Example Cases

My first surgical case Friday demonstrated much of the adjustment to realities of medical care here.

What a cute and stoic boy with an inguinal hernia. In the picture, a bright OR light shines on the spot of planned surgery on this small boy. The marks on his abdomen are scars from a witch doctor’s treatment of his fever earlier in life. 

Thankfully he sought care early for this common problem and the case was a straightforward start to operating here on Friday morning. I found him alone in his bed on Saturday morning rounds, but his grateful mother soon stopped by to ask a Ca va bien? I nodded that all was well and he was discharged. I complimented him to his mother through a translator, knowing that my own son about his size wouldn’t have been near as tough. 

The boy with his mom (younger child on back) before discharge.

Later the mother was trying to tell me something so I flagged down his nurse to explain. 

She says “When you go, you can take the boy with you” he said, half laughing. I laughed along with the mother - choosing to believe / hoping that she was only joking. 

At the same time, a 38-year-old man lay in the triage area in grave condition with the same problem. Only his hernia had been long neglected, and was now the size of a football and containing strangulated intestines. There was much discussion about his poor prognosis and the reality of running up a hospital bill that might not change his outcome. Being relatively young and otherwise apparently healthy,  it was hard to just do nothing. After much discussion with the family, the decision was made to attempt operative intervention.

After  lunch I took my youngest son back to the hospital to check on the on-call team operating on the ill man. We ran into the family of the boy I had discharged earlier. I explained to my son that this was a boy I had operated on and tried to introduce them. The two boys just stared at each other. The father seemed upset about the bill. He showed me, in their patient booklet, where they had paid 80,000 cfa in advance for the surgery (roughly $160) but questioned (in French) additional charges entered upon discharge. I explained (embarrassingly) that I only speak English and thankfully another helpful nurse walked past. I could pick up that she was telling the family I had nothing to do with their bill and she quickly dismissed me and my son from the discussion.

I stopped by the OR and made my son wait outside. I peeked in and saw that our suspicions where confirmed - the intestines trapped in the man’s hernia were dead. I told the operating team I would pray and left. 

When I explained that the patient might die from his problem to my son, he said “Oh” and looked like he wanted to cry. As we walked back to our guest house I tried to tell him how much I like working at this place. He was pretty quiet. Despite an aggressive operative effort and our prayers, the man with the strangulated hernia didn't live past this morning.