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8/18/05 (Thursday)

Our day today again was busy but not rushed.  We did 5 surgeries today, three of which were hysterectomies, the other were laparotomies for ovarian cysts.  This morning I saw a lady on whom Jane and I operated in June 2004 when I was here my first time.  She is from Colombia and had a Burch procedure for urinary stress incontinence.  Subsequent to her surgery she has had persistent pain where I put the sutures.  Her bladder function is okay but the pain is troublesome.  When we saw her this morning, the only recommendation I could offer was to operate again and take down the sutures I placed for the Burch procedure.  This could relax her bladder enough she would have some incontinence, however, I hope there has been enough scarring in that area so the bladder may still maintain good support and function normally.  At any rate, tomorrow we are going to operate and take out the Burch sutures so her pain will hopefully dissipate.  This is the first time I have seen this type of problem with this procedure.  It is frustrating to me to have this kind of complication in someone with whom I have no contact after the surgery.  I feel bad she has lived with this pain for over a year.  I certainly hope we can help her tomorrow.

We operated on Nancy, our cook today.  Nancy always cooked good food and made sure the food was safe for us to eat.  We now have a replacement who I feel is cooking okay, although one wonders about how safe it is.  Here there are two main components to every meal – rice and banana in some form.  Usually, the banana is cooked, deep fried, or baked and rarely raw.  Apparently, there are several different types of banana here and most of them are used in meals like we would use potatoes.  The bananas we have in the States are only one type here.  The deep fried banana actually tastes fairly good, especially when hot and crunchy.  Another type is served sliced lengthwise and sautéed in a pan and served hot.  It is quite tasty and sweet.  This morning, the new cook gave us her version of hot banana.  It was baked, hot, and the most tasteless and dry piece of something Phyl and I have ever eaten.  It just bunched up in your throat and you could hardly swallow it, even chasing it down with some form of liquid.  Of course we had rice to go with it.  Also, the meat for breakfast was some strips of beef that had been marinated in something.  It tasted okay but the banana was not to be ever experienced again if we can help it.  Phyl tried to not look like she didn’t like it but had a lot of difficulty getting the chunk swallowed.  We left the rest of the banana on our plate and most likely it went to someone else.  The Ecuadorian ladies who work in the clinic eat with us and they usually clean up everyone’s plates after we are all finished.  I did notice them whispering back and forth when they picked up Phyl’s and my plates as they were looking at the bananas still left on the plates.  I bet they ate them for us. 

For lunch we were served coconut crusted fish.  Now this fish was covered in grease and had this mixture of stuff on it that supposedly the coconut.  The fish was prepared whole…that is the head, tail, fins, etc were still there…all covered with the coconut batter.  You had to pick through the bones and other interesting items to eat the flesh of the fish.  Of course, this was served with rice.  One thing they do here is blend up fruit for our drinks.  We had cantelope juice this morning.  It is cantelope that is run through a blender.  Actually, it tasted fairly good.  It is much better eaten as a cantelope as far as we are concerned.  It doesn’t taste nearly as good as homegrown Indiana cantelope!  The biggest meals are breakfast and lunch with our dinner usually being some sort of soup with, of course, lots of rice.  Tonight, we had a cheese soup, which was mainly broth with chunks of cheese floating in it.  The cheese has a different flavor and it squeaks on your teeth when you eat it.  I have never eaten squeaky cheese before until now.  Thank heavens for rice!  At least we will make it through some of the meals! J

Prior to Nancy’s surgery, she invited Phyl to come over to see her kitchen.  She was so proud of her kitchen.  She makes some good meals here and serves not only us but the patients and families. 

Nancy's kitchen

Nancy's kitchen

So far this week we have done 14 hysterectomies, 5 laparotomies for ovarian cysts and masses along with tubal ligations, one microsurgery tuboplasty, one torsion of the testicle, and one gallbladder.  We have 6 cases tomorrow, one of which is a hysterectomy and the rest are laparotomies.  We will have done 28 surgeries by the end of tomorrow.  Our anesthesiologist leaves tomorrow evening so we will not have much to do on Saturday but sit around and relax.  We will stay here in San Lorenzo until all our patients have gone home and then we will return to Quito before heading back to the States next week.

Phyl has been busy helping keep the supplies for the OR cleaned and ready for use again.  All the linens that are used for drapes have to be cleaned by hand using this strange bar of soap to clean off the blood stains, etc and then they are put in a washing machine.  Phyl has been laughing at how the ladies load the washer.  She said they fill the washer to the top with linens to the point where there is not much motion when the washer is going through its cycle.  She unloaded the washer one time and took out 13 full sheets, several blue towels, and several other pieces of linen.  She wonders how they get these linens clean but they seem to.  At least everything looks fresh and clean after it has been folded and put into surgical packs and sterilized.  The instruments also are cleaned individually by hand.  All of this is done at one sink in a room that is quite warm and humid.  One feels very drained just working there for an hour, let alone for the entire day.  This indeed has been an experience for her.


Speaking of OHSA, tonight we made some evening rounds.  In one room there was a fan set up and running.  The cord that came from the wall socket ran along the floor and then ended in two bare wires, which were twisted on to the plug on the cord to the fan.  The wires were exposed and bare, no tape or other protection.  This connection was laying on the floor at the feet of several children who were barefoot.  It would be so easy to step on that connection and get a jolt that you would remember for some time.  One continues to be amazed at how things are up to code around here. J


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