You can wander through your photos and think different things…..
Why did I take that?
I can’t remember what that was!
Weren’t we stupid to do that.
I wonder where they are now? etc
This photo takes me back over a lifetime of medical practice.
The past…As a first year intern in Adelaide, in the days when specialists were not as plentiful, I was sidelined into being a temporary anaesthetic registrar for six months to cover a shortage. It would be not even an option in this day of many more available people. But it gave me the opportunity to have a hands on experience which has served me well throughout my years of practice as a surgeon. Almost all of my time in Ethiopia I had to give/supervise all of my anaesthetics when I was the surgeon. So for chests and abdomens, orthopaedic and urological procedures the responsibility for the anaesthetic lay with me. Sometimes I even had to unscrub and deal with a problem before getting back to the operation. And tiny babies are a special problem; this boy was vomiting and needed to have his abdomen opened. I was, once the child (everyone knew that he was a boy, in spite of the troubles which politicians seem to have these days!) was properly anaesthetised going to leave the management at the head end to a cleaner. The length of the trachea in which the tube had to stay was only a couple of centimetres long – if it moved up he couldn’t be breathed for; if it went in too far, one of his lungs and maybe even one and a half of his lung capacity would be blocked off! I can remember my years of specialist surgical training; I can remember leaving my parents and siblings for a life in a land with, to me, a variety of unknown languages and a totally different culture.
The present….Here was the first born son a young family whom they had watched for a couple of weeks as he vomited everything they fed him and they were afraid that he would die. They were unsure if they could trust this young foreign white man, in their eyes an infidel. But they came and all their hopes were hanging on this moment.
The future…He survived and they were very, very happy. But here I have to let my mind float away into the ether. What sort of education did he get; is he married; did he become a good boy and make wise choices; is he a blessing or a curse to those around him. But that is the future of every patient you treat – some you get to follow and know, others are just passing in the night. Do you wonder why I like looking at the photos on my computer?
I spent the last years of my working life in the University at Arba Minch. The city has a population of more than 200,000. The University has more than 40,000 enrolled students. I went there as the medical students were about to enter their clinical years. They were not ready to receive students in the hospital but we had to do so!
We travelled for the first time to Shashemane in April 1968. We had arrived in Ethiopia 16 days earlier and we were taken down the 250 Km ride by a couple of missionaries who were travelling further south to their station (another hospital 120Km on the road leading to Kenya). It was good to hear of their experiences in Ethiopia where they had been for many years. Our mission station was big and very busy. There follows an ‘Excerpt From: Barry L Hicks. “Have Scalpel – Will Travel.” Apple Books.’
We arrived in Shashemane at about three o’clock in the afternoon and were taken straight to the home of Dr Lindsay and Mrs. Marion McClenny, some of the loveliest people one could ever wish to meet. They were due to go on furlough in a few weeks and we just had that time to be inducted into the work. As we arrived and were introduced Lin, usually called ‘Mac’, told me that he had a patient he wanted me to see urgently – but we had time for a cup of tea first. (Tea provided by Americans! And hot tea at that.) By 3.30 we were in the hospital and we eventually got home for the evening meal at about 11.30.
In the mean time we had seen the patient he wanted me to see – a teenager with a right sided large bowel obstruction due to a huge caecal tumour – and two obstetrical emergencies both of whom needed surgical intervention; we had also seen a couple of other lesser emergencies. Mac dealt with the obstetrical cases – a high forceps and a Caesarean – and I did the right hemi- colectomy for the teenager.
I knew that I was going to have to deal with the obstetrical and gynae procedures as soon as he left and so was keen to learn all I could before he departed on furlough. The specimen of bowel removed from the girl, containing the large mass in the caecum, was sent to the only pathology laboratory available in Ethiopia at that time at the Black Lion Hospital in Addis Ababa. The report arrived exactly one year to the day after the operation. It was fortunate that the patient was not kept in the hospital until the report came back. Typical of patients in countryside Ethiopia, she never returned for any follow up anyhow, so I don’t know what happened to her in the long run.
Very early in my stay there I was asked to review the seven hundred inpatient lepers. I think that I was the first one with any specific leprosy surgical training who had ever been there and if not the first then certainly the first for a long while. In India I had learned a lot of reconstructive procedures and doing this review I had the twofold objective of finding those who could be helped by surgery and to discharge those who did not require inpatient therapy. Thinking about long term hospitalisation had changed rapidly in the few years prior to this period of time.
On the first count I found few who wanted surgery, basically because as farmers they valued strength in their hands above the restoration of the finer movements such as those used in writing – the majority couldn’t write in any case. Sadly also they were valued in their families because of the loss of sensation which allowed them to lift hot things, such as cooking pots, off the fire without pain. Many of them, although the infectious element of their disease had been cured, were left with marked deformity and shortening of their fingers.
I am, I guess, getting a bit lazy with the hot, muggy weather and the aging process. So what I am doing today, and may continue to do for a while, is posting a segment of Chapter 20 from my book ‘Have Scalpel Will Travel.
The chapter is entitled ‘A Different Culture’. I was working on a Mission Station as a Surgeon, which was a full time job. But soon I discovered that people had to be assessed and treated taking into account different things. One of these was their religion. For instance i) the dietary requirements can cause real problems treating a post operative case during Ramadan or ii) the strong religious commitment of some created unwillingness to be seen for examination particularly by a foreign infidel iii) There was a very high incidence of low large bowel obstruction due to volvulus and in treating this certain procedures, of necessity, needed the creation of a colostomy. This stopped them going into the mosque to pray. Sometimes they chose to die, although with experience we were able to reduce the incidence of needing a colostomy. This led to one of my areas of disagreement with the Surgical Department in Addis. I am delighted that my way has won the day all over Ethiopia by this time. As seen in the picture below patients, they often presented with infected burns on their abdomens – burnt to try and drive out the evil spirits causing the problem. Or often the patient had drunk the blood of an animal sacrificed to appease the spirits causing the problem. These last two situations were seen because of the animist background of the community.
My book is an ebook, presented through Smashwords. The author is Barry Hicks and you’ll have to decide if this article or the ebook is written under a pseudonym. It is easily found on internet by typing in Smashwords.com Have Scalpel Will Travel. Memoirs of an Older Surgeon. It’s cheap and I think an interesting read; you may or may not agree on that! There are no gruesome pictures, although I have many!