This week has been somewhat busy, getting settled in, getting accustomed to the hospital and learning the local pathology. We operate Mondays, Wednesdays and Fridays, with OPD Tuesdays and Thursdays. The day starts at 0730, and finishes when all is dealt with. There is normally a rush at the end of OPD, and ward problems to sort every evening as well.
The operations vary, with a lot of work being trauma related, either orthopaedic or wound management. I will write a bit more as the weeks go on, but to start on the orthopaedic side, we mainly deal with road traffic accidents and paediatric injuries. The image intensifier is currently broken, so we are doing MUAs, K-wires and ORIFs by eye, which is challenging. There are several people with major open fractures, who have external fixation, but we have to wait until their wounds heal on their own - there is no advanced plastic surgery to apply flaps. Most of the paediatric injuries are supra condylar elbow fractures, but we have had a spate of toddlers with femoral shaft fractures, all now in a row in Gallows traction.
The two most challenging things so far have been knowing the limits of what we can do - referral is possible (to Lusaka) but few patients can afford it, so working out if we should operate or not is tricky - and dealing with deaths which would not happen back home. We have had two toddlers die with burns of about 30%, a survivable injury with modern intensive care and burns therapy. We have only IV fluids, some blood and skin grafting. It is not possible to check the electrolytes even, which makes fluid balance near impossible.
Next week I go onto the on call rota, initially shadowing someone so I can pick up the ropes on the obstetric side. I'm looking forward to it, but with a degree of trepidation!
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