“She has a pneumothorax”
I held the xray up to the light emitting from the ceiling and shifted it back and forth, carefully reviewing the film. “Looks, she has a pneumothorax,” I commented to the resident physician I am working with, a second year resident named Maria. “Oh, wow. I wonder if anyone told her that,” she exclaimed. “No,” she said a moment later. “They called it normal. But you can clearly see that half of her lung has collapsed.” The patient was seated before us, looking comfortable and relaxed. We looked at the date on the xray. Sept 3. Today is October 16. Not likely this issue is causing any problems now. The patient explained that she had been in a severe motorcycle accident, thrown down on the pavement and knocked unconscious. In her coma, and in all of her subsequent visits, the collapsed lung was unrecognized. Fortunately, the condition resolved spontaneously without causing harm.
Next is a patient with one leg considerably shorter than the other with multiple draining wounds from the thigh. He too was in a motorcycle accident several months ago. He has had three orthopedic procedures at other hospitals which failed and now has come to the mission hospital hoping for a cure. The surgeon, Dr. Annaliese, evaluated the patient and reviewed the plans. He will need removal of the hardware from his thigh, debridement and antibiotic therapy, then another surgery to cure the condition.
We have seen multiple patients today with failed surgeries from other hospitals. It seems to be a common theme. Many of the other patients today have neglected their care or have seen other providers, suffered much and now finally are coming in for care. Skin cancers, goiters, complications of childbirth, bone infections, heart failure, diabetes, parasite infections and unstable knees. About half seem to have been in a motorcycle accident. (motorcycles are the taxis in much of the country).
There is a ward at the hospital for women who have had complications of childbirth. When women are unable to deliver their babies but don’t have access to a c/section, they frequently suffer a complication called a vaginal fistula, where urine or bowel contents leak into the vagina. There is a foundation which provides support for the surgeries necessary to repair these complications. Every week the hospital has five or six cases. This is a huge burden for the country and many other areas of Africa where the first child is born early in a woman’s life or the baby is too large or improperly positioned for a natural birth. The results of the reparative surgeries are encouraging, but mixed, in that there are some inevitable failures. The best treatment is fistula prevention- ultrasound during pregnancy to identify large or malpositioned babies, delay in maternal age of first baby, and improving access to high quality c/sections when needed. Unfortunately, looking at availability of physician level care in so many areas of Africa, it’s going to be a while before this becomes a reality.
On the way home, Dr. Sam, Maxim (the visiting medical student from Holland) and I talk about what we have experienced. Maxim asks me what I’ve noticed about this particular hospital, whether it is similar to others I have visited during my years in Africa. I’ve taught or practiced in at least 30 different hospitals in seven different countries in Africa. I respond that this hospital and its staff are unique because the quality of care they provide is high. They come to work every day. They believe in their mission. There is a high level of commitment to teaching, to providing the best possible care for the patients, to compassion, and this combination of characteristics is far too uncommon. The students and residents are serious about their work. They spend time with their patients. They develop carefully thought-out diagnoses and create reasonable plans for their therapy based on their history and physical exam. So yes, this is an exceptional place to learn.
Later, we talk further over supper with our host family and another guest, Brian, who represents SIM, a support organization for the mission. We share with him the diagnoses we are seeing, the suffering of the people, the care that is being provided. Sam and Maxim share the story of a recent surgery on a patient who had the largest goiter Sam has ever seen, weighing in at 2.5 kgs. “It was bigger than the baby that was born the next day!” he exclaimed. “We named the baby Little Thyroid because he was smaller than the surgical specimen!” More stories of remote suffering, unusual conditions related to the use of traditional medicines resulting in liver failure, bladder cancers in very young patients as a result of rampant schistosomiasis in remote areas, other wild and unbelievable health disparities. I throw in a few stories from my years in Malawi and elsewhere, but it’s hard to match Sam for stories from African medicine encounters.
At the end of the day, we relax by watching the Netherlands’ soccer team play against Greece to try to qualify for the European championships next year. Maxim attempts to teach us a song to cheer on the Netherlands team, something about “don’t leave the lion standing in his pajamas.” I offer to learn it and sing it in the Amsterdam airport next time I pass through. “Oh, they would love it,” laughs Maxim. It’s the end of a full day.