The stride continues to progress here in Togo. Surgery is busy, and could be even busier. The need is here, but our hands are few. So far the extent of surgery has ranged from long bone fracture reduction and stabilization (by various methods), cystoscopy, c-section, skin grafting, I&D's with various degrees of debridement, and hydroceles to name a few. As far as general surgical skills, they've come in handy a few times for hernias, but especially for typhoid. The number one cause of perforated viscus that I have seen has been typhoid. It is rarely seen in the US, and even then it's only some slight thickening of the ileum seen on CT scan for which the Radiologist has proudly thrown typhlitis into the differential, which gets lumped into those differentials all treated with IV antibiotics and we all move on. Not such a happy ending here.
First, the patient doesn't present until at least 10-14 days after onset. By this time, without treatment, whether appendicitis or typhoid, there is high likelihood perforation has already occurred.
Second, there is no CT scan. We can obtain an xray, which could potentially hasten our trip to the OR if it shows frank free air in the abdomen, but usually doesn't add a whole lot to diagnostics.
Third, there is no minimally invasive surgery. I try to respect the abdomen enough to limit my approach, but open... is open.
Why?
The Hippo pond; the Harmattan haze creating a softened effect which hides it's true purpose.
It is the main water source for the many villages surrounding Mango. The hippos are not seen in the previous photo because they were across the pond. We had all gathered for a baptism of two Fulani believers as well as one of the MKs (missionary kids). Next to us a small group of kids, large plastic containers in tow, rode their bike out into the pond, pausing on the edge of an island which allowed water deep enough to fill their container.
Considering the water source is contaminated and there is no sanitation, from beginning to end it's perfect for the spread of disease. I'm surprised it has only been three typhoid perforations in two weeks and not more.
The Oti river runs by Mango and is in the distance running through this valley. You can see the Fulani herd of cows grazing. Well, kind of see them, if you squint through the haze.
Drink a clean glass of water today and pause a moment to appreciate it.
Much Love.
Finally had some dedicated time to catching up and following the posts. Thank you so much for sharing the journey! I love hearing about it all. Just this week in bible study we were reminded of our "job" of being faithful and obedient to what we are called to do to the best of our abilities, trusting God to equip us for that work, and leaving the results up to Him. It is His work, and He is faithful. And He lets us join Him in the "doing"!
Think of you often and offer up prayers. Mizpah.