More challenges in the Operating Theatre

Life in the hospital continues to be a major challenge. More trauma cases come in than we have the capacity and resources to treat. I think in general, resources and manpower could be better allocated. It seems that patients have to pay for their care here and that if they pay more they can be fast-tracked. I am finding this frustrating and contrary to why I am here. I expected treatment to be less than modern, but the conditions are considerable worse than expected. Still I like the Residents, Assistant Medical Officer Students, and Medical Students. I have found myself as the only Physician on rounds or in the clinic and patients for the most part only speak Swahili. I will be giving a series of lectures on basic orthopaedic and trauma skills to the AMO students who are new to Orthopaedics. The existing teaching style seems to be mostly by intimidation. The students are very reserved in manner and in addition to Orthopaedics, I will try to include some assertiveness training, especially as they are presenting cases to the more senior staff and consultants.

(a shot of the ward)

Recent operative cases have included intramedullary nailing of a 3.5 month old femur fracture in an adult, reduction of a 100% displaced supracondylar humerus fracture in a 6 year old child, debridement of a tuberculous abcess if the proximal humerus in a 13 year old child, and retrograde nailing (through the knee) rodding of a comminuted 6 week old femur fracture in an adult. The terminology is included for the reading pleasure of my surgical and medical colleagues. Today we met a surgeon from Ottawa, Canada who is running a surgical skills course here for medical students. Tomorrow they are doing a skills lab practicing surgical airways and chest tube placements on goats. Thompson will observe this. I don’t think things look very good for the goats.