I have seen a ‘spontaneous’ colostomy in a strangulated hernia which presented after days of pain. But even more unusual, shortly after that I had 3 cases of lumbar colostomies in children. One was in a boy who fell onto a sharp stick which went into his right lumbar area. Faeces began to discharge immediately but he lived hours away in an area without roads and his parents were very poor. He lived and after 3 months they had enough money to travel to our hospital. By that time he had developed a huge ulcer as seen in the photo below.
Some 25 years ago I wrote an article for presentation at the Ethiopian Medical Association meeting in Addis Ababa. I presented 300 cases of which the average weight was 500Gm. The incidence reported by the pathologist of cancer was 15%. The majority of malignant areas were very small and nothing further was done for those cases. In the following 25 years I saw many more.
After I had recovered from the illness which brought me home from my first stint in Ethiopia, I became the on staff surgeon of a large (602 bed) Queensland country hospital. The previous surgeon had become the full time Medical Director. As I took over he requested that I allow him to manage the patients admitted with burns. I was only too happy to agree. I can hardly remember a single time in my stints in Ethiopia when we didn’t have at least one burns patient and usually more in the wards.
Burns are common in Ethiopia for the following reasons.
- There are open unguarded fires in the middle of many huts.
- Mothers often have to walk considerable distances to get wood or water. They go when the baby or infant is asleep and the children either roll or fall into the fire.
- Most epilepsy is untreated and in an attack they may fall into a fire.
- Mud houses, built around old timber, burn in a flash if they catch alight.
- Electricity is frequently poorly installed.
BELOW THE LINE ARE PHOTOS OF BURNS – SOME ARE GRAPHIC
Over the years the available investigations for head injuries has increased markedly . In 1962 my very first term as an intern placed me in both a general and a neurosurgical surgical roster. Sitting in bed 6 in bay 1 of the third floor general and neurosurgical ward was a young man who had broken his neck playing Australian Rules Football in High School. It had gone both unnoticed and untreated until he had begun to be paralysed. Before I came on the ward he had been operated on and the tracture fixed, but he was still unable to reach the tasty food which his family brought for him. I especially remember the grapes. I made a deal with him that every time I went past I’d give him some, provided that I got a share. We remained good friends until he died many years later. I assisted in some neurosurgical procedures at that time but never got to do one.
This is not a common operation. I have done a few, basically where I thought an attempt to do a pneumonectomy was fraught with a huge risk. The other lung appeared good on Xray, but on the affected side there was a bronchopleural fistula, a pyothorax, and a destroyed lung. Whenever the patient lay on their healthy side they coughed up copious pus as it ran from the pyothorax through the fistula into the trachea, sometimes in sizeable volumes and was coughed up. TB was very common; this film doesn’t show a case suitable for this surgery.
I used to travel to Nazret after teaching Bible and four French lessons on a Thursday. Nazret v Adama It was about a hundred kilometre trip. I’d book in at the hotel where I always stayed and after freshening up a bit go to the hospital. There was a wide variety of cases as you would expect in a city of about half a million and draining a fairly densely populated area of about 50 km radius. They did operations through the week. They tended to keep the more difficult ones for me. In that area there were lots of cases of cancer of the oesophagus.
I didn’t often refer patients to Addis. You will probably have heard of Catherine Hamlin and the ‘Hospital by the river’. They