Crazy Surgical Department

Abasis’ mother was recently unwell, but he was able to get her to the hospital to see a gynaecologist who sorted out the problem. His father also had an ongoing problem with his knees, but again Abasi got him to the hospital for some much needed treatment. Unfortunately another of his relatives died after being misdiagnosed by the local clinical officer. Clinical officers are medically trained but not to a high level, and misdiagnosis can happen. The charity I work for (http://virtualdoctors.org) helps with this problem.

Anyway, after Psychiatry came the Orthopaedic Department…

“As soon as I started my rotations at surgical department I was assigned to start with my favorite of all medical fields which I would love to specialize in. This department attends about 350 outpatients a week and has three wards and ICU (male, female and children) which has a total of 60 patients each. When you are first on call you are supposed to work for 36 hours. You will be responsible for all of the patients and all emergency patients coming to the hospital. The department has 2 specialist and 4 registered medical doctors

This is one of the busiest department, second to General surgery which I requested to rotate for 5 weeks instead of normal 4 weeks.

I was assigned to a ward that deals with pediatric orthopedic which has 30 beds. I started with minor jobs like putting on skin tractions and doing service ward rounds. Later on in the same week I was supposed to assist surgeries at the theater. We had more than 17 patients who had to get operated on per week and usually we were doing intra-medullary locking nail fixation, open reduction and internal fixation by plates and screw or by using compression screws. I assisted on more than a hundred surgeries and did less than 5 by my self, though I usually finished surgeries at their last point. I made a lot of friends with parents and their children. I loved seeing them waving goodbye see you in two weeks at the clinics. Many of them loved me to the point that they wanted nothing to proceed in the OR when I wasn’t there. They said in their own words that I want Dr Ayoub to be here and to do the surgery on me without knowing that I am just an intern who will only assist those specialized procedures. Those who were financially very poor, I made sure that their info reach to the administration so that they get helped. Many got helped and I went back home smiling.

Once I was in the ward I had to dress to all surgical wounds and all septic wounds like those of osteomyelitis. I also drew blood for investigation, and made sure that my patients received their medications. So many times those who were poorly attended by other doctors or nurses would come to me as soon as I show up to the hospital. There was a day that other doctor mistreated a patient and she really didn’t talk to her in a good tone. She yelled at her so much to the point that pregnant woman who has daughter with two broken bones at the thigh started crying. Other patients didn’t like it too so as soon as I entered the ward they told me. I had nothing I could do, as I know the doctor they were talking about. She was lazy and loves arguments and most of the time would fight with all of us. I told them to cool down as everyone has their own calling and do their job as their personality guides them best. They prayed for me to become a good doctor and told me that on days that I am not around, whether I was in theater or I was first on call at the entire department, they would look and wait for me and they wouldn’t tell any one their concerns. I felt really happy.

Four out of 7 days I spent in theater and later on to my assigned ward. I was literally living I hospital as I usually left to go home really late and sometimes as soon as I was home I had to go back as my seniors knew how ready I was when they had an emergency or when anything needed a quick attention.

All of the five weeks I was in OT I saw my self becoming an orthopaedic surgeon and I know that I love it with all of my heart and it is the thing that I want to do in my life. I spent hours in theater and clinic and in my heart all I wanted to do is MORE.”

Then it was on to General Surgery.

“This department also attends more than 400 patients a week with three days for elective operations and has got a total of 7 wards with 40-60 patients each.
They have three specialists and 4 registered doctors.

In this department, where I am still working, I was assigned a different ward which is a male ward. Here my daily activities are doing ward rounds, preparing patients for surgeries, attending all new patients coming to the ward via Emergency department or casuality as well as preparing patients who will be going for elective surgery. I also have to be first on call 2 days a week for 36 hours, attend surgical clinic once a week and lastly be in theatre once or twice a week. In theatre I get to assist surgeries and perform minor ones like lipoma excision, herniorrhaphy and surgical debridement’s.

I became well known to my seniors, I guess, due to my readiness but also my wanting to know. I usually bug them with questions until I understand something.
I also got lucky that my white coat is usually clean so several times my chiefs asks me to lend them mine in case they want to do something political as so many politicians do come to hospital regularly due to ongoing constructions around the hospital. We have a lot of ongoing programs like Hydrocephalus, inperforate anus reconstruction, thyroid and others. Politicians, NGO’s, and press come regularly to obtain information about ongoing projects and so they would want to speak to specialists and senior doctors about it.
In General Surgery a lot of deaths occur several times a week and they are so painful. I lost a child in my second call. She was 4 year old who sustained burn injury 27% of her body. I didn’t even know what happened as I was doing my work in other wards when they called me to review her. When I reached there she was already passed away. It was so, so painful and it ruined my day completely. I was so, so mad as nurses didn’t tell me anything that would have caused her death and the thing is the dangerous time for her had been already passed. I lost other two patients who sustained head injuries whom I tried my best but couldn’t save them.

I got to stay in the hospital more than how I used to stay when I was in OT.

There are so few of interns remaining so we have a huge load in terms of patient-doctor ratio. This week we had an outreach program around Mbeya city centre where we were providing screening for prostate cancer, Benign Prostate Hyperplasia(BPH), breast cancer, cervical cancer, blood donation, etc. All of the hospital sections were there. I was lucky to be among two doctors who were screening for BPH and breast cancer. We could screen up to 120 people a day. It was wonderful and by the end of the day today, hospital director, head of department and other larders came to thank us for our time and support. I felt really good to be recognized for our work by head of department and by the hospital director. The head of department asked me to drive him to the garage where he took his car to be fixed. It was an honour for me to drive him as he could have asked any one as so many cars were there. On our way we talked about his career and he asked what I will do after my internship.
After another week I will be shifting to the Urology department for two weeks and after that I will be done with Internship.”

Abasi and his girlfriend are still hoping to get married and trying to save up the “bride price”, but with the future unsure after the internship ends there is no knowing how long that will be. There was a notice at the hospital about a vacancy for one doctor at Baylor Children’s Hospital. 25 intern doctors applied and Abasi was selected for interview on 27th October.

We await news…