July 10
Today was the kind of day that we came here for. Surgery early and we were able to shorten the time between cases considerably. The day started simply enough with the removal of a large breast mass from a woman who was breast feeding. It had appeared highly suspicious but o removal turned out to be mass of blocked milk glands. Another breast case followed which was a tennis ball sized benign mass in the breast of a 19 year old girl. I say benign only because it appeared that way based on years of experience. In reality there is no way to determine for sure if I’m right but given her age and the character of the tumor the chances are over 95 per cent that it is not malignant.
As we prepared to do three other elective cases the day changed dramatically. One of the assistant medical officers rushed over to tell us that he had a woman that had been in labor for some time and was beginning to show fetal distress. Could we do an emergency C-section? Of course. After quickly preparing the patient I began the case with Jasper assisting. Ara elected to watch and learn as this type of surgery had not been part of his training. The operation went smoothly, quick incision into the abdomen, entering the uterus and delivering a healthy boy who was crying before he left the table. As I reached in to deliver the placenta I was greeted by a wagging foot. Yes, totally unexpected twins. With mother and babies doing well we wrapped up a very satisfying case. Then the day turned considerably more somber.
We were informed that a woman had been admitted with apparent peritonitis and septic shock. She had admitted to the admitting medical officer that she had undergone an illegal abortion five days earlier. All abortions in Tanzania are illegal and are also a cultural taboo. Nevertheless back alley procedures do get done and sometimes the results are disastrous. So it appeared to be with this woman. When these types of patients arrive they are treated with indifference bordering on neglect. Jasper was reluctant to even have us see the patient, probably because he considered it beneath us to become involved in such a case. I insisted and we were escorted to the ward. What we found was a 19 year old woman who was truly close to death. Her abdomen was rigid; she barely had a blood pressure and appeared to be in septic shock, presumably from a botched abortion. Knowing that the assistant medical officer’s plan to operate on her later was a sure death sentence I insisted on moving her to the OR immediately and postpone the other cases. Reluctantly they agreed.
I decided to have Ara take the lead and be operating surgeon on this case. I would assist. After all, this is what he has been trained so well to do. When the abdomen was opened we did not find evidence of the infection and pus one would expect from a septic abortion. In fact the uterus and ovaries looked perfectly normal. What greeted us was a massive amount of dirty looking fluid that contained a large amount of food that looked like spinach. That could mean only that there was an opening in the stomach itself. Sure enough, after thoroughly inspecting the abdomen we found a huge perforated gastric ulcer that was also bleeding profusely. All that was necessary was to close the hole, patch it, wash out the abdomen and close. She might not survive but at least she now had a chance. We were able to get some blood for transfusion but we lacked any of the tools that we would have had at home to manage such a critical patient To my delight Ara had performed flawlessly and at about 8:30 at night we retired to the hotel. At dinner we discussed how close this patient had come to dying because the presumptive diagnosis was totally wrong. And even if it hadn’t been she deserved better than to have been neglected to death.
And so Friday came to an end. The weekend is free and we are going off to Kapili, about a three hour drive, to visit my friends Chris and Louise at their new resort, Lakeshore Lodge, on Lake Tanganyika
This article, like so many we've seen recently in the trade press, is in my view another example of piling-on by journalists looking for material to feed their news machines. Journalists find isolated instances or events from which they extrapolate to conclusions not necessarily accurate.
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