GHANA - DAY 18

Third (and last) shift at the Effia Nkwanta Regional Hospital general surgery department. A closed comminuted tib/fib fracture, new clothes and a new job!

There were 4 procedures on the orthopaedic list today. Three hips (of varying procedures) and a comminuted fracture repair. The first patient was supposed to be a hip repair (as demonstrated by the doctor when I asked him against the x-ray 🤣), but they hadn't organised blood in case of they need a transfusion.
They were O- as well which is rare here too and so they were still waiting when I left at 1400.

I watched the repair of a closed comminuted fracture (a bone broken in at least two places) of the right leg. Which had happened as a result of a car accident where they were driving. A tourniquet was applied to the leg (and preemptive TXA) given, to limit bleeding as much as possible. The surgeon cut on the lower leg and pushed the plate up to disconnect the muscle from the bone.
This part was brutal! They then needed to take x-rays so he knew how well it was positioned (I think he might have taken about a thousand!! 🤣). Those of us without lead aprons were thrown out whilst this was happening. It was so interesting and after the surgery I chatted with the surgeon about the procedure and asked if he'd cut the whole leg open, would he have needed to use x-ray?. He said no, but that it's a matter of physiology. The technique is called MIPO (Minimally Invasive Plate Osteosynthesis). The idea is that the tissue surrounding a severe comminuted fracture like this would remain intact and serve to heal the bone faster and protect the site.

The main advantage of MIPO is that it does not interfere with the fracture site and so provides improved biological healing, and the plate has better angular stability. If opened up fully, the small pieces of bone become dislodged and it's essentially a puzzle, which is harder for the surgeon, and more detrimental to the patient and their outcome. However, the obvious disadvantage is the almost excessive use of x-ray to check placement and position for inserting the screws. There is no cast applied after the surgery. The patient is advised not weight-bear for 6-8 weeks.

I also asked how long the limit is for the tourniquet to be on, he replied that for the type used this morning around 2 hours because we're unable to control the pressure or know about the perfusion. He described systems that could have been used to allow us to know what the pressure was, and also to be able to ease the pressure off and then back on again after 2 hours to allow perfusion.

During the procedure the anaesthetist asked my name... When I told her she said "are you Tuesday born?" (😲WTF🤣) I nodded yes and she said "your Fante name is Abena". I really rather like it too 😁 I'm still wondering what made her say Tuesday 🤷🏻‍♀️

After bidding a fond farewell to the lovely sisters in the main theatres I headed back to the house and a few of us headed back to the sea stress to collect some clothes... I keep accidentally getting clothes made 🤣🤣🤣 I love these as much as I loved the last outfit too!!!

When we got back the lovely ladies that make our food had made kokonte (like fufu, they're both made from cassava) and palmnut soup for themselves (it's a traditional Ghanaian dish) and because when I'd asked for fufu this morning they'd said next week, and I won't be here (I'm at the village) they saved me some especially! ❤️ It was very nice!!

Then, the best news of the day? I have a job!!! I applied for an NQP (newly qualified paramedic) role within SNEE (Suffolk and North East Essex) and I got it! I still can't quite believe it. It'll take a minute to sink in. But I couldn't be more pleased, or proud of myself! My dream has almost come true!!

I'm going to bed, very content and thankful. For so much.

**Photos taken and shared with permission**もっと詳しく