Prayer request /positive vibes (if you don't pray)

We have a burned lady patient, who had 3rd degree burns on her thighs, buttocks and lower back. Really bad. You can see pictures here (not for the faint of heart) and read more about it here.

She was at home for 6 weeks after the accident (her house caught fire and her dress caught fire as she was fleeing), then she came to us and has been here a month. Not in a state-of-the-art burnt unit, with filtered air, sterile everything and no contact with the outside world (full of germs). No, she is in a filthy building with 10 other patients in the same room, laying in filthy sheets, with flies and mosquitoes, dirt and grime.

She is our miracle lady, somehow still alive, not infected, not septic.

However, she is getting a pressure sore on her tail bone and if it gets necrotic, that's harder to heal than her burns.

She also had malaria and didn't eat/drink for days because everything she'd swallow would come back out.

She's doing better now and I've decided to start "force feeding" her. I bring her food and don't go away until she's eaten. But she's going to need a lot of food to regain her strength and grow all the new skin she needs to grow.

Someone said it would probably be better for her to die now, because they couldn't see her surviving and it was just more suffering until she died. I am determined that she will live. She would have died already if she was supposed to die. She's fought this far. I'm gonna help her fight the rest of the way (or until I leave, at least).

Please pray for her. Her name is Adamah.

Pus

We had a couple of really long, full days. One of those days, Dr. Scott had to cancel consults because we had too many operations, a couple of which were urgent. As the name of this post suggests, there was a lot of pus involved.

We had one elderly man with an old femur fracture that had only a small hole on the skin. What was weird was that he was very skinny, and his other leg was very thin, but his broken leg had a huge thigh. Dr. Scott made an incision starting from the hole and as he widened it, pus just started pouring out. We suctioned about 2 LITERS of pus from this guy's thigh. As you can imagine, there was not much muscle or bone left, it was just mush. How in the world he wasn't septic and dead yet, I have no idea.

So we called the family and said there was no way to save the leg and asked if they were ok with an amputation. Well, the patient himself, who was semiconscious*, heard it and said he did NOT want an amputation. So we closed it back up and wheeled him out to get ready for the next patient.

But now the family talked to him, and explained that really, there was no leg to be saved, it would never be functional again, and on top of that, he was going to get septic and die. So he agreed to it, and we had to take him back to the OR.

Then, we had a guy come in with a huge dental abscess. His family almost took him home, but thank goodness, they didn't. The abscess was so big, once he was anesthetized, his muscles relaxed and it actually blocked his airway. He stopped breathing for a moment and I actually had to do CPR while they secured his airway with a nasal tube and administered O2.

Again, Dr. Scott made a small hole and pus just started pouring out. It's incredible!! I can't imagine how he could take days and days of pain before coming in!!!

So today I got to do 3 things I had never done before: made a skin incision and superficial suture on a leg (the amputated one), and did CPR on a real person (not the dummies we use in class).

What a day!!!

*our anesthesia is a combination of epidural, ketamine and diazepam. Sometimes the patients are knocked out, sometimes they're awake, talking, sometimes even moving. We have no respirator, so we cannot do full narcosis.

Before amputation

After amputation

Miracles

Most of our patients get post-op infections. It's a fact of life. In Tchad, if you get a paper cut and don't soak it in alcohol several times a day, it will get infected.

We have a patient who was in a house fire. Her buttocks, lower back and thighs suffered 3rd degree burns. She came to us 6 weeks after the fire, clearly in a lot of pain, but somehow not infected. Not septic. Not dying.

We did 2 small skin grafts on her, and they took beautifully. It covers only a tiny portion of her burns, but it's progress. Her back has some granulating tissue. Incredibly and against all odds, she is healing.

If that's not a miracle, I don't know what is.

A hard day's night...

I'm feeling more powerless than usual right now... 

I am winning the fight against infection in Irene's leg, and that's good. (my amputee lady)

I'm trying to win the fight against infection in Taira's leg (the 11 year-old boy) and it seems to be going well, except for the ridiculous amounts of pain I have to inflict on him every morning...  

I am losing the fight against infection in Blaise's leg. He still has his leg, but every day, there's pus pouring out of it... I'm afraid he's going to get septic and we'll have to amputate. He's a young, strong guy, and if he loses his leg, he'll have no way to work and will probably be reduced to begging. 

There's very little I can do about it. I am squirting betadine straight into his bone, and upgraded him to 2 dressing changes a day, to see if it helps... 

If you're the praying kind, please pray for him. If you're not the praying kind, pray anyway... I'll believe for the 2 of us... 

Infection

You know all the advances made in medicine when we discovered sterilization and the concept of keeping things not only clean, but actually sterile? Well, that phase in human history skipped Chad entirely. 

We do our best to sterilize instruments, but there are flies *inside* the OR. They're not quite as cooperative as interns when you yell at them to keep their hands off the sterile field. 

Yesterday, a lady who had a tib-fib fracture was getting septic, so the only thing to do was to cut her leg off. The infection had spread far above the fracture site, so it was an above-knee amputation. 

Another discovery that skipped Chad entirely was the concept of full-narcosis. We don't have a ventilator (or the appropriate drugs) so the amputation (and all other surgeries) are done under ketamine, but the patients are awake and moving around. Talking. Watching. 

The lady with the amputated leg had an abcess going even further up from the amputation site, so today we had to unwrap her, poke around and wash it out. Our only desinfectant is a preparation of water and 25% bleach. 

The only pain killer is Tylenol. 

Take a few moments to digest that last phrase... 

I did the dressing change on her today. We have sterile gauze, but the patients actually have to go buy it at the pharmacy, because we don't have enough funding to give them all the gauze they need. So as a family member went to buy more gauze, I was standing by the bed to keep the flies off her wound and trying not to look at her face. 

I washed it as best I could, with an audience, as all the other patients (there are 16 beds per ward, we have 2 wards) watched. Tomorrow, I will do the same thing, and pray that the infection can be kept under control so that we can eventually close her wound and she won't die of sepsis. 

I took a picture, so you can have a better idea of what I'm talking about, but you might not want to look if you have a weak stomach... 

...and just in case you were wondering, no, that basin is not sterile, neither were my gloves or the instruments I used (we keep those strictly for surgeries).

If you got this far and you're horrified, welcome to the club. Unfortunately, this is the best we can do. The hospital runs entirely on donations, and we have barely any equipment at all. Stuff that the hospitals in the US and Europe throw away, we would be over the moon to get. A surgery runs somewhere between $30-$50 dollars. If anybody feels inclined to help, ANYTHING helps. $5 dollars would buy enough sterile gauze for one patient for a week. Might not seem much, but that could be the difference between life and daeth from sepsis... and some patients literally cannot even afford that... 

Alright, I'll stop talking, but please, please, please: HELP! 

Here's a link where you can donate: http://www.ahiglobal.org/main/donate-now/

(Just make sure you specify that your donation it is for the Surgical Center of Moundou, Chad). 

Thank you.