit and of course money) An other person to write me the receipt was not there, so I had to come back later for the receipt. After about 10 days I can collect my drivers licence.
This actually went quite smooth. The next day they were closed before I could come for my receipt, but on Monday I got it. Now I am in Masanga and did not have a change to collect my drivers’ licence, but it should be there, and I have the receipt!
This week we (all clinicians) were in the conference room for morning handover, when we heard a motorbike drive up the hospital compound, nothing unusual, but just after that there was quite some noise from the direction of the ward. From were we were we could not see what was the problem, so one of us, dr Thomas Asley went to see.
Not much later an other 2 motorbikes came with even more noise.

All of us went there to assist. It had been a frontal collision of two motorbikes (each carrying 4 people), so we had 8 casualties. The ward is very full, so that would not work well, so immediately we (dr Alex and me) decided to get all of then in the ward for the stabilisation centre (were we had enough empty beds). That showed to be a wise decision as now also we could keep a very large crowd of curious people out. All present staff assisted: they were assessing patients, making chards, suturing cut wounds and giving painkillers.
It seemed no one was wearing a helmet and 3 of then had a brain contusion: “what happen?” one repeated about every minute, despite the fact that he was told.
In the afternoon 2 could be discharged home, the others stayed for the night and some even a bit longer, as they also had other problems which made them take the bike to the hospital…
Even though it is not according to Western standards, I think every one did a quite good job.
I hope the plans for an emergency room (renovation of the part of the hospital near the entrance of the hospital and next to the X-ray) will be realised. That, together with some more training/practise, will make the trauma care to be fairly good.

The next day when we were operating dr Alex was called to see a patient, he got a knife in his abdomen and now his bowel was coming out. Immediately he assessed and stabilised the patient got the Hb checked and informed the theatre. Very quick he was taken to theatre and his abdomen was inspected: he only had a haematoma on his mesenterium (part in the abdomen that takes the blood supply to the small bowel), there were no other injuries! His abdomen and wound was closed and he recovers well in the ward. He still does not tell a convincing story about how the knife got in there…
Oke, enough stories for today, hope to write some more later.
Many greetings from Masanga,
Erdi Huizenga