Viedma: Week 2

We started Monday just as we had started all the other days last week. Nicole was observing in surgeries in the morning. Will was with the children in the clinic. In the afternoon Nicole went off to the pathology and microbiology department and Will went in to observe surgery. The surgeries were pretty straight forward, just cleaning and re-wrapping some wounds. Nicole saw Tuberculosis, Paratuberculosis, Giardia, and a hand full of other bacteria and parasites.

Tuesday was scheduled to have 6+ surgeries, but most were put off to later in the week after a 5 year old girl who had swallowed flaming checha (Bolivian moonshine) suddenly began vomiting blood and eventually died.  She had been recovering at the clinic for over a week and the change in her condition took everyone by surprise.  All possible resources were diverted to her, but after endoscopy and efforts to cauterize the ulcers in her esophagus failed, she passed away.  This is the first patient that the clinic has lost in over 2 years and Dr. Romero is taking it very personally. 

Wednesday was the first day both of us were allowed to scrub in on surgeries. Nicole scrubbed in on a 10 year old boy with second degree burns over approximately 35% of his body all on his front, from his face down to his feet. Will scrubbed in on the previous patients brother, who had burned both of his feet, hands, and his face. Both surgeries were very labor intensive each taking about 2 hours to finish. Everyone involved was drenched in sweat after each procedure. The OR stays at a constant 85 degrees and gets warmer under the OR lights due to burn patients inability to properly thermoregulate. There have been a few procedures that we had to stop in the middle of to apply electric blankets and hot water bottles to the patients because their body temperatures would drop despite the ambient heat in the room.

Thursday Nicole went back to pathology to learn from the parasitologist, visualizing different ameoba, larvae, and discussing diagnostic criteria.  Will's only surgery for the day lasted 6 hours and required harvesting deeper skin from the adolescent's abdomen than is typically required for skin grafts.  Sadly, this boy's burns were 3rd degree and deeper, which meant that the fresh skin also had to be.  The last 2.5 hours of the surgery were exclusively suturing of the skin onto the boy's left hand.  Once the procedure was completed, the improvement was incredible.  Will is really looking forward to seeing the bandages come off in approximately 5 days.