UNUSUAL OBSTACLES ON THE PASSAGE.
As we were preparing to go on medical mission trip someone commented: "expect the unexpected". Tenwek Hospital in Bomet, Kenya was the same place where we served a short term in 2009. The place and most of the people who work there were already. Familiar to us. We landed in N air obi on the second of September and the following morning we were on our way to Bomet by car. Samaritan's Purse had arranged for this road trip for us. The highway from Nairobi leading to Bomet is pretty good indeed. It took about two hours to cover the approximately 150 kilometers, climbing up to this city about 8000 feet above the mean sea level.
Traffic jam is nothing unusual or unexpected for any one from the developed or developing countries. It could be an accident on the road blocking a lane of traffic or it may be some strange thing on the side o f the road making people to slow down and stretch their neck to have a good look at it.We call it "rubber necking". As we got close to the county of Bomet t he traffic almost came to a stand still. We could see the welcome sign to Bomet just ahead. A large herd of donkeys were filling up alll the lanes ahead of us producing the obstacle to our passage. Each one had a heavy load on it's back- the provisions from the market- carrying it to it's masters home. Saturday was the market day in Bomet. These beasts of burden for Kenyans are what pick up trucks are for people elsewhere. We had to patiently wait for them to slowly move away from our path and then to proceed on our way to the hospital just five kilometers ahead.
Seven years old boy was seen in casualty department (that's what we call the Emergency department here) with acute small bowel obstruction. He never had any previous surgery and the cause for his blockage was uncertain. He was taken to the theatre(operating room). At surgery a large soft mass was encountered in the mid portion of his small bowel. A small incision was made in to the small bowel and hundreds of round worms were pulled out from the lumen. They had tangled up there and blocked the passage: an unusual sight for a visitor but not for the long term missionary surgeon or the theatre crew!
Nine years old Masai boy was admitted to the pediatrics (that is how we spell it here) ward with several days history of abdominal distention,pain, fever and deepening jaundice. He sure was sick looking and had an enlarged and tender liver filling up his belly . Ultra sound study revealed a large cystic mass on the top of the right lobe of his liver filled with multiple smaller cysts. Rest of his liver contained numerous small cysts. At surgery the large cyst was excised from the liver after instilling diluted formalin inside the cyst to kill the live parasites in it. Lot of "daughter cysts" were seen inside the large cyst when we finally oped it. Hydatid cyst is nothing unusual among the Masai tribe. Parasites blocking the passage of bile! An unusual case for the visitor, but not for anyone else in the theatre!
Ten years old boy was scheduled for placement of a ventricle peritoneal shunt for relieving his hydrocephalus. The normal passage for the C.S.F was blocked from the tuberculous meningitis that he had few years ago. Tuberculosis is wide spread in whole of Africa, children are not spared from this dreaded disease. Blockage in the brain from tuberculosis? An unusual cause in the developed countries; not so in Kenya.
Twenty years old Kenyan was recovering from his surgeries following a fight he lost to the large obstructing creature on his passage one evening when he was returning home. Neither the elephant nor the man really wanted to yield .our patient lost the fight sustaining multiple large wounds. He was gourd on the left chest, broke the ribs and tore the lung, heart and major vessels were spared. Had a deep wound on his right groin but the femoral vessels were intact. Deep gaping wound on the right side of neck, carotids soared. a large gaping wound on the back of his head; will need a rotation flap to cover it. I am still wondering who was obstructing the passage: the elephant or the man!
Stay tuned; more to come.......
