Did a few cases with the residents and saw some clinic patients with tough problems.

The new resident started on my service Monday and is a great guy. He is from Zaire and is returning there to practice when he finishes his general surgery residency this year. A very strong Christian, good surgeon, who cares well for his patients. He will be the only surgeon for his town, that has a population about 250,000. This means he will be on call every night and do all the surgical cases (general, Ortho, ENT, OB GYN, etc.).  

These guys have to be able to treat everything here--a very tall order. We did several cases together - tibial Sign nail, carpal tunnel release in patient with deformity of distal radius and carpal tunnel syndrome from old fracture, ORIF of ankle fracture, ORIF of displaced open patella fx about 6 weeks out, multiple digit amputation right hand same patient for trauma/ infection, I&D of open humerus fracture with severe infection.

They like being taught some of the more simple/low trauma cases because they don't get much of a chance to do these types of procedures with the overwhelming trauma present.

I saw another child today, about 6 years old, with very bad chronic osteomyelitis of the tibia from an old infected fracture, exposed bone over most of his leg, unhealed fracture. Most of the techniques recommended in the orthopedic literature to treat this kind of problem, which I have never seen in the US at this level of severity, are not possible here due to technical limits. We want to avoid amputation, but this may be inevitable with a destructive infection this severe and with limited options. Other patients with neglected hip fractures, femur and tibia fractures, elbow infections, shoulder fractures that we are unable to offer interventions for here. The infections here are very severe due to a number of factors: delayed treatment, poor sanitation and hygiene, limited antibiotic options, no ability to culture wounds and determine the actual cause, high HIV prevalence, etc. These factors result in overwhelming infections with limb salvage often not being an option.

More good fellowship with the other doctors. We commiserate with each other and try to help find solutions. Please keep praying for these people.

Thank you and God bless. 
Bob