Back to St. Martin's Hospital Agroyesum!

So far there has always been at least one thing a day that surprised, shocked or amazed me. The past days I spent at the hospital in Agroyesum have been amazing! a great mixture of all of the above!

When I arrive at the hospital the doctors are already at the operating theatre. To my great surprise (and enthusiasm) I can join them straight way. As soon as I have put on some scrubs, shoes and nurse's cap and mask, I enter the OR and see that I got “lucky” straight away! They are in the middle of a Goitre operation. (swelling of the thyroid gland due to iodine deficiency) These swellings can get really big (bigger than my fists) and in the rural areas in Ghana people believe that women with such swellings are witches. These surgeries are therefore essential to avoid social exclusion. Since the doctors are only here for two weeks they mostly perform surgeries that local doctors cannot do themselves, one after the other! This means that in the two OR’s there are surgeries all day long: hysterectomies, hernias, goitres. The doctors are all very kind, and I’m allowed to watch any operation! Other common surgeries are skin transplants to treat Buruli Ulcer. This is (if I understood correctly) a bacterial infection which “eats away” the skin and is unfortunately quite a common disease here. Sadly, many wounds are horribly neglected, and some children/people are only brought to the hospital when the only way to treat it, is either a skin transplant or in the worst cases, amputation. I get to see both surgeries, and whereas I find the skin transplant very interesting to watch, the amputation is emotionally too much. After several Goitre operations I have become used to all the blood, but knowing that this boy will wake up without his arm, (and will not have the same support we would have in Europe), makes it too difficult for me to watch.

Overall however, I really enjoy watching all the other surgeries and am once more convinced that this is what I want to do and study and I hope that one day I will be able to do the same! I greatly admire the doctors for their work, especially taking into account the primitive conditions. As has been the general rule to basically everything I have seen/done so far in Ghana, things are “never quite the same”. Whether it concerns the ‘hamburgers’ we have looked forward to for a week, the way they change diapers or how they celebrate birthdays: it’s always “just a little different”. This often enriches our experience, but sometimes makes it more challenging. That in this case it means it is more challenging for the doctors, appears straight away as I enter the theatre and see the list of equipment:
Trolleys: 5 (4 broken)
Computers: 1 (not in use)
Anaesthesia machine: 4 (3 not in use)

I immediately understand why the German doctors decided to take their equipment/narcotics etc from Germany. Although I wonder how the local doctors usually manage. Another “little complication” occurs when there is a power cut during surgery, and the surgery needs to be stopped. Fortunately the hospital has its own generator and after 5 minutes power is back on.
On the third day I am allowed to ‘scrub in’ on a Goitre operation! I have to wear the special sterile apron etc. and follow the strict regulations when standing by the sterile table: you’re not allowed to touch anything, except the things covered by sterile cloth/plastics, always keep your hands up etc. etc….(Terrified by being shouted at in German by the theatre nurse, I make sure not to lose my concentration!). During the operation I have to keep the hole/cut in the neck open using several clamps. Sounds quite easy, but after 4 hours(!) both the heat and muscle ache start to kick in! Nevertheless I find it very interesting and realize it's a great oppurtunity, since I'm also aware of the fact that this would not have been possible anywhere else! Only my mask can hide the big grin I have on my face.

Another highlight of the first 4 days, are the two caesarians I get to see. Although it is amazing to see a baby being born, I have difficulty appreciating the “miracle and beauty of birth” since I was overwhelmed by the bluntness with which the baby is delivered (at one point I almost have to laugh since it just seems so contradictory to the idealized idea of "the miracle of life"). After having watched a 4 hour surgery of delicate and intricate cutting, the force and especially the speed with which the baby is delivered astound me. The womb is cut open in one go, but when they start doing the thing I am about to describe, I am grateful for my mouthcap, hiding how my jaw just drops. The two women start tearing the skin on either side with such force, I immediately have a flashback of Fred and Emmanuel fighting for a toy in the orphanage: with full body weight! Everything goes very fast, the water breaking and the baby being pulled out, within 5 minutes!

After four days of watching surgeries and doing ward rounds, I go back to Anwiankwanta for the weekend, since the doctors don’t work during the weekend. But I will go back on Monday and will stay till Tuesday. So I’m curious what other cases are awaiting me!