A typical day at Mukinge-no such thing exists

A typical day at Mukinge begins with chapel at 0730. Then the docs and clinical officers (they're the equivalent of a nurse practitioner or physician's assistant) have handoff and turnover, discussing interesting cases from the day before or cases that came in overnight. Then, if you're on the surgery team, head to the OR.

Depending on our case load for the day, we would either round before starting the cases or one of the surgeons would round while the other started cases. I guess I should introduce the surgeons I worked with: Dr. David Friend and Dr. Cath Wallis. I totally forgot to take a picture of me and Cath while I was there. My brain was quite scattered the majority of the time. Jet lag.

Patients on our male surgical ward

Some days I would go on rounds, some days (busy days) I would just start cases with either Cath or David.

Dr. Friend operating

 Disclaimer: I will be talking about some of the cases I saw while at Mukinge. If you have a weak stomach, don't read further.

General surgery at Mukinge was very different than general surgery in the states. To begin with, the only imaging we had was ultrasound and Xray. No CT, no MRI. I never realized how much surgeons in the states rely on CT until I didn't have it.

I remember one of my first cases there. We were doing clinic (Tuesdays and Thursdays), and Dr. Missy Sandberg (one of the family docs there) popped her head in (which I soon learned usually meant she was bringing us something either really bad or really fun or both). She throws up an abdominal Xray on the box. Massive amounts of free air under the diaphragm-aka somewhere along this man's GI tract there was a hole. Dr. Friend told me at Mukinge that typically meant a perforated peptic ulcer in the first part of the small intestine.

So we did a big midline incision, found the whole and patched it up. And as Dr. Cath always says, "The solution to pollution is dilution!" So yeah we had to suck bits of food out of his abdomen and wash him out with warm sterile saline.

I had so much fun operating at Mukinge. In the States, generally I would be second or third assistant. Or just standing there scrubbed in watching the operation. At Mukinge, if I was scrubbed in, I was first assistant. Which was amazing experience! I learned so much and I feel like my assisting skills increased dramatically. I've been told to be a good surgeon you first have to be a good assistant. I hope I'm on my way to being a good assistant.

I also learned that general surgeons in under-developed places in the world literally are general surgeons. In the states usually a general surgeon pretty much just operates in the abdomen.

Not at Mukinge. The number of fractures we set, burns we grafted, gynecologic and urologic procedures we did far surpassed the number of abdominal operations. Dr. Friend really likes orthopedic procedures. I learned a great deal from him. I also learned I need to work on my upper body strength. This girl doesn't hold traction very well.

A bladder stone we removed-one of my favorite procedures from my time at Mukinge

smoothing out pieces of skin to graft onto a massive burn

Probably one of my favorite moments operating with Dr. Friend was when we were doing a SIGN nail. The patient had been hit by a car while crossing the street and had broken both his legs at different places. We were able to fix one but had to wait for the orthopedic team to fix the other. So we put this big rod in his tibia (your lower leg bone). It was a difficult procedure and took longer than we expected. At the end, Dr. Friend allowed me to sew up a few of the incisions we had made. When I asked him what stitch he would like me to use, he said, "How ever the Spirit leads you." Michelle, our anesthesia nurse, and I had quite a chuckle over that one. 

Me sewing up our SIGN nail incision

Needless to say, I gained alot of experience at Mukinge. I am so thankful to God for taking me there. As Lawrence and I prepare for a life of global medicine and surgery, I am grateful to be able to look back on this experience to know what I need to be trained in before we launch. Things like burns, orthopedic procedures, urologic procedures, C-sections. I need to learn all these things or at least have some exposure to them. 

I miss operating at Mukinge. I miss operating with David and Cath and the OR team. I'm thankful to be home with my husband, but a part of my heart will always be at Mukinge. 

David, Me, Michelle