Dr. Sherif Emil's dispatches from Rwanda: The first (not so) easy case

Dispatch #4

I started my day today at 6:30 AM and got home around 8:30 PM. My first meal was a banana at 4:00 PM. For some reason, you don’t feel hunger and fatigue in Africa the same way you do in Montreal. It is almost like the strength of the people here invades your body and soul when you arrive, and you learn to survive on less.

Out of more than fifteen cases that were planned for surgery in advance of my arrival, we’ve only operated on three in the last four days, two nephrectomies for Wilms’ tumors and a thoracotomy to explore an esophageal stenosis. The rest of the time we’ve been taking care of acute problems in newborn babies who arrive daily – bowel obstructions, esophageal atresia, imperforate anus and gastroschisis. 

I thought today would end early around 4 PM. Just as we started to round, the emergency room called us for a 4-week old baby with a possible strangulated hernia. Immediately upon arriving to see him, I could recognize the look on the mother’s face. It was the look of apprehension and worry in a parent of a beautiful healthy baby who suddenly falls ill, not the look of resignation I see on many parents’ faces here.  I’ve seen that anxious look everywhere I’ve practiced, whether it was California, Quebec, or Africa. Parents come in every color, creed, and culture, but they all share one thing – profound love and dedication to their children.

We try to reduce the hernia and fail. Within a short time, we are taking the baby urgently to the operating room.  All pediatric surgeons, including myself, anticipate these operations to be difficult. But here, despite the worse lighting and the blunter instruments, this will be the easiest operation of the entire week. We find the intestines stuck in the hernia to be ischemic, but not necrotic.  Had there been just a couple of hours delay, the intestine would have died and the baby would have had a much worse prognosis.

We are able to successfully reduce the intestine and repair the hernia. This is the first patient I’ve encountered this week who presented and was treated no differently than if he would have been in London, Los Angeles, or Montreal – a very satisfying feeling at the end of a tough week.

Dr. Sherif Emil is a pediatric surgeon and Director of Pediatric Surgery at the Montreal Children's Hospital. His trip to Rwanda is part of a McGill program to train surgical residents at the National University of Rwanda and the Centre Hospitalier Universitaire Kigali.

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