It's a new year!

I haven't posted anything in a really long time. I have been sick with Malaria, traveled extensively throughout East Africa over the holidays and have just been plain burned out over what I see here. But...I only have a few weeks left and although some of these pictures are a lot more graphic than my last posts, I think people should see at least some of what I see.

This is Christine. I don't think you can see them, but she has about 1,000 bee stingers in her body. She was playing outside while her dad worked in the garden and was attacked. He brought her in barely breathing and unconscious.

I ran to my house and got her some Benadryl and we gave her some other drugs to help with her swelling and reaction. She did better and by the time I left that evening, this is how she looked. She was very swollen, but was sitting up and drinking sips of water with her parents at her bedside.

I came in the next morning and was surprised to find she had died the night before. I guess her little airway had closed up from all the edema and she couldn't breathe. It wouldn't have mattered if we would have intubated her, because we do not have a single ventilator here, nor do we have any respiratory therapists, so there really was nothing we could do. She was 3 years old.

This little guy was hospitalized for weeks with a severe case of Osteomyelitis. These all start the same...as a small wound that gets infected and the infection travels to the bone. They usually end up losing large pieces of bone and if it heals, it takes months. He did pretty well and ended up being discharged to home.

This little girl was in for a gut perforation. This is VERY common here, as the villagers drink untreated river water, which is contaminated with Salmonella Typhi (Typhoid Fever). It usually remains untreated and then causes their intestines to perforate and their abdominal cavity fills with feces. They get extremely ill, febrile and malnourished. Once they finally come to the hospital, we operate to remove the feces and pus, repair the holes in the intestines and then place a drain and sew them back up. It's not at all unusual for them to have multiple trips back to the OR for repeats of this procedure. Sometimes, they are too late and they die anyway. This little one was hospitalized for a long time, but eventually went home. Yay!

School lets out around the first of December and doesn't commence again until the February and during this time, MANY children present with all kinds of injuries. This boy is 15 and was pushed into the fire by his friends. They were just messing around, but he was severely injured. He was burned over his face, arms, legs, back and feet and required extensive debriding (pulling off the dead burned tissue so the good tissue can heal) and skin grafts. Skin grafts are brutal and require us to slice the top of a person's thigh with a razor and apply that skin to the affected site. I am sure it's very painful. This boy was hospitalized for a very long time and had repeated surgical procedures to repair "frozen" joints and grafts, but he eventually also went home. I think it's best when the kids are in school and don't have so much leisure time to be injured.

This is another case of a mom taking her child to an outlying "Health Center" for her immunizations and the staff there used either the wrong medications or dirty needles (needles are reused all the time to save money and increase the health center's profits) to give the injection. She presented with a severe abcess to her buttock and this required weeks of debriding, cleaning and then finally sewing her back up. She suffered through a lot of painful procedures, but eventually was released to home.

This is Brian. He is a "Paramedic", but here in Africa, that means something entirely different than in America. I would liken it to being a P.A. in the U.S. He specializes in orthopedic cases, but he and I do rounds every Monday/Wednesday/Friday on the Surgical Ward and we are in Theatre (OR) on Tuesdays/Thursdays. We often operate EVERY day, because it seems like there are always C-Sections or emergent cases that can't wait to be scheduled. Brian is one of my favorites because he is always pleasant, speaks the local language since he was born and raised here and is very kind to the patients and their families.

This case really infuriated me. This little boy was brought to the hospital 5 days AFTER he had been severely burned. We couldn't get the straight story from the mother, but we finally deduced after days of questioning her, that someone intentionally burned him...most likely her husband. She would never look at us in the eye and ignored most of our questions. There are no services in place where this type of injury can be investigated or prosecuted. They let it all go.

He was hospitalized for quite a while and suffered seizures and seemed to have some brain damage, but in the end, he recovered and went home.

I am hoping he doesn't experience more of the same type of abuse, once he's home.

As anyone can see by this picture, this bone is dislocated and displaced. This poor woman went to a local "healer" and they applied some sort of an herb poultice, wrapped tightly around the elbow and she was told to go to bed for a month.

This is how her arm looked once we removed the wrap. The herbs had actually damaged her skin, most probably permanently. We took her into surgery and re-broke and then repaired her elbow.

If she would have come to the hospital when this first happened, we could have popped that dislocation back in and she would have been immediately okay.

This is a little girl's hand after we had to amputate her index finger. She's fine now and was discharged later that week.

Her finger was so badly damaged, that it couldn't be saved.

This is one of my favorite patients I have had since I got here. His name is Steven and he's 70 years old. That's his lovely and very sweet wife seated there with us.

Steven came in for a hernia repair and complications developed. The wound got infected and he required a very long stay here until it cleared. He had several trips back and forth to Theatre to clean it up. He has a wonderfully supportive family who came to visit him all the time. He speaks great English and he came to regard me as a daughter. I loved taking care of him and was happy to see him get well.

Sister Theresa Kamugole and I were riding into town and I had her try on my "sun goggles", as she called them. I am pretty sure it's the first time she's ever worn a pair of Ray-Bans. I thought she looked great!

This is 19 year old Robert and his brother Moses. Robert was in a motor vehicle accident and sustained a wound to his arm, which of course, became infected. It progressed to Osteomyelitis and he was subjected every day while hospitalized to cleaning of the wound with burning Hydrogen Peroxide (full strength) and then having gauze pushed into the wound to absorb all the drainage. This went on for weeks and weeks, until we finally got it clean of all infection, it was re-sutured in the OR and he was finally released to home.

This is interesting. This is the "formula" that they use here to feed babies who are malnourished. It's a mixture of cow or goat's milk, sugar and cooking oil. It's used for those who are so malnourished and for whatever reason can't breastfeed. Babies are breastfed here for about 2 years.

This is the Nutrition Department. The man you see here is actually warming up some of that formula for me to feed the malnourished baby posted on my last blog. He has to build a fire and wait for the pot to heat up and THEN can give me a cup of warm milk. We have no stoves here with which to warm anything.

Just an update...Claire Favor, the malnourished baby from my last blog died. Her mother, who also has AIDS, told us she was tired of caring for her baby and they decided that it was the formula that was making her have diarrhea, not AIDS. So they tied knots in the four corners of her blanket to ward off the evil spirits that were making her sick and refused to feed her again. The last we saw of her, they were giving her black tea with a spoon. When I last weighed her, she weighed 2.9 kilograms, which is just over 6 pounds. She was 7 months old.

This 2-day old neonate presented with severe bilateral clubfeet. There is a great method to treat this and can be done with 7 castings and can be almost totally unnoticeable by the time the child is 3 years old. Because her wonderful mother brought her for treatment early, this child should not be disabled.

This is the baby of a patient being seen on Surgical Ward. I just thought she was really cute and wanted to hold her. It's great seeing children who are well taken care of here.

This lady was a frustrating case. She's quite obese, which I have found is VERY unusual here. She came in for a hernia repair and then the site got very infected. She ended up being here for weeks, as she would not assist in her own care. She refused to get up out of bed, wouldn't walk, wouldn't do her breathing or physical therapy exercises and just laid there. Her family and I begged and pleaded with her to try to help herself, but she refused. She wouldn't even move her arms. Eventually, she suffered a pulmonary embolism and died.

She came in for a hernia repair and died! Tragic.

This is an up-close picture of Eva's wound on her upper thigh. It's not so bad really, but it started as a small wound and as they all do, got very infected. This led to Osteomyelitis and her femur became very necrotic (dead tissue).

After weeks and weeks of cleaning it daily, packing the wound and dressing it, we took her into Theatre to close it. Minor procedure right? She was anemic and we couldn't get blood. She bled to death later that night. She was about 9 years old.

This is another view of Eva's leg. There was also a small wound on her inner thigh.

Ever since her death, we check the Hemoglobin level on every patient that is going in for surgery. If we don't have their blood in house, we no longer operate on them.