Kwendin #23 | March 9, 2017
Now, after I sent that last email I was asked if I had remembered to incude the story of the little boy with the abscess. How could I have forgotten it?
He was about 3 and had received an injection in his buttock some weeks before. The injection site had developed into an injection abscess--unheard of in Canada but common enough in Africa. They are less common now that the presence of HIV has eliminated the practice of re-using needles and syringes (unless you are an iv drug user). Anyway, it needed to be opened. Normally that is done with a general anaesthetic, and we do not have that option in the clinic.
We used a combination of restraint and local anaesthetic. Now, restraint means we wrapped his upper body with a sheet, and got the mother to hold his head while our translator held his torso. His swollen and tender butt had to remain exposed for me to work on it. Kate had the job of holding his legs, and tried a variety of techniques until she ended up sitting on him (not weight bearing, she assured me) and holding his legs in an iron grip while I worked. I injected lots of local anasthetic and then sliced it open. He was not a happy camper. He wriggled and screamed and called down all kinds of curses on our translator who was laughing--apparently for a young boy he was very eloquent. Anyway, I managed to open the abscess and drain a huge amount of pus from it. His wiggling spread the pus quite widely on the examining table, and Kate is quite sure there was a significant volume of urine contributed to the mess. It took about 3 tries to put a dressing on him--his sweaty little body declined to stick to the tape we were using. Finally we managed.
He actually came back today for a dressing change and Kate chose to do it while he was standing up beside his mom. He was really very good, and of course we were not doing any cutting. This time. He is already well on the mend.
On our way walking home yesterday we walked past a boy holding a dead armadillo. Actually I'm sure that armadillos are only in the americas, so it must have been a different kind of armoured anteater. An Aardvark maybe? We got a picture of him holding it up. Today when we were walking home Kristie actually saw some of the armour scales in a bowl, so he must have gone in the soup last night. One of the agricultural fellows here brought us a scorpion to look at. It was very much alive--big, black thing, moves very quickly. we got some pictures of it before they killed it. I would not want to get stung by it.
So then walking home today Kristie stopped at a little shop and got delayed there for a while. We wondered what was going on till she emerged with a baby monkey in her arms. I got a picture of that too. But I think that holding a live monkey is taking unnecessary risks in Africa. She won't do it again. But it really was very cute. I strongly suspect it will be in the soup tonight.
This morning I got Spencer to go over our list of medications that we buy in Monrovia. Here we are at the end of the time in Kwendin, and some of our supply has run out. I want to make sure we buy more of those things next year, (if there is a next year, God willing). It's always a challenge to know how much of each thing to buy. I am sure we are seeing more patients this year than we did last year, so our suppy needs to be increased to accommodate that.
The day in the clinic was very busy again. We made a point of putting a limit on the number of patients we could see. Theoretically it was cut off at 70 but in practice I am sure there were more than that.
I ended up taking out a lipoma from a lady who had 4 lipomas. I chose one over the others and it came out very nicely.
One of my hernia patients has developed a blood collection in his wound. I ended up squeezing much of the clot out this afternoon and I think it is ready to heal up now. I'll check on him tomorrow.
Kristie called me to see a fellow today who had developed obstruction of both sides of his nose, ever since he was working on clearing bush on his farm. Both nostrils were completely blocked with swelling, nice smooth swelling. I could tell by the feel that there was fluid inside. I put in a needle and got pus out. so I put in some freezing and sliced them both open. Lots of pus. How strange to get an abscess in your nose! He should do well.
Part way through the day Kate and Kristie were called to the delivery room because a lady was in labour. After a while they asked me to come too, and they were just delivering the baby. But the head came out and the shoulders got stuck. I have taught seminars on what to do in such a situation, and fortunately the first two manouvres released the anterior shoulder and the kid came out just fine. That certainly interrupted the flow of seeing patients--and that room was then occupied for the rest of the day. It was a baby girl, and they named her Kristie!
I also saw the lady who delivered normally after we brought her to Tappita a few days ago. She is fine. They named the baby John after me! The baby is doing fine.
We had Kristie do blood work on a number of patients today. One was a young boy with an abdominal mass that I saw a few years ago. They showed me the referral letter I have written to Tappita. I think it was 2012. He has not gotten treatment. He needs to be admitted to Tappita and have an ultrasound and then have his tummy opened and the mass removed. I wonder what it is. They are not interessted in going back to Tappita and they will come see me next year.
I also saw a girl who had a burn to her hand a year ago. Her ring and little finger are scarred down into the palm. they still wiggle but she can't strighten them out. I suggested that she see Dr Sherman at Tappita Hospital but the mom said they have been attending there already and have gotten nowhere. I suspect they have been offered surgery but cannot afford the fees--probably they would be asked for about USD$50 for the admission and surgery. Which is prohibitively expensive for a villager without a job. She will come see me next year when I come and I will make that girl a priority.
I just had a visit from Luah (the RN)'s brother, who has been looking after the little netbook computer we gave to Luah 4 years ago. The current problem is that the battery life is shrinking. Luah himself lives in a house with electricity about 4 hours a day so he has little time to use the computer if he wants to. My solution is to use a back up 12v battery, and charge it during the time when the power is on, and then use it to power his computer outside of those hours. Luah already has a charging cord to do that but does not have a connector from the battery. I will leave him the one I use--they are easy to replace back home in Canadian Tire. No, it's hardd to find Canadian Tire around here.
OK it's now after supper and I better send this off.
Dr. John Potts