Christmas in the hospital

Charlotte is the better person to talk about the fun and games on Christmas Eve and Christmas Day, so I will talk about our working week instead!

Unsurprisingly, Christmas in Katete is not the commercial extravaganza that it is at home. At most, people spend more time in Church (there was a service that lasted at least 4 hours on Christmas Eve and another similar length one on Christmas day) and government employees get the day off. As it is planting season, the workload has already significantly diminished, and a lot of our planned cases are now not coming for their operations, I assume because they are in the fields.

The week has however been a busy week for emergencies. Last week we did a string of laparotomies for advanced bowel obstruction or severe abdominal sepsis. By far the worst was the young man on whom we had brought out a stoma because he was critically ill with a typhoid perforation. We had to take him back to theatre, just at the point he was getting better, because his relative had pushed the stoma back inside the abdomen because he did not like the look of it. The week has been another week of multiple laparotomies. On Monday, it was a semi-elective cholecystectomy and a colectomy for an intusussepting polyp. Tuesday was pleasantly quiet, although come Wednesday I had booked four laparotomies. One internal hernia with extensive small bowel necrosis needing a right hemicolectomy, one sigmoid colectomy for volvulus and one quick small bowel intususseption for reduction. The fourth was just too ill to anaesthetise and was managed non-operatively (she had been unwell for two months prior to their referral and showed it).

Friday was a bit quieter, although we still did 5 skin grafts and a string of fracture manipulations. Perhaps the most rewarding op (provided it works) was on a 4 year old boy who had lost a chunk of skin and muscle from his forehead falling over. One of the rural clinics had tried to suture it, but it had fallen to bits. We sought some advice from home, emailing a photo to a plastic surgeon, and did our best to close the defect primarily. In the end though the only way we could cover the bone was with a little rhomboid flap, which currently looks pretty good considering everything.

Next week, I'm looking forward to the division of the groin flap on Wednesday!