A 30-something, 6-month pregnant lady came to clinic the other day with a complaint of having a rash on her abdomen. When she lifted her shirt, I saw three medium sized papillomas in a curved line on the right side of her pregnant belly. They appeared to be in 3 different stages of development, 2 of which had central ulcerations.
I really had no idea what it was. I looked to my translator/ nurse for an idea. She said “it looks like yaws.” “YAWS?” I said, trying to figure out if she was just pronouncing an English word in a funny way. She repeated it. Then Mrs. Faile came into the room and agreed. “That looks like yaws.” I was still confused.
Come to find out, yaws is one of those diseases that I read about a long time ago, probably just once, figuring I would never see it. It is a non-venereal cousin of syphillis. The treatment is Penicillin or Erythromycin, both of which are safe in pregnancy.
In Africa, many of the young children are running around with umbilical hernias (small defects in the abdominal wall at the belly button – AKA a big “outie”). Some protrude only a centimeter while others are considerably larger.
Last week in clinic, Dr. Fort called Jessica and me into his examination room to examine an umbilical hernia on a young woman. I had never seen a hernia so large. It appeared as though the patient had a small watermelon covered in skin attached to the abdomen at the umbilicus. I examined the abdomen. At the top, I felt the bowels moving (peristalsis), but towards the bottom, there was a hard mass. It was not one distinct mass…and it moved. But the movements were not peristalsis…they were fetal movements. She was pregnant and likely 20 weeks along.
The question now is this: how is that umbilical hernia sac going to support a full term pregnancy? Fortunately, this lady lives in town and we can keep a close watch on her pregnancy.
**UPDATE** October 20, 2007 – The woman came back to clinic this week for a check-up and an ultrasound revealed that she is actually 32 weeks pregnant. She has been admitted and will most likely undergo a caesarean section at the hospital.
Yesterday when I was climbing the mountain I came into contact with some sort of toxic plant. Today my arm has broken out with a hideous, raised, red rash. It itches like mad and doesn’t look very attractive either.
Being market day, I headed into town and went by the medicine man’s booth. I showed him my arm and asked what cured a rash like mine. Without hesitating he picked up a dried monitor lizard head on a stick. He explained that I could burn the head and crush its ashes into a powder. That powder, when spread on my arm, would cure me of the rash.
It was a really rough day for her too because four patients died. Please pray for her as she deals with the stress & emotions of loosing those patients. Also lift up the families of those four individuals as they grieve.
There is good news though. Heidi was able to save a newborn today that came in limp, blue, and barely breathing. She had to stimulate the child for almost an hour and give it oxygen. It finally started responding and as of the last check she did late this evening it is recovering slowly but surely. Please pray that the child will continue to recover and begin nursing regularly.
Another praise is that a young Argentinian doctor named Thomas randomly showed up today and offered to help. He was on his way to another hospital farther north and decided to drop in and see if we needed any help. How’s that for an answer to prayer?
Emergency surgeries happen at any time during the week, but as I mentioned previously, Tuesdays and Thursdays are the main OR days for elective surgeries. My first day in the OR was quite interesting. When I went to the sinks to scrub, I looked all around for scrub brushes like I am used to. Then, the doctor passed me a bar of soap. I did the best I could to clean all surfaces of my fingers and hands. Then, the doctor used his elbow to get a small amount of pink soap (which I later realized was chlorhexidate) from a pump bottle mounted to the wall. I followed suit and scrubbed my hands a second time, then headed into the OR. I think I was a bit nervous on that first day. When the doctor handed me my cloth surgical gown for me to put on myself, I reverted back to how I put on gowns when doing “sterile” procedures in the ICU. I began to snap the neck of my own gown. With a concerned look, Dr. Faile corrected me, and the anesthesiologist snapped it together for me. (By snapping it myself, I would have contaminated myself, and had to scrub again.)
At the BMC, the theater is the location of the 2 operating rooms and the 2 minor procedure rooms. Tuesdays and Thursdays are surgery days. On Tuesday I saw 5 hernia surgeries, scrubbed in for 3. To see so many hernias in one day is not uncommon on a general surgery rotation in the States. As expected, there are many differences between the circumstances I’m used to back home and here. For instance, I was lancing an abscess on a woman’s thumb yesterday. She was lying on a stretcher with a baby on her belly nursing. We just had to keep a close watch on the baby’s wandering hands – keeping the sharps away from her tiny fingers.
* Warning * Today, I assisted/ observed 2 debridements of wounds and the following descriptions are fairly graphic.