Night in Casualty

Where do I even begin with this one…

Last night, I decided to join 3 other medical students for a night shift in the Casualty/ER ward. We had planned a wine and cheese night at the apartments but I couldn’t turn this opportunity down and I’m so glad I did! Wow, what a eye-opening experience. You would think emotional too but you just have to learn to set your emotions aside. First, I just want to say that the Casualty ward was nothing like I had ever seen before. The beds are only a few feet apart with no separating curtains, patients are constantly moaning from pain, and supplies are limited. Doctors in the ward do all they can to help but sometimes their abilities are restricted due to lack of hospital funds. The four of us arrived at 8pm and immediately walked into a room to find a patient laying limp with his eyes rolled back into his head. Already not looking too good. Unfortunately, the language barrier made it difficult to communicate with his family but we finally understood that the patient had a history of seizures, was not taking regular medications, and had an epileptic episode at 6pm that day (it was now 8pm). I started to take his vitals, only to find that he didn’t have a pulse or heartbeat. After grabbing the doctor to recheck, we pronounced the 14 year old boy dead. That was my first case in casualty. 

The second patient came in with a horribly mangled hand from some sort of machinery accident. His thumb was split down the middle, he had lacerations down the side of his middle finger, and his index finger was literally ripped to shreds. You couldn’t even tell it was a finger, just a mangled mess of skin, blood, ligaments, and bones (sorry in somewhat of an advance for the graphic post). Dr. Malambo pointed to the med students and said “suture and amputate.” And so it all began. Two hours of cleaning, suturing, and amputating his index finger. My job was iphone flashlight holder while the 3 med students cut and stitched, cut and stitched, cut and stitched. The surgical environment was far from ideal. The man sat in a chair with his hand over a bucket while the guys were on their knees operating. We couldn’t even find a table to rest his hand on so one person had to hold his hand in place while they other two did the procedure. We gave him some lidocaine for local anesthetic but he was still in A LOT of pain. Despite the horrible condition, the guys did a great job as plastic surgeons. AND, guess who got to do their first shot…ME!! Alex taught me how to give a shot and then I gave him tetanus to prevent infection. It was actually pretty easy and I’m confident I can do another one now! The boys said my next task will be a suture so we are going to practice on some oranges later this weekend. 

 Zigi and Ben suturing

After the whole hand deal, a Maisi woman came in looking very anemic, dehydrated, and in a lot of pain. Maisi is the only tribe in Tanzania that doesn’t speak Swahili. They wear Maisi blanket wraps and often gauge big holes in their ears. Since the woman’s family only spoke the Maisi language, we couldn’t figure out what exactly was wrong. Ben struggled to find a good vein for an IV..he even tried to cannulate her foot. FINALLY he got one in her arm and thank God because that woman needed fluids fast. Dr. Malambo continued to examine the woman and finally figured out that she had a partial “spontaneous” abortion. I say “spontaneous” in quotes because woman will often try to give themselves an abortion, usually with a sharp object, even though it is illegal in Tanzania. Anyways, the fetus had been aborted, but the umbilical cord was still hanging out, which meant the placenta was still inside. Dr. Malambo told Zigi to do this one. He was the only one with gloves on and gloves are precious in Casualty…something that is so easy to come by in the US. Ben (who only has 4 months of med school left) instructed Zigi through the procedure for removing the placenta. Really a pretty crazy thing to watch. Besides those three major cases, we saw patients with sickle cell anemia, malaria, and a woman that was vomiting blood. Not a single dull moment in Casualty last night, definitely learned a lot, and learned the importance of putting any emotions aside—one of the most important things to learn in healthcare. 

Grace and I slept in this morning and Adam just walked in with breakfast. What a cutie making us breakfast in bed! Another student is coming today and we are having a welcoming dinner tonight. I’m excited for a day of rest and relaxation :) Sorry for the long post and graphic nature but it is what it is--Africa

 Adam made us breakfast in bed :-)