The biggest spleen I have ever seen!

We had a man present to our hospital with pain and swelling to his abdomen. He had been treated previously for Malaria and was found to have Splenomegally (enlarged spleen), which had to be removed. Spleens do not self-correct, once they become enlarged to this point.

We don't remove that many spleens here, so this was considered a complex case and we had to wait days to get enough of this man's blood to have for transfusion. Since we were taking a large portion of his blood supply, it had to be replaced.

This is our Medical Superintendent of Kilembe Mines Hospital, Dr. Wefula Edward on the left and Dr. Isaac Ojangor on the right.

They have made their incision, inspected the spleen and are planning their attack.

Dr. Edward holds a portion of the spleen, while Dr. Isaac prepares to clamp off vessels.

Dr. Edward pulling the spleen slowly out of the body cavity.

Dr. Isaac clamps off vessels in preparation for removal.

Here it is! This spleen weighed 6.54 pounds and spills out over the sides of this large bowl! A normal spleen weighs approximately 8 ounces or less and usually measures 1 inch x 3 inches x 5 inches. I didn't measure this one, but as you can see, two men are holding it and it's much larger than their hands!

The last splenectomy we did was not successful and the patient died later that same day, but this patient did surprisingly well after this surgery and was eventually discharged from the hospital.

Wounds, wounds and more wounds!

This is me...this picture was taken by one of the little boys I have been caring for for weeks. He had never taken a picture before, but after a quick lesson (difficult since he speaks no English), I think he took a decent picture.

People here are absolutely amazed by digital cameras and crowd around me to see the instant images I take of them.

I just loved this couple. They have been together for 54 years. The husband was the patient and presented with the severe heel wound seen in the next picture and his sweet wife never left his side.

This is what his wound looked like after several weeks of debridement (removing dead tissue), deep cleaning and casting. I know it looks gross, but this wound is doing very well in this picture. All of the pink tissue is healthy new growth and shows no more infection. We placed a cast to keep him from bending his foot and damaging the healing that had taken place. The wound did really well, healed and he was released.

This 56-year old man came in with a very distended abdomen and was in Septic shock. Dr. Richard Kajubi and I operated on him emergently on a Saturday about 4 weeks ago. He ended up having a giant intussusception, which is when the intestines telescope into themselves, cutting off the blood supply to the portion of the intestines that is inside the telescoping. After a period of time, the intestine dies and becomes gangrenous and causes perforations of the intestine.

When we opened his abdomen, we washed almost 2 liters of pus away and we weren't sure he would survive the day. He had just waited too long to get treatment. He did survive, but needed another follow-up surgery to clear out the rest of the infection. But...because we couldn't get his type of blood, he never was operated on and he died last Friday night, February 12th.

This little boy was so cute and so scared to be in the hospital. He initially had a small wound of his lower leg, which became infected and eventually invaded the bone.

In order to treat the bone infection, we have to be really aggressive. The wound is opened and all the dead and infected tissue and bone must be removed. It's then packed with gauze and sutured loosely back up. Each day, he had to endure one of us removing the soiled gauze, pouring full-strength Hydrogen Peroxide into the wound (which burns very badly) and then re-packing it with sterile gauze. This goes on and on until all the bad tissue and pus is gone and it's replaced with healthy, pink tissue. Sometimes a bone graft or skin graft is necessary to replace all that was lost, but in this case, we sutured him up and he was eventually discharged.

This picture really doesn't do this condition justice, but this is necrotizing fasciitis or the "flesh-eating bacteria" that attacks skin, muscle and connective tissue. According to statistics, it has a mortality rate of 75%, but the docs here tell me they have never had a patient with this, survive!

This girl is 15 and presented with a small wound, that resembled a burn. Nasty microbes enter and go to work, eating all the healthy tissue in its path, until the patient becomes septic with a systemic blood infection. The dead tissue must be quickly debrided (removed), but it's almost impossible to get it all. Her leg was so grossly affected, that we didn't even try to debride this. Her family just didn't get how seriously ill their girl was and pressured us to release her from the hospital. We finally did, after trying to explain to them that this condition is fatal. They never did believe us, thinking she just had a minor leg wound.

This is Ronald. He had been involved in a RTA (Road Traffic Accident, as they call it here) or MVA as we call it in the States. He was unrestrained, as everyone is here. No one uses seat belts and I have never seen one car seat or infant carrier.

When he first came in, he had terrible road rash all over his body (see next picture below) and a probable skull fracture. He was unconscious and bleeding from one ear (bad sign) and had multiple fractures.

This picture was taken after he had been on Surgical Ward being cared for, for weeks. He is holding one of the Crayola markers I gave him to write with. He couldn't speak English, but once he was better, he imitated everything I said and did it quite well (although annoyingly).

Ronald had multiple fractures and lacerations and had such bad wounds, we placed him under a cage, so the sheet wouldn't touch his body and hurt him.

This sweet girl was on our Surgical Ward for weeks. She too, has Osteomyelitis and had the same treatment as everyone else...open the wound, clean out all the dead tissue and bone, suture it loosely, pack it with gauze, endure the horrible burning of Hydrogen Peroxide being poured into it every day, followed by re-packing with more gauze.

She was tough and never complained, but every day, she sobbed as we cleaned her leg. I hate cleaning wounds because of the pain we inflict. The little kids scream when they see us coming with the surgical instruments. They don't understand that we are trying to help them.

This is an up-close look at her leg. She eventually did much better and was allowed to go home last week.

This little girl is very unhappy with Brian, as he removes the dressing from her infected foot and inspects it for healing and infection. He casted it to prevent her from bending the foot and damaging the healed areas.

After weeks of hospitalization, her foot did very well and she was discharged from the hospital.

Children come in with these abscesses around the ear, jaw and face all the time. We take them to Surgery, sedate them, drain the abscess, pack it with gauze and then clean it with Hydrogen Peroxide on Surgical Ward for a few days, until the wound is clear of all infection.

This is another view of the same abscess. She did very well and was discharged after several days of treatment.

This is the back of a lady who has terrible scars from previous assaults. She has the type of skin that forms abnormal scar tissue called keloids, instead of normal scars. I never did get from her why she had been assaulted so much, but she had these giant keloids all over her back and chest and they were totally disfiguring.

This is how her chest looks. Very unusual.

This little boy also had an abscess. I actually won a bet with Brian about this little guy. Brian thought he had swelling of his parotid glands (tonsils), but I knew he had a big abscess. They drained a ton of pus out of this in Surgery and Brian still has to pay me my Fanta orange drink. lol

A side view of his abscess. After surgery, he did very well and was discharged to home.

I'm making up for lost time!

It's been another busy week in Kilembe, but unfortunately we have a severe blood shortage and this is costing lives. The Ugandan hospitals get much of their blood from drives held at Universities, but school was in recess for 2 months and that caused a terrible shortage. So, many of our surgeries have had to be postponed and many of them were critical.

This lady came in with a severe infection on her scapula, under her skin. It was swollen and had no external evidence of the problem, but we operated on her and as we often do, got tons of pus out of the site. We leave it open like this for several days, until we are sure there are no signs of infection and then we take her back in for what they call secondary suture. We sutured her and she's doing fine and should go home in a few days.

This is Comfort and he is 7 years old. He is the face and classic picture of a gut perforation. We have so many of them here, because the villagers can't obviously afford bottled water, so they obtain their water from the local rivers and streams. These waters are infected with Salmonelli typhii which causes Typhoid. If remained untreated, it causes the intestines to perforate and intestinal contents spill out into the abdominal cavity. Once they FINALLY come to the hospital, they are malnourished and have huge abdomens, filled with pus and feces.

Dr. Richard and I operated on this boy emergently one Saturday and got over a litre of feces from his belly. We really didn't know if he would live. Unfortunately, he is one affected by the blood shortage and although he needs surgery again, he is too unstable to undergo general anesthesia and as you can see, he's emmaciated and now has holes in his skin...possibly necrotizing fascitis. He's just now starting to eat and hopefully he will get well one day. It's not looking good though.

I really like this little boy. His name is Ishmael and he is 10 years old. He had an untreated infected fracture of his femur, so we repaired it in Surgery and placed pins for stabilization. He's been here in the hospital for a very long time, as the pin site became infected. He is better now and we were able to remove the pins this afternoon and placed a hip spica cast. He should be able to go home soon.

This is Florence. She's been a nurse for 20 years and is EXCELLENT! She is my favorite nurse here in the hospital. This woman knows what she is doing and is very aggressive in caring for sick patients. She is very organized and I LOVE working with her!

This girl is 18 years old and has Type I Insulin-Dependent Diabetes. As is common with diabetics, she developed an open wound that would not heal and came to us for treatment. Her particular wound is actually on her butt, so that causes problems with sitting and ambulating. We were able to get all the infection cleaned up with daily cleaning with horrible Hydrogen Peroxide and dressing changes and she was finally discharged last week, after being her for weeks.

This poor man came to us with a large, weeping swollen area below his jaw. At first we thought it was an infection, but Dr. Edward and I operated on him and found large cancerous masses. We sent the tissue off for to Kampala to be analyzed, but we are pretty sure he has Lymphoma and therefore will be Stage 4 Cancer.

Unfortunately, there is not much we can do for this man, other than palliative care, as they don't have the resources to fight cancer the way we do in the U.S.A. His prognosis is very poor.

This is a cute little 4 1/2 year old boy who had been attacked by a dog and bitten on his arm a few days ago. He is smiling in this picture, but is really unhappy about having an IV and surgery on his arm.

These are his dog bites and as you can see, they are dirty and likely to become infected. The bites were so hard or the dog was so big, it actually broke his arm. We took him to Theatre to clean his wounds up and set his arm in a cast. He did very well and is happy on the Surgical Ward now and should go home soon.

This is Timothy and he is one of only 3 Nurse Anesthetists here at the hospital. He is very good and usually just works on weekends, but is called in all the time to assist during the week and at night. They are worked to death here and are grossly underpaid and underappreciated by the Health District for which they work. The average nurse working full-time makes approximately $150/month.

This is our Supply Room/Break Room/Office, right off the Minor Surgery side of Operating Theatre. It's always strange to be eating our food while watching someone get operated on.

I am taking a quick lunch break. Dr. Edward is so nice and has lunch delivered to us every day we are operating, since we obviously can't leave to eat. The usual lunch consists of rice, beans, strange-tasting beef in a red broth, matoke (unripe bananas that are mashed), sweet potatoes (served plain and boiled with no seasoning), and sometimes cooked cabbage, ugali (millet porridge that looks like a red, congealed blob) or posho (kind of like white, solidified grits with absolutely no flavor). The beans and rice are good though and that is all I will eat. The refrigerator to my left holds the blood for our surgeries, as well as our water and other drinks!

This is Dr. Robert Masereka. He's only 27, but has been working here for some time. He's very smart and very good at his job. He's also somewhat of an expert on Malaria and often is called on to care for VIPs in the area. He's also one of my good friends here and we have lots of intense "discussions" about politics and such.

Doctors are also grossly underpaid. The average surgeon makes about $300/month. They also get a free house in which to live, but that is it.

This is Dr. Richard Kajubi and a medical student doing a hernia repair. Richard is one of my best friends here and he is also about 27 years old. He's an excellent doctor and I love working with him on surgeries. He's been very patient teaching me to how to be a surgical nurse and we have both learned a lot by working with each other. He's very laid back and doesn't hesitate to give me the sutures to close someone up or to listen to my opinion on how to treat a patient. We make a great team in the O.R. and he often calls me in to work on emergencies with him.

This is Dr. Wefula Edward and me operating on a severe hernia, in which a large percentage of a man's intestines had entered his scrotum and were stuck there and were causing a lot of pain.

Edward is the Medical Superintendent at Kilembe Mines Hospital and is a true workaholic. He's not only an expert Orthopedic Surgeon, but he's responsible for EVERYTHING about this hospital. He is very passionate about what he does and really cares about the patients. I never have heard him turn down "just one more patient" to operate on, even after a long day of surgery. He laughs at me, because I won't help him operate on bones, because I can't stand the sound of the hammering, chopping and drilling on human bodies. He also laughs and tells me I "give too much TLC to children", but he's the same way. He's very gentle and careful with all of his surgeries.

This cute little 2 month old baby girl came in with a fractured femur and had a hip spica cast placed at another facility. This really irritated me, because it's very difficult to break baby's bones and the mother's excuse of "We dropped her", just didn't fly with me. No one even questioned this excuse though, as there is no system in place here to investigate cases of suspected child abuse. This baby was really good and allowed us to remove the cast and place another.

This is Ronald and I believe he is 8 years old. I was so worried about him when he first came in, as he had been in a motor vehicle accident and severely injured. He sustained a skull fracture, open head wounds, a fractured leg and severe road rash all over his body.

But...as you can see, he's happy and well and up walking around some now, with the help of a walker. He doesn't know how to speak English, but imitates everything I say and actually does a pretty good job. He was able to go home yesterday!

This is unbelievable. A group of thugs came to this little girl's home and assaulted her and her mother, while the dad/husband was at work. They severely broke this little finger and caused a wound to her cheek and eye.

The injury was a few days old when she presented and this is what it initially looked like, with deformity and gangrene present.

Unfortunately the finger could not be saved and had to be amputated.

This is her a couple of days after surgery and is doing very well and was discharged to home.

This is Maclyn and she's 4 years old. She sustained a bad fracture to the growth plate of her femur/hip and had it treated at another facility. They did not treat it correctly and the bone popped back out of place and then healed in the incorrect position. Her right leg is at least a foot shorter than her right. Dr. Edward took her back into surgery and re-broke and tried to repair her hip and leg. He placed her in a hip spica cast and she's getting around pretty well with crutches, but I am afraid too much damage has been done and too much time has passed for her gait to ever be normal. She's really a cutie though and I played with her every day she was in the hospital.

This poor man came to us with this horrible growth hanging out of his neck. We were pretty sure from the beginning that it's advanced cancer, probably Lymphoma and cannot be treated. We biopsied the site in the OR and sent it to Kampala for analysis and then referred him for palliative care. The tumor is so large and invasive, that it's in his throat now and his speech is grossly affected. His prognosis is obviously not good.

This is a 15 year old girl who came in with severe burns to her entire head. I never did hear the story of how exactly this occurred, but when she first arrived, her face was swollen to twice this size and her eyes were completely swollen shut. She lost her hair, but only temporarily. She had to go to the OR repeatedly for burn debridement, but she's young and her burns seem to be healing quite well and without infection. She was discharged last week to home.

As you have seen, we have an exorbitant amount of children who present with very severe injuries and illnesses. Even though I am no longer on the pediatric or "Toto" Ward, I feel like I still am, since I am surrounded by children.