Medical Post #1—Returning "Home"

Any surgeon who has traveled halfway across the world (should) anticipate that he will be challenged in many ways.  Whether he finds himself in Europe, Asia, or Africa, the obsessive, detail-oriented surgeon will suddenly find that all the familiarity of his home operating room is gone.  That favorite suture, the scrub techs who have the procedure memorized, or the specially ordered equipment.  This is nothing specific to working in a LMIC (Low and Middle Income Country) setting—it’s just part of working in a new environment.

More so then when I was here as a resident (2008-2009), now that I am an attending (consultant), I find accommodating to those details to be my greatest challenge.  Yet, it is also a lot of fun at times to find creative solutions.

The biggest help during this whole process has without doubt been the PAACS residents that I work with (Pan-African Academy of Christian Surgeons).  When we were last here this was a fledgling general surgery residency with only two residents.  One of these is now faculty here, Dr. Agneta Odera, a future pediatric surgeon awaiting further training.  Now the program is at full capacity with fourteen high-quality surgical residents.

The PAACS residents are impressive because not only are they capable technically in the operating room, they are also quite knowledgeable on the wards.  But this is not just in the narrow scope of general surgery that we know in the United States, but also in the fields of urology, neurosurgery, orthopedic surgery, and plastic surgery.  When you’re training to be the only surgeon in a remote, underserved area, you can’t rely on a specialist to be of any assistance!

Most of all, I have been impressed by their commitment to serving the Lord with their gifts.  They are training to be servants in tremendously underserved regions of Africa.  And they do so with the desire to share the love of Christ with others.

-----

Personally, it has been returning to my training as an adult general surgeon that has been both refreshing and challenging all at once.  I have done my first trauma splenectomy in years, honed my skills with thyroidectomies, rounded on a few ruptured AAA’s who were status post repair, burns and wounds of all ages, and refreshed my knowledge of acute limb ischemia and open revascularization techniques.  I have really enjoyed this time of re-expanding my care to patients of all ages.

From a pediatric surgical standpoint, this week has been about undescended testicles (4, 7, and 14 years old).  And to any pediatrician or pediatric surgeon, those ages would seem quite old for an orchidopexy for an undescended testicle.  This is reflective of what I perceive to be one of the greatest surgical public health issues in this region—delayed presentation.  Not limited to the pediatric population, diseases usually present end-stage, well along their course, or after many years of suffering.

My other cases have included a neonate and a pre-schooler with probable Hirschsprung’s Disease.  This led to my performing my first contrast enema—something I normally write an order for (or tell my resident to write for!) and then follow up with our pediatric radiologist.

It is exciting to see a pediatric surgical practice here that is both active and alive thanks to the devotion of the full-time general surgeons here, but also growing and with tremendous potential to rapidly expand.