Tuesday, May 20, 2008
Scott and I were kindly welcomed into the "operating theater," where we were first led to the men's locker room and handed a full set of scrubs, a surgeon's mask and cap, and surgical scrub boots. We were instructed to change into these clothes and then prepare to enter into a live surgery room. The anticipation rapidly built as we furiously changed clothes, and made the transition from straight-up American volunteers to aspiring physicians.
Relieving Fluid Retention
We entered into the first surgery room, where an elderly man was sitting upright, naked on the operating table preparing to receive an epidural in his spine to paralyze the central nervous system for operation (no other anesthesia was used). He then lied down, was hooked up to an ECG/blood pressure/pulse ox machine, and waited for the procedure to begin (he was awake the entire time and made some disgruntling noises throughout the procedure).
The Chinese surgeon (who spoke nothing but Chinese and basic French) began scrubbing the patient down, and covering him with surgical drapes, leaving only his genitals exposed. There were three staff members in the room: an anesthesiologist watching the patient's vitals and rehydration I.V., the surgeon, and the surgical technician who helped the doctor throughout the procedure. All communication took place in French, but fortunately the anesthesiologist spoke a bit of English and was able to tell us the gist of what was taking place.
Although we were slightly confused at first, it turned out that the patient had a condition known as "hydrocele," and was retaining an extreme amount of serous fluid in his scrotum (almost 2 liters worth…. It was VERY swollen!) The cause of this condition is unknown. The surgeon dissected down through the layers of the scrotum using a cauterizing device, and eventually relieved all of the fluid from the scrotum. In the process, he nicked a major blood vessel that began spurting across the room (literally). Once he cauterized that vessel (stopping the bleeding) and the scrotum was fully drained, he cut away a huge portion of the tunica vaginalis (the inner lining of the scrotum), that had been stretched from the severe fluid retention. He then turned that layer inside out preventing fluid from ever accumulating there again and sutured it in this position.
He also found several cysts on the epididymus which he removed. He then sutured the patient back up, leaving a small portion of a sterile latex operating glove in the incision to allow for drainage over the next 8 hours (when it is then removed). The doctor was sweating profusely during the one hour procedure and said to us several times that he was "nervous," one of the few English words he knew. Scott and I were not sure how to interpret that statement, as confidence is what you'd expect from a surgeon.
Reparing a Broken Humerus
The second procedure we watched involved a 10-year-old girl who was climbing a tree to harvest fruit, and fell from very high up, completely breaking her humerus in half (the humoral head broke off from the rest of the bone). This was confirmed with an x-ray. Again with a staff of three: the anesthesiologist, the surgeon, and the surgical technician, the procedure was carried out in about 1.5 hours.
This time full I.V. sedation was used (ketamine), and the patient was placed on oxygen, a pulse ox monitor, and an ECG/blood pressure machine. The surgeon ended up dissecting down to the broken bone in her shoulder, exposing the broken ends (through a very harsh and physical manipulation of the girl's arm), cleaning up bone fragments, setting the two bones back into place, and drilling two pins across the break to hold it together and allow it to heal properly.
He then stitched her back up in about 6-7 layers of sutures. The two pins penetrated her skin and stuck out from her arm about ½ an inch, and will remain in place until the injury heals, wherein they will be removed. The patient woke up numerous times throughout the procedure in agony, indicating that the anesthesia was not sufficient enough to induce sleep.
Scott and I then changed back into street clothes, and met up with the entire group for lunch. Having worked as a surgical technician in the states for an entire summer myself, it was very interesting to see the differences and similarities between surgeries here in Rwanda and back at home. The sterile techniques, tools, instruments, medical equipment, anesthesia, and procedures here in Rwanda are tremendously rudimentary. However, I observed many similarities as well.