Minor Theater 

Tuesday and Wednesday afternoon found me in minor theater where minor surgeries and procedures are taken place. Tuesday when I came in after half the morning on labor ward (still didn't see a birth) there were my fellow interns doing a finger abscess drain. They believed the finger had pus in it but upon cutting it open no pus drained. First things first, the doctors do not wait for the local anesthetic to start working so they inject and then they cut. It was very painful for the guy and he at one point even told the doctors to stop. It turned out he had a fungal infection and cellulitis so they prescribed anti fungal and antibiodics. They wrapped up his finger and sent on way.

The next case was very upsetting. A man came in with 3 very advance staged melanomas on his legs. They were around 4 cm high and one was about 5 cm in diameter. Upon examination and history taking the man's story changed multiple times on how long he had noticed the skin abnormalities. He said one month but by the progress of the cancer it was much longer than that. As the doctors prepared him for a biopsy my fellow intern felt his inguinal lymph nodes and when I felt them I found two enlarged solid masses. This was indicative that the cancer had metastasized and had spread. With this man's condition the outlook, especially since the melanoma was highly vascularized and kept bleeding after biopsy, is not good and probably has a couple months to maybe a year to live if lucky. Cancer treatment is expensive and super painful so him doing the treatment is unlikely. It was very hard to watch the man walk out of the theater just knowing he was not going to live longer. But that is the reality here. I am curious on what the average age of death is here because the presence of elderly people is very minimal. The reality is that the problems with diabetes and hypertension make living past 50 very rare because of strokes ect. 

This is the melanoma 

The following day I saw a chest drain. This man had TB and had a significant amount of fluid in his pleural cavity. We watched as after the local anesthetic was put in (not allowed though to become numb) the intercostal muscles were cut and tube was inserted and had filled over 3 one liter containers. Some even went on the floor when the man coughed and tube fell out. The technique here was different than what would be performed in the UK or US as my colleagues explained to me. The man was in a lot of pain and had much discomfort with the new area for his lungs to breathe. His X-ray showed that his the whole right side of his chest was filled with fluid. I have never seen an X-ray that bad before. The man was in his late 20s early 30s. TB is a common disease here and most people let it go without getting tested even though it is free to be tested. 

Once again after these days we got to go to the school and teach. I taught English and math and science. It's been great. Teaching them to swim in our pool is very fun too. They love the water and the "muzungus" or white tourist.