For the last two weeks my brother and sister-in-law have been visiting me here in Kiwoko Hospital, Uganda. They’re probably the last people I’ll have coming to stay, as I now have less than seven weeks until I’m back in the UK. Before heading on another grand tour of Uganda, we spent some time at the hospital – the first and probably the last time that Alan and I have worked together as doctors. It was actually quite fun: we were able to operate on a couple of patients together, and helped each other out doing an orthopaedic clinic when our visiting specialist failed to turn up. I introduced him to some of the more tropical aspects of orthopaedics, and he was able to help with some of our more complicated patients.
Life here seems to be getting ever busier as time goes on. I’d love to leave some of the surgical work to our Ugandan surgeons, and concentrate on finishing off a few of my projects, but complicated patients keep turning up, and I’ve found myself doing even more big surgery. The biggest miracle of the last few weeks was an elderly (well, forty-something is elderly here in Uganda) woman who was admitted with a large abdominal mass. An ultrasound scan by one of the other doctors suggested a fluid-filled structure in the upper left of the abdomen, probably the large bowel. In the absence of any further possible investigations, I took her for a laparotomy (opening the abdomen to see what is going on), operating with one of our Ugandan surgeons.
We were surprised to find that the mass was a huge distended, necrotic stomach, which had perforated leaking gastric contents into a swollen mass of inflamed tissue. Short of just closing back up and allowing her to die from sepsis, the only option was to remove as little as possible and join up what we could of her bowel. I ended up having to perform a total gastrectomy, joining part of her small bowel directly onto the end of her oesophagus, along with a little extra plumbing further down. I felt that was the minimum that could be done to give her a chance of surviving. I’ve certainly never done such an operation before, although I’ve probably assisted at one at some time. It was completely new to my Ugandan colleague!
Given the size of the operation, and her weakened pre-operative condition, she should have died before waking up from the anaesthetic. As we have no facility for ventilation or intensive care, she should have died shortly after the operation from lack of oxygenation. She did develop a very fast heart rate, Atrial Fibrillation at a rate of 250/minute, and without the ability to shock the heart back into the correct rhythm, or even give any suitable drugs other than some Digoxin to try to slow things down a little, she should have died that night. Over the next few days she should have developed major intra-abdominal infection, as a result of the perforated stomach, and died. At five days after her operation, she developed a fever, which should have been the result of a leak at the point of joining of the bowel, and she should have subsequently died.
However, God is good… It is now over two weeks since her operation, and she is going home tomorrow. She woke up without difficulty from her anaesthetic. Her heart rate slowed and went back to the correct rhythm with minimal assistance. She didn’t develop infection, or sepsis. An x-ray with contrast showed no leak from her joins. The malaria that had caused her fever was treated, and she has slowly recovered her strength. She is left without a stomach and will require frequent small meals plus Vitamin B12 injections for the rest of her life, but I feel another miracle has happened just with her surviving to leave hospital. It remains to be seen whether the tumour that caused the problem will recur… we will have to leave that in God’s hands, as there is no further treatment I can offer her here. Yet again, the hospital’s motto seems very appropriate – “We treat, Jesus heals”.
Surgical work aside, I am making progress in finishing off some other projects. I’ve now managed to complete my trauma course for the doctors, so hopefully we’ll be better at looking after seriously injured patients. My Endoscopy room is almost fully equipped, and Dr James is rapidly learning how to perform the necessary Endoscopy procedures. I’ve two more lectures/talks to give to our nursing students over the coming fortnight, and hopefully there won’t be too much more to prepare for.
My thoughts have started turning towards preparations for returning to the UK – I suspect that one of the hardest parts will be getting used to the relative cheapness of things, and the relative cost of time. It seems to be the opposite here in Uganda. Still, that’s next year, and there’s Christmas to come first. Although Christmas is big here in Uganda, I’ve been pleasantly surprised to find that it hasn’t really been mentioned here yet… I suspect it’ll become more obvious through December. Apparently most people are fattening up a pig for their celebrations! Which reminds me, someone gave me a chicken a couple of weeks ago as a way of saying thank you. It was quite an experience watching one of the local boys cutting its head off for me and then plucking all the feathers off – still, it tasted good, and confirmed to me that I’m definitely not a vegetarian!
God bless,
Steve
