Week Four

Special Surgical Scrubs

 

My final rotation at GF Jooste is in the Surgical Ward and it has, so far, been a great week!  Each morning the surgeons perform ward rounds to review the cases of surgical patients. After rounds we move to theater (the operating rooms).  By far, the two most prevalent surgical issues that patients present with are 1) stab wounds, and 2) diabetes related infections requiring amputation.

In the general Cape Flats community, when you mention GF Jooste people will raise their eyebrows in a wary, disapproving way because they say, "that's where you go if you want to die."  The truth of the matter though, is that the hospital is located in one of the worst neighborhoods in the city and so its volume of aggravated traumas is enormous.  But to set the record straight, of the stab wound victims that present at Jooste, they have over 85% "save" rate.

So back to stab wounds in the ward... attackers go right for the heart.  Most of the stab wounds that I have seen have been left upper abdomen wounds.  In fact the first surgery that I observed was a stab wound of this kind that had penetrated and nicked the stomach as well.

The other recurring theme in the surgical ward is diabetes related sepsis and amputations.  This is a huge problem in the aging population, and because patients without medical aid (insurance) do not present for routine medical care, they often end up in the hospital with wounds that have gone too long without treatment.

On my first day in theater, I actually got to assist with an above the knee amputation (AKA).  I was not expecting that privilege whatsoever, but when the surgeon asked me to scrub in, I couldn't say no!  The level of sterility in the OR is mostly on par with standards back in the States, but the surgeons have to be more resourceful with the tools they have at their disposal.  For example, putting patients under general anesthesia is the exception not the rule.  Spinal blocks are used more frequently because they are less expensive and require less concern for recovery.  So the patient who presented for the AKA was awake the whole time!  Aside from the cauterizing tool (which I got to use a lot), everything else in the surgery was performed by hand, using blades, a saw, and a pitcher of sterile saline water.

Scrubbing in for surgery was an amazing way to spend my last week at Jooste.  The level of medical care provided at this hospital is great due in large part because of the Medical Officers (doctors) who choose to work here.  Given its reputation, there are a lot of other places that these qualified providers could find work (including the private sector), but for many of them (native South Africans at that), they come to Jooste because they care about this community; one where the people fight everyday to stay alive - and so they join the fight to help them survive.