The last thing I want is for my blog is it to be a source that is fueling some kind of bad reputation for Ecuadorian surgeons, but I must be bad luck for Cholecystectomies even though I don't believe in luck. The reason I say this my first day back at Militar there were once again complications in an usually short laparoscopic procedure. I hate to beat this into the ground but I want to make it perfectly clear that these stories are written with no intent to disrespect any of the health professionals at Hospital Militar.
Above is the OR where most Cholelaps go down. This is while the surgeon is putting the four ports. This is the third different surgeon I have seen perform a Chole and its very intriguing to me how each surgeon has their own respective style. Like I commented before, one surgeon works between the patients legs, and the others to the patient's left. Every surgeon puts the camera port through the navel, but all other ports are respective to the surgeon.
From the beginning the surgeon continually made comments about what a pain this specific gall bladder was and how he had never seen one like it. He commented several times on how the excess fat surrounding the gall bladder made the surgery very difficult "Una vesÃcula grasosa".
While cutting the fat away from the Gall Bladder the surgeon accidentally made a small cut in the wall of the Gall Bladder. Right away bile started pouring out followed by many small gall stones. At this point the relaxed mood of the OR turned into a mix of frustration and hurry. Due to the location of the cut, the gall bladder essentially evacuated into the patient's abdominen. The surgeon wasted no time: he removed all the laparoscopic equipment and began making a large incision in the patients right upper quadrant, as shown above. One thing I found very surprising was how the surgeon called in another surgeon to help. From this point it was pretty routine.
Above is just before they stapled the gall bladder and cut it out. At this point the mood of the OR changed again back to the more relaxed, usual atmosphere.
Here the surgeon is inspecting the gall bladder. Where his left thumb is marks where he accidentally cut.
I never took the time to count, but these are all the stones that leaked out. This doesn't include all the stones that were still in the gall bladder. In my amateur opinion, this seems like quite a bit of stones!!
While having the patient open, the doctors also discovered this. New to me, it is a case of Meckel's Diverticulum which is an usually asymptomatic deformation in the small intestine.
Now i'm going to jump back to last week. Due to my unfortunate sickness the week before, I returned to Tierra Nueva in the Emergency room. This hospital is also called Padre Carolla, who was a priest in Quito. He started a foundation with the view of providing good, affordable healthcare apart from the public system. It is interesting that this particular has a lot of financial support from many international sources. According the doctors at Padre Carolla, this hospital falls somewhere in between public and private. It is open to the public but not free like public hospitals. Not to say that is not very affordable. A routine consult only costs a patient $4 and a normal birth costs $100. Unfortunately I don't have any pictures from Tierra Nueva so this section will be all words!!
The hospital is the second nicest and advanced one I have seen in Ecuador (please excuse my repetition if I have already talked about this). I only saw a few interesting cases while I was there, but I had the opportunity to spend a lot of time with several residents and interns and I learned a lot about some of the problems with the medicine in Ecuador. The first notable case I saw was a young girl who was having a heart attack. She suffered from antiphospholipid syndrome which from what I have found manifests as a very complicated syndrome so I not begin to try to explain for fear of giving false information!!
Another interesting case I saw was a 4-year-old boy who fell playing in the park. He hit his head on some metal part of the park structure and had quite a large laceration on his forehead. It stretched from below his left eyebrow across his forehead to his upper hairline. The cut was deep enough that you could see his skull. The kid was surprisingly calm, and I feel bad for him because he will always have quite the scar on his forehead. I asked the doctor about taking a CT and he said it wasn't necessary. Even though the kid displayed no signs cerebral damage it just seemed necessary to me, but thats simply my amateur opinion!
The one night shift I worked at Tierra Nueva was fairly slow. I worked from 8pm to 3am and the only case I saw apart from people with the flu was a highly intoxicated male who had fallen and cut his head. What was surprising to me was how this fairly small laceration was bleeding profusely. Blood was basically pouring out of his scalp, much more than the young boy with a cut four times the size. Maybe as punishment for being stupid and drunk but the doctor didn't bother with a lidocaine block, he just cleaned it up and sutured him up. This goes without saying but the man had a tough time dealing with the pain of getting his head stitched with no local anesthesia. He was heavily intoxicated however, so maybe he wont remember anything. After about 1am the ER really slowed down. I spent a lot of time talking to an intern about the problems Ecuador has in Medicine.
One major difference from the states is there are no "drug seekers" that come into the ER looking for drugs. Every patient that comes in is genuinely in need of help. According to the intern there is no problems with patients seeking narcotics due to a newly implemented system that makes it fairly difficult to get narcotics. I'm not entirely sure how this system works so I will have to get back to that. One problem she emphasized was antibiotic resistance. Due to careless administration of antibiotics there is a high prevalence of antibiotic resistance. According to her, doctors here have a tendency to give antibiotics that are much stronger than necessary, which has been leading to this problem.
Another problem she touched on was inadequate ambulances. Apparently it is rare for medical professionals to be present in the ambulances. This also depends on the hospital, because each hospital also has their own ambulances (public vs. private). A lot of lives could be saved if this system were to change, but right now there is only one school in the entire country that teaches EMT-like courses. A sad example is how she lost her brother a few years back because he was having heart complications but the ambulance had no one with adequate knowledge to help him and by the time he arrived at the hospital he was in a vegetative state.
I hate to end on a sad note but thats all I have for now. I'm back at Militar and i'm hoping to see some great surgeries this week because my time here is slowly slipping away!!
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