Starting To Wind It Down

July 20

The last two days have been spent doing routine cases and a couple of standouts such as one of the biggest breast cancers I have ever seen. The tumor itself was about the size of a softball and located in an enormous breast that showed all the characteristics of malignancy. On these findings alone I elected to perform a mastectomy, a procedure that is not done very often any more in modern countries. Nevertheless, this was the only option and it is doubtful that the woman will be able to receive the necessary chemotherapy and radiation that is needed to prolong her life. We probably bought her 1 to 2 years with the surgery.

The lady with the skull fracture died. She would have needed a simple neurosurgery procedure to possibly save her. Neither Ara nor I are neurosurgeons but we could have figured it out. Unfortunately the necessary equipment is just not here. There is a murder investigation about this lady underway.

The poor 13 year old with the botched abdominal surgery has also died. We found out this morning when we went in for rounds. It was so sad but her suffering was unimaginable. Between us we must have spent more than 24 hours working on this girl trying to save her but the odds were just too great. Ara was feeling particularly bad and began questioning whether or not we are really doing any good.

Just as we were questioning our reason for being here I received an email from one of Ara’s fellow residents who had spent a year in Kenya prior to starting practice. He’s been following our blog and a summary of what he said is as follows: There does not exist in Africa the absolute dedication to getting the job done no matter what. They will make some effort and if it doesn’t work they will let it go and move on. When they see western trained volunteers doing whatever it takes to do the job right it makes a huge impression. Spending all night working on a kid with a collapsed lung or taking 3 or 4 hours to get an IV going when everyone has failed makes an impression. The outcomes of what we do are, of course, important. But far more important is the example we set. This is what the medical personnel here will remember.

We felt much better after reading that.

And of course the bright spots appear such as our little Johnny Thomas, the boy with the kidney tumor, who, despite a collapsed lung which has been handled, continues to do well and is committed to a trip to Dar for further treatment. Spinach lady has a bit of a wound infection but appears to be turning the corner. All of the cases that are doing well remain unremarkable for just that reason.

We are working with a wonderful man named Jasper Nduasinde. He is the chief (and at times only) physician on the premises. (Read more about him in the previous post from last year bearing his name.) He has been an extraordinary help and support and has taught us a great deal about how things are done locally. He remains a steadfast government-employed doctor and really cares about his patients and improving the system. He has been a terrific host and we have enjoyed the give and take and exchange of information.

Tomorrow is out last day at the hospital. There are 2, maybe 3, surgeries scheduled and we will finish up. Wednesday, after rounds we leave for Arusha which is a 2 day bus trip through Mbeya. There we will go out on safari for a few days to the Serengeti before departing Africa. I’ll sum up my final thoughts about Sumbawanga in my last post from here tomorrow.