Frustrations Abound

Fem and I were consulted to a case today of a 31 year old woman with a large "abcess" of her inguinal region. When we went to see her, we found a large, actually visibally pulsating mass that was causing this woman to have severe burning pain down her leg. Amazed that the nurses didn't realize that abscesses normally don't pulsate and that this woman had been sitting there since the day prior, we quickly realized the severity of the situation. A dissecting femoral artery aneurysm of this size could burst at any moment, and our hospital is not equipped for a major vascular surgery such as this other than clamping the artery off completely to prevent her from bleeding to death. After finding out that no ambulances would be available for at least 8 hours (EMS service here is stretched thin/ is more of a non emergent transport system), we made arrangements to have the helicopter come and pick her up and take her to a larger hospital. This was only to be followed by a phone call back from the helicopter service telling us that the accepting surgeon, who had never spoken to us or seen this patient before, refused to have her transported by helicopter, as he did not feel this was an emergency. How frustrating!! 

After much arguing over the phone and attempts at convincing the helicopter service that we could not afford to wait all day for the ambulance. We had no choice but to book her the next ambulance for transport. With all of the speedbumps and dips in the roads out here this woman will likely be lucky to make it alive to the next hospital. I hope luck is on her side tonight. Sometimes I just feel like everyone is working against us here. I don't know if this doctor just did not trust our diagnosis or was overwhelmed already with his own patients and did not want another, but I can't help but think about how lucky we are back home to have such a relatively excellent health system. 

On a happier note, I was able to successfully perform my first LP (lumbar puncture/ spinal tap) today completely unassisted! Also saw a woman with probable miliary TB.... Her chest X-Ray was incredible! 

Back home at the house I'm staying in, it is extremely busy. 16 people showed up for dinner tonight and the Fredlunds have a brand new kareoke system that has been being put to very good use. For dinner we had traditional maize meal with a peanut sauce and mashed butternut squash, which was delicious. 

Back of the Fredlund's home.

View from the back deck...

...and now I'm off to bed!!