Time to Update

I have elected to not update during the week in Chone. Spanish keyboards are a pain, and its too much work to upload pics without a jump-drive. I figure its easiest to start out with whatever first comes to mind... which is surgery. The two Docs I shadow are orthopedic/trauma surgeons: Dr. Vera and Dr. Robosky. Both are great surgeons and always work together... not sure how common that is amongst orthopedic surgeons. They work Tuesday and Thursday and it is one of the highlights of my week.

The latest surgery I saw as the amputation of a man's left leg. He was diabetic and cut his foot on the inside of the his heel. He didn't take care of it and he was admitted the day before surgery with some pretty bad necrosis. The tissue had died in an area about four square inches on the inside of his foot. As one can imagine the amputation was pretty gruesome. They just did local anesthesia to block him from the waist down... the poor guy was conscious for the amputation of his left leg. They started by just cutting skin with a scalpel, then used cautery to cut pretty much everything else. The docs showed us the sciatic nerve and also put my finger on one of the major arteries (I was scrubbed in), which was cool too feel/see an artery directly. They cut his leg about mid-femur. When they got to the bone they used a file that looked like a rope with two T-handles on both sides and see-sawed right through the femur like it was nothing. The patient kept picking his head up and looking, and the surgeons kept telling him to stop... not sure what I'd do in his situation. Then they sewed him up and it was only about a 30 min procedure not including anesthesia. 

The above picture is of the OR. I believe there are five total, I haven't seen them all. The fore-mentioned surgery was this last thursday. Tuesday we had two patients. The first was a 9 year old girl who cut the top of her foot and needed to top tendons/muscles on her foot sewn back together (it was a lot like the machete wound, but the foot). The second surgery was a young boy who broke his radius and ulna playing soccer. It was pretty bad break, both bones were broken completely in half. They put a rod in the radius and a plate with five screws in the ulna.

Above is the public hospital in Chone where I work: Hosptial Napoleon Davila Cordova. Its the only public hospital in the city and within a two hour bus ride for that matter. The hospital sees mainly people from Chone and the "campo" outside of the city, but its public and open to anyone. There's also a social security hospital in the city that is private. The pediatric ward can hold 40 patients as with the floor above (internal med). All hospital employees are government employees and all the care provided is free to Ecuadorian citizens (paid by the Ministerio de Salud Público). I still start every day with pediatric rounds with Dr. Díaz and then depending on the day I end up somewhere else (tuesdays and thursdays are surgery days). Friday we did a tour of the Neonatal ward in the hospital. There was one baby boy who was born premature (27 weeks 4 days). It was pretty sad/incredible to see the little guy on a ventilator. Everyone was kind of on their toes not knowing if he was going to make it. Today the word was he was doing well and his O2 sats were good off the ventilator. However, I don't believe Chone has an MRI so theres really no way to tell if he has brain damage. The rest of Neonatal was mostly newborns with colds or fevers.