Day 5 Surgery Day

Today started as the others. Rise early, breakfast and off to clinic. As usual, a long line was waiting for us. The Drs that have been here before note that there is more order with the Jamaican army presence. Most of the unit leaves every morning to go to more remote areas to distribute food and medical care. They also refer patients back to us. We joke about the fact that as rudimentary(comparatively to what we have at home) as our facilities are, we have become a 'level 1 trauma and referral center'. The rear guard or security team that stays behind are present in the compound and at the clinic doors. They each are carrying an M-16 rifle and unlike the US military, they have a 30 round magazine in the weapon. They told me they don't have one in the chamber. It certainly helps maintain order.
Although there were enough surgeries to do, we unfortunately have to defer on some. "First, do no harm". If the surgery could wait on an anemic patient with poor nutrition (a given), and we are concerned about potential blood loss with no backup blood supply, we defer. I also saw a lady with inflammatory breast cancer with half of her breast just necrotic tissue. We deferred. She has an extremely poor prognosis.
Surgeries to date include wound/abcess debridement, D&C, many lipoma excisions, breast fibroma excision, circumcision on an 11 yr old with phimosis and adhesions covering his urethra. The orthopedic team has been extremely busy with wound debridement, fracture follow-up, trauma and anything else. We ended up our day with plans for Jim and I planning a large lipoma excision from a lady's side.
One of the operating room suites has no air conditioning (not complaining, just stating), so by the end of the case I could take off my scrubs and wring them out. That's why that cold shower at the end of the day feels so good.
Tonight we are going to treat ourselves. We are going out of the compound to Wahoos, a restaurant about 20 minutes from here. I will write later with an update.