The NEXT WEEK + photos

Day 4 (Thursday) 

for Neil was taken up with two taxing operations - the first one, a 10 day old baby with  a congenital abnormality called ‘Macrostomia’ (or a big mouth) which needed fairly prompt surgical correction or the baby could not adequately feed. The surgery went fairly well but with such tiny areas of muscle and skin to repair, it was tedious.  

Macrostomia = big mouth

Post-operative view

Secondly, he then embarked on a 6.5 hour operation to replace the oesophagus (swallowing tube) for a 29 year old man who had a strictured (narrowed and blocked) oesophagus due to inadvertently drinking battery acid. The operation involved using part of the man’s colon from his abdomen and passing it up through his chest in front of his heart and behind his sternum (breast bone) and relying on the blood supply from the abdomen to keep the colon alive and then join it to the oesophagus in the neck and the stomach in the abdomen, thereby by-passing the blocked oesophagus

 So hopefully, the man can eat normally again.  He has been fed by a tube in his stomach for about 2 years.  The surgery went well but was exhausting for all concerned.  Thankfully the early signs of the man’s recovery are good, but this type of major surgery in the Congo where one cannot open the chest to gain direct access to the organs, is fraught with dangers of the surgery and the post-operative recovery due to poor nutrition of the patient and therefore the potential for poor healing and infection.

After this exhausting day, the drive to our accommodation was interesting as there were at least 7-8 UN gun cars that we passed on the streets but we were assured there is “nothing of concern happening”.

On Day 5 (Friday) 

Dr Kimona, Director of Surgery, came back from leave to assist Neil with a large goitre.  Then it was time to tackle two other difficult cases – the first was a 19 year old girl who had her bowel divided in a caesarean section at a village hospital quite some way from Goma.  She had two operations there but still had bowel motion leaking out of her wound.  One further surgery after transfer to HEAL Africa was also unsuccessful. Neil has been consulted and try and gain some quality of life for her.  Surgery went very well and she is making a reasonable recovery to date.  

The second case involved a 20 year old who had undergone an illegal abortion somewhere in a village and her uterus and bowel had been perforated.  Although one surgery had been performed at HEAL Africa, she still had a major abscess in her abdomen which Neil has had to deal with.  These were lengthy operations and the frustrating part from Neil’s perspective was that he knew he could use different techniques and obtain a good result if this surgery was performed in Australia, but with limited resources and equipment here, he had to do what he could and trust that they will survive. 

It is heart-wrenching to see young women’s lives affected so greatly by inappropriate treatment - which again underlines the reason why we are here – to help train staff so they can teach and train others. 

Monday 

Neil was involved in an operation for a rectal cancer in an older man, but sadly the tumour was inoperable and he already had liver secondaries.  

He then embarked for a third time on a case of a 20 year old who’d had her bowel cut during a caesarean section, again in a village – a different village to the one he treated on Friday.  She also had bowel motion leaking out of her thin abdomen. The added risk in this case was that the girl was HIV positive.  

She has been in HEAL Africa for 4 months. The surgical staff had come to the limit of their knowledge on how to deal with the leaking parts.  She still has a long way to go to recover and her nutritional status is so poor that it will be a miracle if she survives.  This underlines the second reason why we come.  Sometimes the cases are beyond the knowledge and training of the local doctors and they really need our help.  Neil was exhausted after this case, as it was performed in a non-airconditioned theatre and took 3½ - 4 hours. He followed with a teaching session to HEAL Africa doctors.  Medical students brought the audience to 30.  Neil's subject were the management of  cases such as the three 20 year old girls with bowel perforation.