Saturday October 1

A change from last week as I have been working in a couple of different rooms this week. This situation is quite normal here. Anaesthetic assistance spread between two rooms. I have been working in max fax (maxillary facial) and cranio-facial. There is a difference between the two so let me tell stories about one patient from each.

First in room 4 where Dr Gary Parker works for the most part. He has been on the ship for over 20 years having decided to forgo the opportunity of working in the US when he finally finished all his training. We had an 11 year old girl who was very pretty, all except for a large tumour that she had growing from inside her mouth. It had completely taken over the upper jaw on the one side so that she looked as if she had a grapefruit in her mouth, size wise. Her eye was pushed out of line and she had teeth within the tumour. The tumour prevented her from eating normally and she was underweight. (Again situation normal here). We thought we might have a problem passing a breathing tube but in the end it wasn't so difficult and we weren't too long in putting her to sleep.

During the surgery she needed blood. As a blood donor onboard I had been warned the night before that I might be required to donate a unit and therefore it wasn't really a surprise when the call came. Quite something to give a unit of blood and ten minutes later see it going into your own patient. One of three untis she received that day. There are not the facilities onboard to store blood as there at home and so we keep our blood warm by drawing it from volunteer crew members as its required. It does mean that patients receive whole blood and it does not need warming, but it does need a close match. She's making a good recovery so far.

My second story, although there are several from this room and its hard to choose, is a little girl 15 months old who had a small encephelocoele. (Swelling on her head) When she was seen by the anaesthetist, he realised that she had a problem with her heart. In his normal practice back in the US he works as a cardiac anaethetist. She appeared fit and well so it was agreed to go ahead with surgery. When she came to the operating room he was able to perform ultrasound of her heart and found that she had an enlarged heart. Surgery was performed and again she has recovered well. Her mum knew nothing about a problem with her heart. To talk to mum we had to use another patient who spoke the same dialect/language. Imagine, I'm talking to a translator in English who translates to Krio to the patient translator, who then translates into the mum's language. Now you understand why consultations can take so long! But to also have an anaesthetist onboard who could carry out a cardiac ultrasound and he was only here until yesterday morning. What's more is that I have contacted an organisation I know about through the time I spent in Haiti with another nurse. Truly Father organises these things and I am ever amazed by what He does.

But just one other little one to mention, as I said I've been working in a room with german cranio-facial surgeons and we have placed a V-P shunt in a baby this week. The shunt drains off the excess fluid from the ventricles in the brain and it passes down a tube which is placed inside the body to the peritoneum/abdomen. Not only are these uncommon in Sierra Leone we can prbably say with a degree of certainty it was the only one performed in SL yesterday. A crew member arriving from the States brought the necessary kit over. The baby is 11 months old and weighed 6kg. I'll let you know how he does.

And today - I'm on call and need to do chores, washing, ironing, vacuuming and hopefully later, if it stops raining sit out on a deck and read!