Jenny has started working at the new hospital, but has actually gone up to the old hospital most days she works to give a hand.  The new hospital is going well now with up to 30 inpatients a day. This number is slowly growing.  The smaller numbers has allowed the hospital to iron out problems with  supply and service.

She started call last month, covering General and Orthopedic Surgery in both hospitals on Tuesday.  At night she has to be picked up by the hospital car (ensures she arrives there safely). This can have its fustration as you stay awake waiting for the car.

A recent case highlighted what it is like to work in a resource poor country.   Apologises to nonmedical people for the medical jargin. A patient with a very large goitre (thyroid gland), who was medically controlled for his thyrotoxicosis, whom Jenny and the other surgeon had co jointly removed one of the thyroid lobes had, had problems with ongoing hematoma formation since the operation.  On several re-explorations he was noted to be generally oozy without a definite bleeder. However we are limited in the blood test we can do (prothrombin time being out of stock) or the treatment we could give him to reduce the bleeding. Patients receive whole blood (normally taken from a relative). There is no platelets,fibrogen or activated factor VII available here.

As he was getting progressively weaker we decided to again re-explore. Jenny had to come in on one of her days off, as there was no one else available. She was assisted by a visiting neurosurgeon. We painstakingly, for 4½ hours, stopped every bleeding point from the top of the wound down using bipolar diathermy and then placed hydrogen soaked gauzes over the areas. Previously bipolar had not been available but on a more thorough look, through all the store rooms, a bipolar forcep was found.  During the 4½ hours we had several power cuts, taking out all electricity to the operating theatre.

Finally we had got most of the bleeding under control but found a small bleeding vessel sitting under the sternum.  Jenny asked for a 5'0 PDS but all that was available was a 5'0 nylon on a cutting needle (not good in a man who was very oozy) or a 6'0 nylon on a taper needle. Using needle holders, designed for bigger sutures she placed several stitches over these ends. Using these and a muscle pledget the bleeding was stopped. On previous explorations a spongistan had been used to try to aid in hemostasis, as no hemostatic agents are available.   Finding a closed sunction drain system again required using different bits from donated equipment but we managed to achieve one.  The patient did well post operatively (the recurrent laryngeal nerve undamaged - phew!!!)