From the capital we travelled north west for 4-5 hours to get to Djibo, on the edge of the Sahara not very far from the Mali border.and Tembouctou !! It is the end of the dry season and there is no grass to be seen but there are scrubby trees some with but many without leaves in thousands of hectares of sand. The road started with bitumen seal but the last 40 km are corrugated and potholed making the bus ride memorable for the wrong reasons. Several stops along the way to pick up or drop off people in places sometimes where no habitation is to be seen… and they start walking off between the trees across the burning sandy land…. temperatures at 3 pm in the shade 45-47 deg Celcius !!!
Dr Ken and Jocelyn Elliot meet me at the bus stop in Djibo and that after noon I sit in on his 3 times weekly surgical clinics. Amazing problems are seen …-longstanding fungal infections of ankle tissues,osteomyelitis with bone coming through the skin surface, prostatism, large inguinal hernias, some with rugby ball size hydrocoeles, maxillary facial tumours, genital tract tumours in a woman
With limited laboratory and X-ray facilities, diagnosis is by years of experience with an awareness that cure is an unlikely outcome in many cases. Ken has an exercise book with operating days 6 times a week booked up pretty much for a month in advance. Ken carries out more than 100 operations a month, gives all his own anaesthetics and provides an amazing service in acute and non acute operations.
Operating starts around 7;30 am and the next day was no exception. 2 hernia repairs, removal of osteomyelitis sequestra from a thigh, open prostatectomy, removal of ganglion, removal of bladder stone (calculus the size of hen’s egg)
Ken is teaching me the skill and art of operating on people who need repair from many things, from partial leg amputations to removal of large ovarian tumours, and in the 3 afternoons a week of clinic he passes on his wide experience assessing those to be operated on and those not (usually because of possible hidden malignancy)
As well as operating technique he teaches me the skill of, safe spinal anaesthesia, to ready the patients before we start operating.
I see at his clinic things I have never seen before like osteomyelitis extruding bones, eyes that are coming out from the sclera due to Vitamin A deficiency and infection with the only possible choice being to remove the blind eye under anaesthesia to stop the dull pain, traumatic cataracts, cystic hygromas growing from a childs neck and 2 weeks old babies with saucer size appendages present at birth protruding from their skulls. A young woman presents with a large vesico vaginal fistula . Ken removes 2 large bladder stones irregular and rough in nature from her bladder through her vagina So many large bladder stones causing recurrent urinary infection and so many hernias, one has to wonder if the limited water intake of the men here leads to constipation- straining at stool and hernias Maybe.
Meanwhile Tessa and Melioni busy themselves at the house in the compound living under the constant gentle hum of a fan moving the 45degree air about in an effort to keep coolish. and walking around Djibo which every Wednesday boasts the largest cattle market in the Sahel. Roads here are of sand and there are many small motorbikes as transport with some donkeys and camels for the back to nature types. Everything is covered with red dust
Soon enough the 28th arrives and time for Tessa and Melioni to fly back to New Zealand leaving me for for 8 weeks that will be filled with very constructive learning . I am hoping for both anaesthesia and rural surgery with handfuls of bush experience thrown in for good measure !!