More surgery, more admissions with problems that are hard to fix, more learning new ways to reach an endpoint. 

I fixed a intertrochanteric hip fracture in a Fulani lady first. We usually use a compression hip screw or IM nail under fluoroscopy but none of the above available so we had to improvise. I  used a distal femoral locking plate and a combination of 6.5 and 4.5 screws and made it work. I was praying about that one last night.  


Also did a quadriceps tendon repair that was torn for at least several months (also had ankle fracture in same leg), ex- fixed an open, comminuted supracondylar femur fracture, took out a retrograde femoral nail and hardware that was causing knee problems, reduced a distal radius fracture and placed a femoral traction pin in a morbidly obese lady with a hip fracture that we can't fix here. I saw a child, about 6 years old, with severe osteomyelitis of the tibia. He had an open wound on his leg from his upper tibia to ankle with exposed, contaminated tibial bone that had been present for several months. We will try to clean it up and mobilize the surrounding soft tissues enough to get some coverage and try to prevent amputation. We can't do the types of flap transfers that would help with this. Another patient with external fixators on both femurs and left tibia that have been there for about 3 months has an infection so severe that he needs an above-the-knee amputation, another guy needs part of his hand amputated, more of the same. It's a bit depressing when there are so many people with bad problems that could probably be fixed in the US - but I'm not in the US. God is good and we do our best.

Going to dinner at Rick and Debbie's house tonight - he's a pathologist and she's a nurse in the HIV ward, both Americans who live and work here now as medical missionaries. The fellowship has been great. Everybody understands the stresses of being a medical person here and they try to keep you going. 

I went to the school for the deaf, about a quarter mile from where I'm staying, with Rick and Yvonne Snell yesterday. Rick does general surgery and Yvonne has been working in the school for the deaf while here for a month. There are about 130 kids of all ages who live there as a boarding school. They are beautiful kids and were very happy to see us. Yvonne organized some crafts and Rick and I did our best to help. They loved getting their pictures taken, so we did a lot of that. Came home last night and had 7 REALLY BIG spiders on the wall above my bed - killed about half, the rest are under my bed I think.

Please pray for my patients, especially the kids, and for wisdom in providing care for them. 

God bless.
Bob