warning: gross pictures ahead

This week was absolutely one of the best ones I’ve had since being here. Skyler and I were in the theatre (aka operating room) and experienced some amazing days that we’ll never forget. Sorry if this post is a little lengthy but there’s just so much to talk about!

            One of the head surgeons at Our Lady of Grace Hospital is Dr. Paublo, an older man from Cuba. He took a little warming up but loves us now and is really good at explaining everything he does. On average he does about 400 hernia surgeries a year since it’s one of the most common problems among Ghanaian men. This week alone we saw 7 hernia surgeries, a breast lump removal, a prostatectomy, hysterectomy, C-section, bullet wound, cist/possible hematoma, and a goiter removal.

            I’ll begin with a little background information on how they do things here. Epidurals and localized anesthesia are basically the only numbing methods used at our hospital. Most of the time the patients are awake throughout the entire surgery and can feel a lot of pressure in the area that’s being operated on. We only saw general anesthesia used three times this week and it was on children and the woman who was having her throat operated on. So unless you’re under 15 or an extreme case, you’re lucky enough to be awake. The hospital only has one type of monitoring device that doesn’t really work so to monitor patients they usually tape a stethoscope to the patients chest and listen when they think there’s something wrong. In addition, they clamp an O2 sensor to the patient’s finger to keep an eye on the blood pressure throughout the operation. Overall, I’d have to say they’re extremely sanitary and work very efficiently with what they have. Yet, when a patient starts to crash (which I’ll talk about later) they don’t really have the means to save them that well.

            My favorite surgery this week was the goiter removal. An overweight woman came in with two masses on either side of her trachea that needed to be removed immediately because they were starting to affect her breathing. Going into the surgery none of us knew how extreme these masses would be…. I put the picture below because I don’t know if I could properly describe the size of the goiter, just think of those two large lumps in someone’s throat. The operation took longer than the doctor expected because he never thought they would be as big as they were. In the middle of the surgery we began to lose the patient when her blood pressure dropped really fast. Since he was operating on her trachea the nurse anesthetist had to breathe for her with a bag pump throughout the surgery. Sure enough, in the middle of her bp crash the bag also popped…. Luckily we had another one just across the room and within a couple minutes she was stabile again but they equated a lot of her success to luck.

            The bullet wound was also a really interesting case to see even though there was no surgery involved. A hunter accidently shot his foot and came in with half of the bullet still lodged in there by the pinky toe. I’ll do you a favor and refrain from posting the picture but after a lot of cleaning we were able to see tendons and bones, which was pretty amazing. The hospital doesn’t have an orthopedic surgeon so the only thing we could do was clean it, stitch it up and send him to a bigger hospital.

            Seeing a total hysterectomy is definitely something I never thought I would see… especially when the uterus was as big as this lady’s was. She had five children already and they were planning on going in and just removing the problematic section. Since they don’t have adequate technology at the hospital it’s really difficult to prepare for what the surgeons will see once they open the patient up. As a result, once we got in there he realized the entire uterus was huge and misshapen and decided to take out the whole thing. It was one of our longer surgeries since it takes a lot of attention to detail but watching it was absolutely worth it.

            After a while all hernias look the same but we saw three different methods for how they take care of them. A hernia is where an internal part of the body pushes through a weakness in the muscle or surrounding tissue wall. If the patient can afford it, the doctor will clean up what he can of the protrusion and then put mesh on the weak spot so it won’t happen again. However, insurance only covers the conventional method so they have to pay about 100 GHC ($50) for the piece of mesh. Most patients can’t afford that so the surgeon will just tuck the bulge back in the opening and then suture the weak spot. Dr Paublo explained that both methods provide a chance for the hernias to grow back but the mesh lasts much longer and has a better success rate.

The breast lump removal, prostatectomy, and cist removal were also really awesome surgeries but I’ll spare you all the details for now since I’ve already rambled long enough. The only thing I will say is I NEVER want to have a C-section after seeing how they’re done. But no worries, the baby boy was super cute and healthy after the delivery!

This week was one for the books and I’m so thankful for the OR staff for dealing with Skyler and I and our endless questions and jokes (that they don’t understand…ever). This weekend we’re back in Cape Coast to relax and do another community project so I’ll update again soon!