The end of the fifth full week on the Africa Mercy has come to an end but with a three-day weekend attached. It was good – fatigue was setting in. In addition to being bone-weary, we have been more than a little stir-crazy and it was good to get off the ship for a little recreation and sight-seeing today. We went with some friends from the ship to an ocean and river beach only about 45 kilometers south of Freetown, but it took over 2 hours driving both ways we went. We rented a poda-poda (van) and crammed 19 people into it – it was not the ultimate in comfortable rides. As you can see, it was overcast and it kept the temperature wonderfully pleasant and the humidity down. We enjoyed both the ocean and the tidal river to swim in – and we had a nice little beach hut to keep the rain off (mostly).
I have mentioned before that one of the most frustrating things about missionary medicine is the need to turn away, or only partially treat, patients because of limited resources. I may have the required skills but not always what I need to fully treat the patient. Next week, I will do a mastectomy for an advanced carcinoma of the breat – but the simplest post-operative hormonal therapy is not available in country. I will help her, but not as much as might be possible elsewhere. The following two cases also demonstrate that feeling of inadequacy that we live with constantly.
I mentioned the emergent hysterectomy in the newsletter three weeks ago. This woman had begun to bleed spontaneously into her abdomen and nearly died. She probably would have had we not been able to take her to the OR and remove the uterus with its ruptured bleeding tumor. We were stunned Wednesday of this week to be shown a pathology report that showed this to be a rare malignancy of the uterine muscle. This particular tumor tends to be aggressive. She will be leaving the ship to return to her home country in Africa to obtain further treatment advice but I am concerned about the availability and affordability of the required chemotherapy. She is the mother of an adopted young girl. Please pray for the family and for this lovely Christian woman.
About ten days ago, a young child had a spontaneous rupture of his popliteal artery (behind the knee) several days following a surgical release of a severe contracture that made his leg non-functional. Infection of the overlying grafts and tissues caused the vessel to weaken. He nearly bled out. We were able to do an emergent venous bypass and tie off the artery, but the distal tissues were weirdly scarred and the vessels were not normal. My plastic surgery colleague was able to do a microvascular anastomosis using suture half the diameter of a human hair, but it failed with 24 hours. We didn’t have some medication on board that might have helped us either. The poor child eventually had to undergo an above knee amputation. Given the horrific nature of the civil war here in Sierra Leone, there are excellent prosthetic labs here in the country and certainly, the child will be more functional on a prosthesis than he was with a shriveled useless leg, but it is deeply disappointing. It is this sort of disaster that is difficult to deal with as a patient, family member or surgeon. The truly saddest thing about this whole story is that it should have never been necessary at all to operate on him. It all started when he had a problem with pain in his lower extremities – and was treated by the national healer with a hot poultice of leaves which burned and scarred him.
Micky was a great hit one evening this week. Many of the pre-teen and teen-aged girls were having a nail party in the mid-ships lounge – and she showed up with her supplies for nail art. They absolutely loved it. I walked by to take the picture and was nearly overcome with the smell of solvents. Glad OSHA wasn’t around! On the other hand, given all the giggling, perhaps it was giving them a pleasant high.
The mass emigration from the ship has begun. We said good-bye to many friends and will do so again over the next 10 days. Many of the long-term crew and their families return to N. America and Europe for the summer. Some are leaving for good. Sean will definitely miss his friends as most of the boys his age will be leaving the ship. However, there is a summer camp planned for the kids and he is looking forward to that.
Praise and Prayers:
- Pray for the residents and me as we switch around and start new rotations. They are studying hard, preparing for their annual PAACS exam on June 25.
- Praise God that the 2011 annual PAACS exam has been finished and is ready to be sent to the programs.
- Praise God that the Ethiopian Ministry of Health has accepted our PAACS graduates as fully qualified general surgeons in Ethiopia!
- Praise God that my father’s neurological status is improving after the surgery (he is only using a cane and that not all the time). Also, his heart failure has responded to therapy and his bladder scope was negative for tumor (despite the positive cytology). Thank you for your prayers for him.
- Please pray for my (Bruce’s) daughter Bethany. She found the return to university too much for her and returned home. She hopes to attend courses there in Fayetteville. Please continue to pray for her and for us as we strive to support her choices.
Yours, and His!
Bruce for Micky and Sean