Today I went to theatre, it was a pretty great day. I met an orthopaedic surgeon and then got changed into my theatre uniform.
The first case I saw was a man of about 60 years, who lived in a village. He had been climbing a tree and fallen out of it causing his right hip to dislocate, this happened 2 weeks ago! He had been walking as best as he could on it, but finally came to this main hospital for help. I guess maybe he didn’t have healthcare services available in his village, or maybe he would have been worried about the financial implications of getting help.
The surgeon told me they had tried to manipulate the bone back in to place the previous day under general anaesthetic with no luck. The patient was laid out on the operating table with spinal anaesthetic in place, I could see a big pin going through the lower part of his leg just under his knee. Everybody was busying themselves so I didn’t ask what it was for.
Whilst I stood watching this surgery another procedure was going on behind me, maybe 2 metres away, Caesarean sections. It was a really busy room.
You could see this guys hip was obviously dislocated, he was a thin man and the bone was clearly not where you would hope to see it. They cut through the layers of skin and muscle using incisions and heat. Then the surgeon and 2 small nurses would try and manipulate his leg into place. The piece of metal I had been wondering about came into play here. This was used as a handle to pull on and twist the leg! Oh it made my eyes water! The surgeon explained this was a very difficult procedure because of the length of time the patient had left between sustaining the injury and this surgery. The muscles had tightened around the joint making it hard to manoeuvre. After about an hour of pulling, twisting and sweating they got it in place. They drilled in some pins and put in a drain. The surgeon then sutured it and stapled it. It looked really neat, but I couldn’t help but wonder how much this guy would be aching the next day!
Immediately after this another guy came in for a procedure on his back. There wasn’t even 5 minutes between the procedures, I started to see how the room got so dirty looking. No time is given for really cleaning down equipment, tables and floors. They do sterilise equipment on site, which is wrapped in pieces of fabric. An aseptic technique is generally followed, it’s just very different due to the difference in resources and experience.
This second patient had previously had spinal surgery 11days ago to repair a fracture. The wound had not quite healed so the surgeon debrided it and resutured it. The patient was awake the whole time just with local anaesthetic, no one spoke to him through the procedure and he was wincing sometimes when the surgeon was suturing. The surgeon then exposed a sacral wound on this patient, he told me these are bed sores. When I asked how he got them I was told it’s because he’s now paralysed. Meaning this sore had developed within approximately 12days. It was such a shame to see work done to heal the spinal wound but there was clearly a lack of preventative measures in place to stop pressure ulcers forming.
The final patient I saw was an elderly man who had suffered an open fracture on his lower leg. I didn’t get a lot of explanation about his situation, but I could see a lot of external metalwork around his foot and lower leg. They said this was a procedure to debride the wound, apparently they had done this several times before, the patient was diabetic and the wound was struggling to heal. He had an open wound from his knee all the way down to his foot and around his heel. It had a lot of infected looking material in it, and his Achilles’ tendon was hanging out in a bad way. They used hydrogen peroxide in the wound, it stank, and it went all over the floor and on the surgeons feet. He was wearing flip flops with no socks on as most of the staff do, there were bits of tendon and flesh on the floor as well.
It was such an interesting day, I really enjoyed it. It’s made me really excited to see more of the village communities, where health issues are probably left to develop and worsen because of lack of health services. It was also interesting to see how many patients here are diabetic, so this evening I have been trying to read up on diabetes in Nepal, which has been challenging with our frequent power cuts!
Now I’m super tired and ready for a day sorting out stuff for village health camps tomorrow!
Sleep is good, goodnight! ☺️