Since returning from Safari, I've been extremely busy. I gave 4 lectures in three days. Since Tenwek now has a CT scanner (just opened 4 days ago) I taught a session on reading head and neck CT scans. Tuesday I taught on Head and Neck disorders - a topic that covers most of my specialty, but I thinned it down to 45 minutes by skipping nearly everything! Also Tuesday I taught a lunch session with clinical officers on handling nosebleeds. Wednesday morning was a session on Approach to Neck Masses. Again, a huge topic boiled down to 30 minutes.
I was relieved that they went well and I could focus on patient care the rest of the week. Wednesday after lecturing I repaired this baby's cleft lip. The result wasn't perfect - which is the only thing I'm not happy with, but the family was pleased and this kid won't grow up as an outcast.
It's a national holiday here in Kenya. Heroes day it is called. But, I've been working all day but at a more casual pace than most days. Only one trip so far today to the OR (or theatre as it's called here). A young lady who presented to casualty (their name for an ER) with 5 days of lockjaw. This wasn't the tetanus variety, but the kind that comes from a persistent open bite deformity. Her pterygoid muscles were in chronic spasm, so we had to put her under anesthesia to reduce her jaw dislocation. She really needs a good orthodontist as this is going to keep happening over and over again. Since that will never happen, a surgery where the jaw is essentially broken and reset to give her proper alignment may do the job. Problem is, I have no room on my remaining OR schedule for it. So, we put an elastic bandage on and will see if she can get some banding and elastics from dental clinic after the holiday.
Being the holiday, I'm working without residents. So, I'm using nurses and nursing students as translators. In many ways, it made things easier as my words are getting translated directly, instead of being filtered by another doctor. They call me "daktari" which I believe is Swahili for "funny looking pale man." Some of the real young kids are genuinely frightened by my white skin. They sometimes cry just when they see me, then really wail in fear if I look right at them! I try to smile but maybe that appears like an animal bearing it's teeth. Come to think of it, my very presence used to frighten my nieces so maybe it's not just the white skin?
Finally, I want to close with the story of this young lady who we are desperately hoping to help. She has an aggressive tumor, called rhabdomyosarcoma. It's pushed her eye aside, is flling her sinuses and is growing near her brain. We're working her up today to determine if it has metastasized. If it has not, then we'll be operating on Monday to remove the tumor.
It seems that God has put all the right people in place to help her. I was worried about whether this tumor was into the brain, but a neurosurgeon arrives on Saturday. So, even if it has, we might be able to remove it with a craniofacial resection - an operation not possible without this unique combination of visitors. We have a radiologist here, who has been valuable in studying the films to make sure we can accomplish a resection. Amazingly, we also have a pediatric oncologist here who is assisting in her work up. I am praying that this tumor hasn't spread. If we an remove it, she'll still need chemotherapy and possibly radiation, but she'll have a fighting chance. Without surgery, her prognosis is dismal at best. Your prayers for her are needed!
I still feel so blessed to be here! My energy levels remain high as I realize my time here is approaching a rapid end. My surgery schedule is full, but patients continue to come who need surgery. I wish there was a way to even things out. My first two weeks, when there were two ENT's here, we weren't overly busy. Now, Im wishing I had more time to help some of these very unique patients. I miss my family, but I know that they understand my call to be here and try to help. Thanks to all who continue to pray for these people and my ministry here.