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.

Male Anatomy - part 2

Apparently there have been a few cases of flesh-eating bacteria, with very particular tastes. They don't eat everything, just skin. 

If you're a boy and/or a little squeamish, I suggest you stop reading now. Continue at your own peril. 

It so happens that this very unfortunate guy had flesh-eating bacteria eat away at the skin of his scrotum. Not his penis, not his legs, just his scrotum. He showed up with completely necrotic skin (1st photo). 

So Dr. Scott debrided it, put him on massive doses of antibiotics, and left the wound open, with his testicles free. Luckily for him, the bacteria were not interested in his testes. 

But now comes the question of what to do with his testes! There's no way to grow that much new skin, and the tiny amount of skin not eaten by the bacteria was not enough to cover the testes. So Dr. Scott went back in, separated the two, made a little pocket under the skin of each thigh and inserted them. 

This ensures their safety from the elements, but has a particular side-effect. You see, the reason why the testicles hang in a pouch outside the body, is because sperm need a cool environment. The 37C of normal body temperature is too hot for them. So this guy has not lost the ability to produce sperm, and all his hormones will still work properly. But his sperm will likely die of heat, from being confined inside his thigh. 

The lesson of the day is: when you scratch your balls, make sure your hand is clean and don't break the skin!!! 

Necrotic skin

After debriding

The next day

Separating and inserting into thigh

Male Anatomy -part 1

I actually wrote a post about this last time I was here, but for the new comers, I'll explain it again. 

When a baby boy is born, the testicles descend into the scrotum and the little orifice which allowed them to pass down from the abdomen closes naturally. Most of the time. 

However, sometimes the hole remains open and allows fluid to trickle down and accumulate in the scrotum. This is called a Hydrocele, for those of you who want to read up. In the western world, mom realizes something weird is going on and takes the baby to the doctor. The liquid is drained, the hole is closed, and the problem is over. 

In Tchad, they don't come in until they can't walk anymore, and that usually takes years. So we get a lot of grown, sometimes elderly men, with giant scrotums full of fluid. In other words, giant balls. 

We drain it, sew it up and they can go home. With normal sized parts...

Children

(Surgical pictures at the end of the post, scroll slowly if you don't want to see them.) 

It's a recurring theme in Tchad that nobody seeks medical attention until they're about to die, or whatever ails them becomes unbearable. And since they are extremely resilient, sometimes that means years.

Today we had 3 surgeries, the first of which was a 4 year old with an exposed femur fracture for 1 year. The exposed bone was dead, of course, but surprisingly, he had no infection.

So Dr. Scott cut off the dead bone and put the 2 ends together, put them on an external fixator and closed. The hope is that the bone will actually grow enough to compensate for the loss and he will have legs of equal length. In any case, he will definitely get to walk. Again, something that isn't possible with an exposed femur fracture...

Then another little kid, from yet another motorcycle accident. That one was 10 days ago, but the arm had gotten stuck on something and almost completely ripped from the torso. Almost, but not completely. Except the nerves, ligaments and blood supply was part of what got ripped... and the result is a child attached to a completely dead, cold, putrefying arm. I'll let you imagine the smell. So it was an amputation, leaving the wound open because of the infection.

The third was a woman with a large, hard mass on her thigh. It looked like a giant mole. It was deep into her sub-cutaneous fat, but had not reached her muscles. Besides a little bleeding, it was removed without complications. Of course, we have no way of knowing if it spread somewhere else, and that thing was massive. 7cm by 5cm at least.

Anyway, I had been craving surgeries, and it felt great to scrub in again, but that little kid who lost his arm made me really sad.

Things that happen in Tchad that you have to get used to but probably never will...

Living arrangements

A lot of people have asked me how the living conditions in Tchad are, so I thought I'd make a post with some pictures to give you guys a better idea.

The first time I came to Tchad, I didn't know what to expect when it came to my living arrangements. The hospital and the living quarters are located in the same walled complex, and separated from each other by a brick wall. The house is pretty modern, with everything you would expect in a normal house, normal bathroom with shower (cold water but you don't really need it to be hot) and flushing toilet. The only exception is wifi which doesn't exist. Electricity is provided by a generator and internet from mobile phones. I got a little bedroom with a lockable door, a nice bed with mosquito net and a dresser. I was beyond happy, as I had expected a lot worse.

This year, when Bekki wrote me to say they were excited for me to arrive and my room was ready, I had expected the same room. What isn't my surprise when Bekki takes me to my own little apartment!! When I was here last, it had been a shipping container used for storage. They converted it into a full apartment, with full kitchen and bathroom! And it was just for me!!

Here are some pictures:

That's the door on the wall that separates the hospital from the residencial area

That's the outside of the house I live in

My very own kitchen!! 

Bedroom

Bathroom

Garden at sunset 

So there you have it. I really had not expected to have all the comforts we expect in other countries. Coming to Tchad is hard in many ways, but the living conditions are not one of them. Of course, this is not how the general population lives... but I'll have to write another post about that. :) 

Tchad- round two

I am sitting on a bus, crossing Tchad from the capital, N'Djamena, to Moundou in the south. I'm really excited, and can't wait to get there and see Dr. Scott and Bekki (his wife) again.

The first time I was here, it was the unknown. Arriving in the middle of the ebola epidemic, there was fear it would come to Tchad (it didn't). And like this time, I was arriving at 11pm in N'Djamena and leaving at 6am on a bus to Moundou. It was certainly an adventure and I won't deny, there was a little bit of fear mixed in with excitement. I knew that trip would change me. I was afraid I wasn't up for the challenge.

I hadn't even started med school yet, and my only training was what I had learned in a nursing's assistant course and the basics of giving shots, drawing blood and putting in IVs, that I learned during my internships in hospitals in Germany.

Now, after a year of med school, my practical knowledge hasn't changed much, except for all the things I learned my first time in Tchad. This is such an incredible opportunity, I am very lucky and blessed to be able to do it. I hope to learn a lot more, maybe even suture and catch a baby or two! (The hospital where I will spend most of my time does not have maternity/gynecology, but I will spend 2 weeks at a different hospital, where they have it!)

It's funny how the unknown has become familiar, and I can feel like I am going back home, in the heart of Africa.

I'll leave you with a picture of the sunrise. It's bad quality, but it will give you a small idea of the beauty I am lucky enough to see. Enjoy!

Irony in the New Year

Right before New Year's 2014/2015 I wrote a post about losing my phone and feeling guilty and stupid when I thought about buying a new one and how many people that money could help. But I found the phone and everything was ok.

This time, the phone was actually stolen from my bag, so I obviously didn't get it back. My mom offered to buy me a new one, but I declined. As much as it sucks to not have my awesome iPhone, I borrowed and old Samsung from a friend and it will have to do. 

I guess I learned something. 

So for this new year 2016, as I prepare to go back to Tchad and deal with real poverty, hunger, need, I hope to keep my priorities in order and remember that there are many things more important and necessary than a phone. 

And I wish for all of us, whether you have something to do with medicine or not, that we strive to make the world a better place. Even a little bit. We really *can* make a difference, and if we all do just a little, it all adds up to something great. 

Happy New Year from Berlin!!!!