Today started as usual with ward rounds, visiting my patients: Stephen, baba with DM and Mr. SO whom we operated on for appendicitis. I really feel sorry for Stephen’s dad.
Then we went to the OR where we had one scheduled surgery and one emergent ex-lap. The scheduled surgery was removal of a breast mass; turned out to be a chocolate cyst (grossly). I really enjoyed having scrubbed in. I started the IV line and first-assisted; also got to close the skin. I really do enjoy surgery especially on days like this when I feel competent; when the operation went well, when I closed skin properly, when I feel I helped the team help a patient.
The second case was interesting. A man in his 60s/70s presented to the hospital after a road traffic accident in which he obtained rib fractures and perineal laceration. He also had an acute-appearing abdomen with left quadrant tenderness, hypoactive bowel sounds and free air on x-ray. We were concerned about stomach/small intestine perforation or splenic laceration. The interesting part of the story is that upon entering his abdomen, what we found was indeed a perforated viscus (small intestine) but there were surrounding adherent exudates to suggest bacterial perforation such as typhoid perforation, not due to trauma. His spleen and other internal organs were fine. We wonder if he was ill preceding his accident; I’d find out from him on rounds tomorrow
After the OR, went to physician conference where Dr. Aremu talked about the responsibilities of family physicians to their patients. There was a post-presentation announcement about ensuring patients pay their bills up-front especially in non-emergent cases. The thing is that this is a small town where many of our patients cannot afford the hospital bills; many go into debt as a result, but the hospital needs funds to run to be able to keep helping patients; there really is a need for a national/state-wide health insurance system.
Overall, I’ve had an excellent experience here in Ogbomoso. The physicians here do so much with very little. I admire the tradition of praying before every surgery and before every clinical encounter. There is obviously room for improvement, need for specialists such as pathologists, cardiologists and ICU physicians, and need for better diagnostic and monitoring equipment such as ECG monitors (there isn’t one even in the ICU) and CT scanners (especially given the volume of patients that present with head injuries). I think though that beyond the hospital and immediate control of hospital personnel, general road safety urgently needs to be addressed. Too many patients present with and die from otherwise preventable injuries secondary to road traffic accidents. Also urgent, is the need for a health insurance system as too many patients end up being turned away or under-treated due to inability to afford medical services.