A volunteer asked me last month, “Which is the more important work in Chad, public health work or running a hospital?”
You can argue both sides. So many children die from malnutrition here that it makes you want to quit everything that you are doing and TEACH. Teach about clean water. Teach about proper nutrition, even with limited funds. Teach about hygiene. Teach about parasites.
On the other hand, I see the change between life and death all of the time working here in the hospital. Medicines save people’s lives. One day they are on their death’s bed seizing, and the next they are sitting up and eating. One moment someone is hemorrhaging, the next, after a life-saving surgery, they are perfectly fine.
How can you choose between the ways to save people?
So if I had to choose I would choose both. Both are equally important. I suppose it depends on your passion and training.
But it would be super difficult to just let someone die while knowing how to fix them.
One of the cases today was actually a GYN case. A nice change for a while, although this case tried to be super dramatic on me.
Three weeks ago Sarah asked me to see a patient who was in her first trimester with a mass on her cervix that was bleeding a little bit. I examined her and found what seemed like a prolapsing fibroid originating from the cervix. It was bleeding some, but not too much at the time. We made plans to see her later and hoped she didn’t bleed too much more. We discussed that she may end up needing a c-section due to bleeding risks.
Last night this same patient came back in hemorrhaging. She is 13 weeks pregnant with the baby doing great on ultrasound. Her silly prolapsing cervical mass (of which I have no pathology to biopsy) was bleeding quite a bit. The nurse had already packed her vagina several times and the bleeding had soaked through them. Fibroids don’t like to be moved at their base. And when they do get moved, they bleed more.
I go examine the patient again and gently yet firmly pack her around the mass and very firmly in the vagina. It took several tries to get her to stop soaking through the packing. Finally she stops bleeding. I stick a foley in to encourage no movement, wait a bit longer and decide I can sleep the night without doing anything more to her.
She was my second case today. We discussed the possibility of a hysterectomy (intact with her 13 week old fetus). I told her I would try something vaginally first, but there was a good chance that she would end up with a hysterectomy. This poor mother had 9 children. Five of them had died and four are still living. She wanted more children, but accepted that the hysterectomy might need to be done due to bleeding.
After a spinal for anesthesia I examined the patient with retractors. She has a 4cm protruding mass coming out of her cervix. Her outer cervix was all stretched out and out of shape due to this large mass taking up residence there. How on earth did she get pregnant past that thing anyways? That’s beside the point. I want to save this baby for her. But if she bleeds too much, I will save the mom’s life by doing a hysterectomy. And she will never have any more children. She accepted it. I accepted it.
But this baby. This baby is important too. So I have to try.
The more I manipulated the mass, the more I was convinced that it was a fibroid and not cancer. Sometimes you can put an endoloop over the prolapsed fibroid, cinch down on it and then just lop off the fibroid. But not this thing. This thing had quite a broad base. So I try to clamp in towards the base. No luck, just tears the tissue. So I break out the cautery, stick a tenaculum on the mass and put some traction on it.
Not the type of thing you want to be manipulating while someone is pregnant. But I had no other choice. Either take it out, or she keeps bleeding. So little by little this crazy prolapsing cervical fibroid comes out. It bleeds some at the base after getting it out, so I put a few stitches in.
Wow. It came out. It’s not hemorrhaging anymore. Her external cervix is really dilated, so I put a cerclage in to hopefully keep things put.
We don’t know what will come out of this. Today, my work in the operating room was more important than the work in the field. But tomorrow, tomorrow will be for the public health team. This woman has already had five children die. Today this unborn baby got a second chance at life. But what about tomorrow?
It is an impossible task to do it all. Thankfully we are a team.
Running a hospital. Operating. Rounding. Nursing care. Nutritional program. Fixing electricity. Evangelism. Cleaning the grounds. Public Health. Watching the kids.
It’s all important.
You can argue both sides. So many children die from malnutrition here that it makes you want to quit everything that you are doing and TEACH. Teach about clean water. Teach about proper nutrition, even with limited funds. Teach about hygiene. Teach about parasites.
On the other hand, I see the change between life and death all of the time working here in the hospital. Medicines save people’s lives. One day they are on their death’s bed seizing, and the next they are sitting up and eating. One moment someone is hemorrhaging, the next, after a life-saving surgery, they are perfectly fine.
How can you choose between the ways to save people?
So if I had to choose I would choose both. Both are equally important. I suppose it depends on your passion and training.
But it would be super difficult to just let someone die while knowing how to fix them.
One of the cases today was actually a GYN case. A nice change for a while, although this case tried to be super dramatic on me.
Three weeks ago Sarah asked me to see a patient who was in her first trimester with a mass on her cervix that was bleeding a little bit. I examined her and found what seemed like a prolapsing fibroid originating from the cervix. It was bleeding some, but not too much at the time. We made plans to see her later and hoped she didn’t bleed too much more. We discussed that she may end up needing a c-section due to bleeding risks.
Last night this same patient came back in hemorrhaging. She is 13 weeks pregnant with the baby doing great on ultrasound. Her silly prolapsing cervical mass (of which I have no pathology to biopsy) was bleeding quite a bit. The nurse had already packed her vagina several times and the bleeding had soaked through them. Fibroids don’t like to be moved at their base. And when they do get moved, they bleed more.
I go examine the patient again and gently yet firmly pack her around the mass and very firmly in the vagina. It took several tries to get her to stop soaking through the packing. Finally she stops bleeding. I stick a foley in to encourage no movement, wait a bit longer and decide I can sleep the night without doing anything more to her.
She was my second case today. We discussed the possibility of a hysterectomy (intact with her 13 week old fetus). I told her I would try something vaginally first, but there was a good chance that she would end up with a hysterectomy. This poor mother had 9 children. Five of them had died and four are still living. She wanted more children, but accepted that the hysterectomy might need to be done due to bleeding.
After a spinal for anesthesia I examined the patient with retractors. She has a 4cm protruding mass coming out of her cervix. Her outer cervix was all stretched out and out of shape due to this large mass taking up residence there. How on earth did she get pregnant past that thing anyways? That’s beside the point. I want to save this baby for her. But if she bleeds too much, I will save the mom’s life by doing a hysterectomy. And she will never have any more children. She accepted it. I accepted it.
But this baby. This baby is important too. So I have to try.
The more I manipulated the mass, the more I was convinced that it was a fibroid and not cancer. Sometimes you can put an endoloop over the prolapsed fibroid, cinch down on it and then just lop off the fibroid. But not this thing. This thing had quite a broad base. So I try to clamp in towards the base. No luck, just tears the tissue. So I break out the cautery, stick a tenaculum on the mass and put some traction on it.
Not the type of thing you want to be manipulating while someone is pregnant. But I had no other choice. Either take it out, or she keeps bleeding. So little by little this crazy prolapsing cervical fibroid comes out. It bleeds some at the base after getting it out, so I put a few stitches in.
Wow. It came out. It’s not hemorrhaging anymore. Her external cervix is really dilated, so I put a cerclage in to hopefully keep things put.
We don’t know what will come out of this. Today, my work in the operating room was more important than the work in the field. But tomorrow, tomorrow will be for the public health team. This woman has already had five children die. Today this unborn baby got a second chance at life. But what about tomorrow?
It is an impossible task to do it all. Thankfully we are a team.
Running a hospital. Operating. Rounding. Nursing care. Nutritional program. Fixing electricity. Evangelism. Cleaning the grounds. Public Health. Watching the kids.
It’s all important.
