Thursday, June 4th

Today was the day the visiting surgeon came. We went to prayer, ate breakfast, went on rounds and then went to surgery. Keiko scrubbed into the first case which was a laparoscopic appendectomy. The surgeon only charges the patient $100 for the surgery and he bought all the equipment himself. He owns it and he brings it with him in his car wherever he goes. I was talking with the anesthesiologist and I bagged that patient for the entire case. He was telling me how to only use two fingers because it was a two liter bag and the tidal volume was only about 500ml. The surgeon was a great teacher and showed us everything in the peritoneal cavity via the scope. 

The next patient I scrubbed in for. It was an anal fissure that was accompanied by constant constipation. We were there to cut the internal sphincter to relieve the patient. First he had me examine the anus with my finger in the anal canal to look for any polyps. After a negative screening we proceeded with the procedure. We felt the external sphincter and then he made a parallel cut on top of the internal sphincter. Then I took the foreceps and held the muscle body while he cut the sphincter 2/3 of the way through. This was to increase the anal opening so the patient could still have control over bowel movements but wouldn't be so constipated anymore. We didn't sew anything up. Instead, the surgeon cauterized the incision and the fissure. Then we made a gauze butt plug, covered it in lube, and made sure it was secure in the patient for recovery. 

After that the surgeons invited us to come with them to the next hospital for the rest of the surgeries that day. So we went, grabbed lunch, and headed over to the government tribal hospital for two hydrocele surgeries. Keiko scrubbed into the first one which turned out to be much more complicated than we thought. The testicle was as big as a cantaloupe and when we cut it open, a lot of clearish but yellow tinted fluid came out. However, we discovered he had an inguinal hernia because we also found his cecum in his testicular sac. So the surgeon literally shoved all his intestines back into the abdomen and then recreated the posterior wall with a polypropylene mesh. Then he thought the bladder might be in the testes too because there was another structure there as well. So we threaded a catheter up the urethra and ruled out the possibility of the bladder being in the testes as well. Then he put in drain and sewed the patient up. 

The next case was much simpler, it was a plain hydrocele, but it was just as big. I scrubbed in for it and we turned the testes inside out so the lymph would drain in the future. Then the surgeon put in a drain and stitched the patient up.

We came back to the medical center just in time for dinner. Then we played games, wrote thank you cards, and read before going to bed.