Cutting away.

Some relationships don’t last. Cut them off. Certainly some bumps and lumps need to be cut off. Cancer is often cured by its removal. So much money is spent on face lifts and tummy tucks that it is almost unbelievable.

But, as I’ve mentioned in other posts, I’m going through slides and memories. I’ve been thinking, as I’ve looked at slides, about the reasons for which I have amputated kids’ limbs. I’ll tell you a few!

Personally I have not been involved in amputating a child’s limb in Australia. In Ethiopia I have done a lot – too many to count! I just want to mention the reasons. These are not listed in a time sequence, except the first.

The first one, and that soon after I arrived as a young surgeon (28) in the country, was because a kid, playing in the paddock came across an old unexploded Italian bomb. He succeeded in making it explode amd lost an arm, an eye and had a piece of bomb lodged in his heart. Three operations on the same boy at the same time. He did well and left – one armed, one eyed but with a normal working heart.

2. Another because he was run over by a train. He lost 3 limbs, both legs above knee and one arm below his elbow. I was not the first to operate on him but had later to revise a poor job. As he told me the story later, I wished that I had been the first surgeon, because if he told me the truth (and I have no reason to doubt him) we could have preserved more limb length than was saved. I had to reoperate soon after I first met him because there were spikes of bone sticking into his skin making every movement there excruciating.

3. One because of an electrical burn. He lost both his right arm at the shoulder and his left leg below the knee. He had other extensive burns and suffered tetanus infection before his eventual survival.

4. The majority because of no doubt well intentioned but faulty local healer treatment. Of these over many years we had almost one a week. The splints applied were too tight and post splinting principles of normal follow up were not practiced. That is you must release the splinting if there is any sign that it is too tight.

5. Certainly I had to amputate in lepers because of uncontrolled infection, but the only child with infection as the primary cause of amputation was a girl with extensive gas gangrene.

Often in these children there was so much severe infection that they needed quick early surgery to remove the mess and then reconstruction later. One I remember had 3 cardiac arrests on the table. Others were brought so late that they died , sometimes within hours of arrival, because of septic shock.

6. Several for limb cancers. The pictures, if I showed them, are revolting as they came so late. The smell often was nauseating, but you just had to hold it in, and get on with the job at hand!

There are some nice photos of happy customers below the line – no blood, few bandages.

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Pictures or Words?

Already some people have indicated their gladness because I put a marker across my posts if I’m going to show a few medically mild photographs. We all have different backgrounds but I’ve been thinking a bit lately about this issue. I wonder what people do when watching a news presentation about rioting or some natural disaster or catastrophic event and a nasty scene comes on. Do they immediately turn them off? Is it possible or wise to hide from these terrible realities?

Thinking again, I wonder if more damage is done by what enters the mind via the eyes or through the ears. Reports of the political discussions about the very abnormal sexual behaviour being accommodated, or the legal destruction of life, both at its beginning and its end, entering the mind by reading or hearing, in my thinking, immunises minds against truth. I’ve read of high school kids being expelled for insisting that there are only 2 sexes. I personally think the authorities should be expelled.

Some may explain me away as a psycho-pathological religious nut. But it is they who are forsaking science for emotive who-ha. Please don’t think that I’m totally naive.

I had a young trainee Orthodox priest come to me with his penis halfway severed through because he, as a normal young man, was having difficulties balancing normal human reactions to the monasteries insistence on celibacy. He was trying to cut off his problem.

I’ve had to deal with a pre teenage child brought up as a girl but with strong desires to be male. On examination he had testicles but a grossly deformed penis, and no female organs. I won’t show you the pictures, which I have.

I’ve had to deal with a young man who often had meals with us, who as Orthodox got a Muslim girl pregnant. He was too terrified to tell his father so he used me as a listening ear. I said if you want an abortion you’re talking to the wrong person. He replied that neither he nor the girl wanted that. They had obviously discussed it. We had good talks, but in the end I said he had to talk to his father but that I would go with him. I had discovered that he was the illegitimate son of his father, but had been brought up with the family’s other children by the father’s wife and treated as one with the other kids some older, some younger than him.

The father booted him out of the house and stated he never wanted to see him again. We cared for him until the ‘mother’ persuaded his father to take him back some weeks later.

The girl was not prepared to meet me, but the young man and I had input with her. She, too, was unprepared to talk with her family. He could have remained quiet but she had an expanding reason to do something. So while her father was away she spoke to her mother who demanded that she have an abortion. The mother explained that her father would kill her if he ever found out that she was pregnant and particularly to an Orthodox boy. Eventually she was, very tearfully, dragged off to the local American run abortion clinic and the child’s life terminated.

Am I being judgemental in discussing these things? I guess the answer in some ways is ‘yes’. Are there many things with which I disagree? Celibacy should be chosen not forced; a decent look at the child could have seen testicles and no vagina; he explained that he had erections but although everything became hard nothing stood up except for an intense C-shaped thing; intecourse runs the risk of pregnancy – so although not uninformed the pair were stupid. I would say that intercourse is intended to be within marriage but I recognize that is an unpopular concept these days. However, the knowledge of pregnancy prevention is well known and easily obtained; I can’t understand the parents behaviour on either side. Am I judgemental? Maybe, but I sought to help without verbalized criticism to anyone except for the young man, who was like a son to me. Certainly I didn’t reject him.

I loved treating kids. Under the line are some of my ‘kids’. I challenge you to look at them and see them as real people! You will see some dressings but no open wounds.

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Haile Selassie – a slide discovered.

I’ve mentioned Emperor Haile Selassie in previous posts. I’ve met him, liked him and thought that he did a lot to help his country advance. He created an elected government with partial power. I think basically as an advisory body; he gave up a palace to open the country’s first University; he was very cooperative with foreigners in the country, who were there to help with education and health etc.

He was put under house arrest when the Derg arrested him and took over power. A bit later he had prostatic surgery and was doing well. He was seen on the day before his death by the Professor of Medicine (who had looked after me when I had heart problems) and was declared fit and progressing well. The next day the Professor was ordered to sign a death certificate. I presume he requested a post-mortem, because of his good health the day before, which was denied, and within a couple of days the Professor was dead, and nobody knew where the Royal remains were.

Years later, after the Derg was overthrown, the truth came out. He had been suffocated with a pillow and buried five metres under Mengistu HaileMariam’s desk. Mengistu was the Derg leader. His remains were dug up and buried with much pomp and ceremony in the church where his Majesty had regularly worshipped.

I could say a lot more very interesting stuff about him but I came across a slide in my present cataloging mania. The background to it is interesting, or at least it is to me.

The emperor, in his care for the very poor, had a hospital (Kidus Paulos, St Paul’s) built for the free treatment of the very poor. In the the foyer there was a beautiful mural painted in his honour. With his overthrow his followers felt that the Derg would certainly destroy the mural. So they rapidly but carefully had a false wall built to cover it. The wall wasn’t discovered by the Derg.

After the overthrow of the Derg, when I returned to Ethiopia, I was appointed to Kidus Paulos and was there when the false wall was pulled down. Hence the picture below.

There are some very interesting things about the mural.

He was a short man but he is the tallest in the picture. There is a foreigner in the line up of dignitaries and the medical advisor to his government was a Scandinavian.
The hospital building looked just like it is painted in the mural.
The angel has its wings painted in the Ethiopian flag colours, but interesting in that the order is reversed. Usually the green is on top. In times of war they are reversed so that red is on the top.
It was the sunrise of a new era of caring for the poor and the crowd is obviously ecstatic.

Dominic Cartier