Introduced to the staff this morning at the 6:40 chapel service, which is held every morning, with attendance expected! Rounded on the ortho ward with the staff - lots of severe trauma, neglected treatment, BAD stuff. Did my first case - subtrochantic comminuted femur fracture - with a Sign nail. No fluoro like I'm used to, new technique, but it worked. I was quickly broken of my sterility paranoia by the way they do things here, kind of like a MASH unit. They do a great job considering what they're dealing with. The best part was praying for the patient as a group before cutting skin - including the patient himself, if it is a spinal.

The hard part is the level of trauma and neglect present before treatment - these would be hard cases in the US under optimal conditions. Second case was a tibia fracture nonunion 1 1/2 years out - osteotomy, takedown of nonunion, Sign nail.  Third was a boy with an open humerus fracture from a motorcycle accident at least several days out with a terrible infection - possible necrotizing fasciitis - which I cleaned out and will bring back for an ex-fix in a couple days. I pray that he is doing better then - this is a bad place to have an infection that severe. No vancomycin, poor hygiene, and no cleanliness - a set-up for amputation or death. 

Last case was a young boy (about 7) who had a crush injury to the right hand about a week ago that was pinned and then the fingers died.  Had to amputate his thumb, index and middle finger. Also saw some cases from clinic where they needed advice. Two year old boy with congenital tibia deformity - probably neurofibtomatosis, which I've never seen in practice- who may need amputation eventually - I pray not. Other cases not as bad. 

Had dinner with a medical missionary couple , typing, then going to sleep. There's a dog howling right in front of my window so that may be tough.  I'm really starting to appreciate clean water, which is thankfully available here. They filter it and give it to you in plastic bottles - I've been drinking it and am not sick.  The guy docs want to take me for a hike Saturday and see the waterfalls from the mountain tops - in one spot you can see 7 different ones at once. That would be great.  

Praying for a blessed day tomorrow, for my family's safety and comfort, for good news from home.

Bob