First Two Days Working at Tenwek Hospital: Variety Like Never Before

Hello everyone,

This is my first blog post for my summer 2013 trip to Kenya.  Thanks to all who are reading about my experience!

June 27th was my first full day working in the Hospital.  Like a child waiting for presents on Christmas day, my excitement level was ridiculously high. Working with missionary doctors and impacting lives through medicine is, for me, living the dream.  I could not wait to meet the doctors and patients, assist in any way possible, and add to the vivid collection of memories that I have made during the previous two summers.

The day began with the familiar 6:50 AM hike up the hill to make rounds at 7:00 AM with the doctors. Having worked primarily with ophthalmologists (eye doctors) and orthopedic surgeons (bone surgeons) on previous trips, I decided to begin my work with the general surgery team this time. During rounds, our group of eight (including two missionary doctors, five Kenyan doctors, and myself) proceeded to examine the patients staying at the various wards.

Diverse medical trauma is to be expected while working at a mission hospital ensconced in the heart of a developing country.  This fact could not have been more pronounced than during rounds and working in the surgical theater so far this summer. Last year, I was amazed at the complexity and variety of the ophthalmic and orthopedic cases; each one I assisted with was an unforgettable experience. Working with general surgeons this summer, however, has exposed me to an even wider range of medical maladies and ailments across a broader spectrum of human anatomy than ever before. In just two days, cases have ranged from a hugely bloated abdomen due to dysfunctional intestines to a nose that had been entirely bitten off, and a face missing half its skin due to a very invasive cancer.

Due to my limited medical knowledge, rounds have proved largely educational, and I assist by adjusting bandages, encouraging the patients, and occasionally adding to a patient chart. Once the condition of the patient has been adequately assessed, we proceed to perhaps my favorite part of the day: assisting in surgeries at the operating theater.

The type of assistance I provide during each surgery varies. In almost every case, I help the surgeon by transporting the patient to and from the O.R., retracting the wound site, keeping the wound site visible using gauze and a small suction hose, cutting the suture as the surgeon closes the wound, and applying appropriate bandages after closure. In some surgeries I was able to assist in very unique ways.  A few highlights of my first two days include a thyroidectemy (removing an inflamed thyroid gland), a small bowel resection (removing a piece of the small intestine), and an open ankle fracture washout (cleaning out a severely infected open wound).

Me in O.R.

The Thyroidectomy:

Because this was the first case I observed in the O.R. this summer, I did not scrub-in, but it was still a fascinating surgery. The massively inflamed thyroid gland was an anatomical organ that I had not previously seen. In this patient, it was also cancerous, containing multiple enlarged nodules. As the doctors skillfully removed the gland, avoiding critical nerves and blood vessels, they explained to me the significance of the gland and the lifestyle adjustments the patient would have to make. I was able to assist in a small way by labeling the sections of the thyroid gland for the pathology lab. Thankfully, the patient seemed to be recovering quickly during examination the next day.

The small bowel resection:

This was the longest case I’ve ever encountered while at Tenwek, lasting four-and-a-quarter hours. The bloated abdomen I mentioned previously was, in fact, an obstructed small intestine, creating high pressure inside the alimentary canal and abdominal cavity. Upon re-opening the abdominal cavity (this was the patient’s third operation on his abdomen), we discovered that the small intestine had twisted around itself (like the joints in balloon animals), preventing any fluid from passing through and permanently damaging that portion of the intestine. The delicate nature of the intestine prolonged the procedure, thus the reason for the operation’s long length. We had to ensure that no major blood vessels were cut during the resection, thereby preventing the death of a large section of the small intestine, and ensure that no other twists were present in the intestines.  A memorable moment for me occurred when I was able to assist in cutting the mesentery surrounding the intestine (a clear, film-like tissue holding the intestines together) in order to free it and allow for a closer examination.

The washout:

In concept this is a relatively simple case, but because of its simplicity, my involvement in the operation was much more extensive. The patient had a severe open ankle fracture (breaking both tibia and fibula). It had been previously treated with an external fixation device, but had become infected. It was my job to pour several liters of saline through the wound and help the surgeon to remove dead tissue.

I’m tremendously grateful that God has gifted me with these opportunities as a mere Junior in college.  I am looking forward to the week ahead and to the rounds tomorrow to see how those patients are doing!

Thank you all for keeping me in your thoughts and prayers.

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