In which medical terms are used

I opt to go a bit out of order today, skipping over my exotic weekend day trip in favor of writing about my day yesterday while it's still fresh in my mind. (Random tangent: "Fresh" is a very hip slang word here. Someone asks you how you are and you reply not with "mzuri" (good) or even "poa" (cool), but "fresh", in English --> instant street cred.)

Although last week's attempt to observe a fistula repair surgery was thwarted by an untimely onset of patient malaria, I had learned at that time that a noted fistula surgeon would be visiting the CCBRT Hospital this week, with approximately five surgeries scheduled every day. So yesterday morning I hightailed it north on the Posta-Masaki daladala and made my way down the newly paved road to the hospital. (True, the paving actually only goes as far as the bar that shares the street with the CCBRT. But then, halfway's better than none, right?)

The CCBRT specializes in disability repair - they fix orthopedic problems like club feet and polio, eye problems, fistulas, and a few other specialized treatments. I threaded my way through the very crowded waiting room and returned to the fistula ward, a shabby but clean room with lots of light and beds for perhaps 25 women. Dr. Robert, who I'd met before, has his little office off to the side of the ward, assisted by an quiet but efficiently friendly nurse. Waiting for the cheif surgeon to arrive, the nurse decided that I was a worthy visitor (I think sometimes the sheer asking of questions earns one brownie points) and began showing me patient files and surgery logs, all of which helped me immensely to figure out what was going to be happening that day. She also introduced me to a fistula patient being successfully discharged that day - the patient had received a congratulatory kanga from the hospital and was happily trying to see how the color suited her.

So by the time we were called to the operating theater, I felt a bit more confident. I'd felt rather unprepared going in that morning, honestly. Fistula surgeries are simply never done in the States, or taught in med school, because they don't happen to US patients. I didn't know the theory of the surgery, or how long one repair took, or what made a surgery more or less difficult, or any of that stuff. Maybe it's because I'm a slacker and any good surgeon wannabe would have somehow figured it out, but some of it must also be due to the absence of the surgery in the West. Why learn or teach what you'll never use?

This post now becomes a little tricky, because I want to talk about the surgery but I also don't want some of my more squeamish readers to get queasy. (I see you, Matt Rocklin.) Even in sterile medical terms, it seems a little indelicate to describe in great detail on blogspot. Plus it's a tough surgery in terms of dignity - these women are already dealing with strange men (because all the doctors were men) in delicate areas. They don't need me further chipping at their privacy via the interwebs.

So I'll try to describe things a bit more experientially. The surgeon, in the traditional Tanzanian style, was very late - 3 hours late, to be exact, meaning that we didn't get to half of the scheduled women. Such is the country. I spent the extra time looking on during club foot repair surgeries (8 month old with two full-leg casts = sad panda) and drinking tea with the nurses. As a peace corps volunteer here told me, Africa is all about waiting, waiting and chaos.

Once the surgeon did arrive, he made his way quickly into the theater, where his first patient had been waiting for him ever since her scheduled surgery time 3 hours before, reclining peacefully. I introduced myself and he nodded courteously, but that was essentially the end of our conversation for the day - neither surgeon made another effort to talk to me for the rest of the surgeries. I really haven't done much surgery shadowing in the US, but I gather that it's not atypical for surgeons in any country just to leave onlookers to their own devices, so I was fine to just observe over their shoulders as they worked. It's not a particularly tricky surgery, though it certainly requires a lot of attention to detail, and luckily it's not a tiny orthoscopic thing or anything like that. So one can learn a lot via silent shoulder-spying.

Academically, it's actually a rather clever surgery, I think. It essentially involves making a new wall for the vagina out of tissue that's already there. At the end, the surgeons even check their work, filling the woman's bladder with blue dye to check for even the smallest of leaks. Very thorough.

But I felt a little bad for the woman - she's awake the whole time, with just an epidural for waist-down anesthesia, and the surgeons/nurses never tell her what they're doing or try to reassure her. They didn't even introduce themselves to her at any point. And there are little things the surgeons do for their own convenience that seemed undignified to me, like temporarily sewing the woman's body in certain ways so as to be able to see better. I know she can't feel or see it, but...I'm not sure. It's hard to know what I should be offended by here, whether it's different than surgery back home. Not that surgery back home is always inoffensive either, of course. It's confusing.

But despite mixed feelings, I'm planning to go back tomorrow. I'll never get a chance to see these surgeries for the rest of my medical training, most likely, and I actually like the environment at CCBRT a lot. It's a hopeful place. Also hoping to continue my record of not passing out (yesssssss).