Salle d'Opération

The first two days of surgery went so well!  We spent all day in the operating room--from 8am to 5pm. The HEAL Africa hospital has three operating rooms, so at any given moment there are usually two or three surgeries happening.  A large part of the American doctors' job is to help teach new skills and procedures to the surgeons here.  The motto is "See one. Do one. Teach one."  The Congolese doctors see our doctors do procedures, eventually learn to do the procedures themselves, and are then able to teach other doctors and/or residents how to do the procedures.

A lot of the cases we work on are unique, more complicated cases that have been saved for our arrival. Many of these patients came to the clinic weeks ago and were told to return when the American doctors come.  These are the patients we saw in clinic on Tuesday and if we can help them, they are told which day they should come to have their surgery.  Some people come from hours away, and some are from nearby.  They stay at the hospital overnight if they are from farther away until the day of their surgery.  On the specific day, everyone gathers at the hospital outside of the OR, and waits.  Patients are not scheduled to have surgery at a certain time during the day, so they all just sit outside and wait to be called.  This means sitting for hours, and hours, unsure of whether they will actually have surgery that day or not.  If they do not, they are bumped to the next day, and hopefully they will have their procedure done then.

Operating here is drastically different than in the U.S.  Pretend you're operating for 6+ hours a day in two layers of long sleeve clothing, a hat, and gloves, and pretend you're in a sauna.  That's pretty close to what it feels like.   The OR does have air conditioning, but it is rarely on because of all the power it takes.  I sweat enough just observing in my scrubs (and I can leave the OR whenever I want to get some fresh air), but I can't imagine how warm it must be all scrubbed up and operating, unable to leave the room for a few hours.  When the air is on (and even when it isn't) the power comes and goes.  During our very first case on Wednesday the power went off, leaving the surgeons to operate in complete darkness except for their single head light.  This happens multiple times a day, and no one thinks anything of it. The picture below is during our last case today when the power went off.

My dad works in one OR, taking care of the plastic surgery cases, and the other surgeons work between the two other ORs for the general surgery cases.  The doctors here are so passionate about their work and helping their people.  It's so wonderful to see their enthusiasm and desire to learn.  They can be quite ambitious regarding the number of cases they schedule for a days work, though.  My dad was scheduled for six cases on Wednesday, and we only completed three in the whole eight hours we were there.  Dr. Erickson, Dr. Ekbom, and Dr. Wilson were also unable to make it through their complete case list.  It can be so hard to judge the timing of certain procedures here due to many factors that are absent in the U.S:  some of these cases are procedures that are not routinely done in the U.S., more problems can be exposed after the surgery starts, there's a limited selection of instruments and radiology available, etc.  But, all the doctors work so hard and so meticulously to do the best they can with what's available, and the results are often wonderful!

So far, I've just been observing in the ORs.  I can walk back and both between the three ORs whenever I want to observe the different procedures.  On Wednesday, my dad operated on a little boy who burnt his hand in boiling oil, and his fingers were fused to his hand.  He separated the fingers, then did a skin graft to cover the exposed area using a section of skin from the boy's groin area.  As you can imagine, this is very tedious work to carefully separate the fingers and to graft a small piece of skin perfectly on to the raw area.  We saw the little boy today during rounds, and he has been doing well….besides the fact that we made him cry when he saw us.  I can only imagine that he's thinking, "Who are these funny looking people?".

On Wednesday I also saw some keloid removals on a man's chin, another skin graft for a large arm burn (wow, was this intense and time consuming and cool!), and a mastectomy on a woman with a large breast tumor.  Today, Thursday, all of the doctors were scheduled for a plethora of cases. My dad was scheduled for seven cases (like I said, quite ambitious) and he made it through three.  The first one was the removal of two infected keloids on a man's face.  This didn't take too long.  The second case, however, took about three and a half hours.  This was for a little boy who had previously had a bilateral cleft lip repaired, but also had a cleft palate that needed to be fixed.  His cleft palate was very wide.  He's about two years old already and has his front teeth, which added another challenge as those can get in the way and make it more difficult to see and repair the palate. I could try to explain how this was done, but I honestly have no idea how to explain the procedure.  It was crazy complex, but looked great at the end!  The final case was another child--a baby girl this time--with another hand burn, very similar to the baby boy from yesterday.  The tension was released, and the fingers separated and closed with a skin graft.  Her tendons in some fingers were so contracted that she will probably never have full extension of her fingers, but they are certainly functional now.  Unfortunately, we didn't get an "after" photo, but here is the "before" photo:

It was a long, sweaty day, but an amazing one, just like every other day so far!  We left the hospital around 5:30pm and headed back to Maji.  I don't think I've commented too much on the roads here, yet.  Most of the roads are dirt and lava rock and just covered in potholes.  Trying to have conversations while riding down the roads is hilarious because everyone is bouncing up and back and side to side.  There are more paved roads as of recently, though.  The president of the Congo is building (or bought? I can't remember which one.) a house on the same road as Maji, so a lot of the roads are being paved for him and for the upcoming election in the fall.  The busyness of the city and roads is astonishing!  It's literally just a free for all.  There are tons and tons of people just walking along the sides of the streets and crossing the streets where they please--including little children.  Cars pass in any available area no matter what side of the road it's on and motorcycle taxis zoom past and between any space they can get through.  I can't believe I haven't witnessed one accident yet.  On the sides of the roads are shops, restaurants, homes, etc.  People set out whatever they have to sell on the sides of the narrow streets. I haven't gotten any good pictures of the city, roads, and people yet, but will try to soon.

There are multiple big volcanoes around this area, but there is one massive one that we can see very well to and from the drive to the hospital. It is called Nyiragongo and is one of the most active volcanoes in the world! It is twelve miles from the city.  In 2002 when a group of doctors was here with HEAL Africa, including my dad, this volcano erupted and destroyed a huge amount of the city, including parts of the hospital.  The streets, buildings, cars, and houses were demolished by the lava flow, and some of the damage can still be seen.  When it is not too foggy or hazy out, Nyiragongo can be seen smoking from the top.  I'm trying to get a good picture one of these days on the ride to or from the hospital, but it is so hard because of all the buildings and rainy, hazy weather.

Tomorrow we will be back in the OR for another full day of surgeries. I may get to scrub in and help with some of the procedures! Updates to come!