6/21/11

Tuesday was both better, and worse. I had decided that I didn't want to spend all day in the Theater if nothing was going to happen for most of the time, so after waiting there for a little while for a surgery to happen I went over to the dental clinic, which deserves a bit of a description.

The dental clinic is one small room with a chair, a lamp, a drill that's been broken for 10 years and a whole bunch of pliers. The woman who works there is a dentist who's lived in Iganga all her life, and has been working in this clinic ever since she was trained. Long ago, she filled cavities and cleaned teeth here, but when all of the equipment broke she became a one-stop extraction shop. Five patients file in, one at a time, and after a cursory examination of the tooth that's hurting she gives them each 5mL of lidocaine in the gums and sends them back out into the hall. Then the first (hopefully by now anaesthetized) patient comes back in, and she reaches in with some very scary looking pliers, pops out the tooth quick as you're reading this, and sends them on their way (presumably someone outside the room explains what they're allowed to eat and when to wash the clot out and everything, but it sure doesn't happen in this little room!). The sheer quantity of teeth she pulls is staggering.

Superimpose on this two things. Firstly, many of her patients are children, and they often have to be held down as they're shreiking blood-curdling screams in terror and pain. Secondly, her personality is incredibly quirky. After sending these children away, bloody and tear-stained and at least one tooth lighter, she'll often do something like look at the bloody tooth, then look at me, and ask something like "Am I a savage?" All in all, it was a very weird experience.

Just before lunch, Anne Marie and I went to the main operating theater to see a Caesarean section. Just as it was about to start, however, another surgeon insisted that I come with him to see an adult circumcision, so I missed the C-section as my first-ever observed surgery and saw that instead. As a side note, it was here that I discovered that Ugandans are CRAZY TOUGH. As a surgeon later told us, "Ugandans do not fear even death." Because circumcision reduces HIV transmission rates by 60%, they circumcise as many adults as they can find over here... and in an environment in which the patient is all but forced to watch the entire bloody procedure, this guy joked the whole time, and even took a phone call in the middle of the thing!

Anne Marie had mentioned that the C-section had been pretty intense, and we went into the operating theater after lunch to find that the infant had not improved, and some 2 hours later was still being respirated with a little hand pump, the best the hospital has. He couldn't breathe well on its own, but could gasp about once a minute. He clearly had liquid in his little lungs, but wasn't strong enough to cough it out, and we had no way to remove it. He was very much alive, and in the US, would have been fine - placed on oxygen, put in an incubator, he would have finally gotten strong enough to survive on his own. But the hospital had no oxygen - it apparently costs about $25 to refill, and the hospital hadn't the funds or the means to get to Kampala (3 hours away, and somehow, the only place to refill the tanks). And the hospital certainly had no incubator. Just a little hand pump, and finally, a nurse who got tired of trying. I took over with the pump, and got really, really emotionally involved with this baby's survival. It was incredibly hard knowing that he was probably going to die - feeling him get colder, feeling his pulse get weaker and weaker, watching his lips and gums turn white, but all the while seeing him gasp for air between my rescue breaths, knowing that he wasn't dead yet and shouldn't be. About an hour later, I couldn't feel his pulse anymore. I was devastated. I went around back and for the first time in a really long time, bitterly wept.

I really couldn't get over how insane it was that for lack of a $25 oxygen tank, this baby died. It never would have happened the US - the obstructed labor would have been emergency C-sectioned immediately, not 2 hours later, and the baby would've been rescued with some basic oxygen. And yet. Perhaps the worst part was all the doctors and nurses comforting Anne Marie and I (who were certainly the most affected) with fatalisms. The baby had to die. It was God's plan. We left the hospital early, both pretty heartbroken, and for the first time confronted with the dark side of developing world medicine - all the death.