The patients

There are some patients I meet that I will remember for a long time. Their names will escape me but their stories I'll remember. Sometimes the patients who make lasting impressions on me have good outcomes with happy endings but more often than not the patients who I remember are the sad cases with very unfortunate outcomes.
I met the patient above in the ultrasound room today. She is a 60 year old woman who came with increasing abdominal pain and early satiety. By the looks of her abdomen you would think she's about to deliver! But unfortunately this patient has an advanced stage cancer probably of ovarian origin. The ultrasound showed a ton of ascites and a large pelvic mass. I wanted to admit this patient to the gyn ward for exploratory laparotomy for diagnostic/therapeutic purposes, but the patient declined. Her relative explained that her family has no money and can't afford an operation. I told her that she would have to pay Tsh 6,000 (about $6 US dollars). She said she has to go home first to collect her belongings and discuss with her other relatives. I had to agree with her plan and I let her go home. (Unfortunately) I am not allowed to waive the fee for surgery or personally help patients pay for surgery. I'm sure the financial issue was one of the reasons for presenting to the hospital at such a late stage!!

Here we are preparing a patient for a cesarian section.

This young girl is only 22. She has a full term pregnancy, one previous cesarian section (when she was 16 years old) and she is HIV +. She came to the hospital alone, without any relatives! Although she does say that she has a husband, he wasn't around. The cesarian section went well but she had a ton of adhesions in the abdomen/pelvis. The baby had good apgars but we won't know if the baby is HIV+ for another couple of weeks.

I took this picture in the operating "theatre" just before the cesarian section. I'm lucky to use this operating theatre which was just constructed last year and opened about a couple of months ago. There is plenty of space and much better light source compared to the small, dark, operating theatre we had been temporarily using when I arrived in September!!