Aira Hospital

As stated before the surgical cases you see here are pretty much the same as back home only that they present far later and are far more larger and advanced.

Never did I see a soft tissue tumor of this size back home in Sweden.

It is a soft tissue sarcoma. Malignant in that sense that it will recur and spread locally if not excised radically, but seldom metastasize distantly or widely.

The best would be to have one surgeon do the excision and another the reconstruction. Otherwise there is a tendency to cut the corners short thinking of how to cover the defect later. You have to behave a bit “schizophrenic” – cut radically without thinking of how you are going to repair the defect later, and then do the reconstruction as if being another person.

In this case the tumor was removed radically together with the whole abdominal muscle layer. After that it was easily covered by skin grafting.

Hopefully and probably the result is a cure.

To lose a leg is catastrophic. There is no supply of prosthesis around and without a leg you cannot do the farming which is the only way to survive for 95% of the rural population.

It is an old dream of mine to be able to supply our amputees with an artificial leg. Readymade prosthesis in different sizes left and right are available and can be purchased from abroad if only we had the money. Made of out of plastic they need only some heating to be adjusted to an amputation stump. No need of high tech equipment or trained staff - only money is needed.

Recently during the Swedish election campaign the country’s infamous Marxist-feminist nr 1 burned 100 000 Swedish crowns in public to get the attention of the media. She got it with the same success as when she urinated on the red carpet among dignitaries during a gala in Stockholm. This time however she was sober.

In the same election campaign various car companies pay 8 million crowns for free champagne to everyone.

One of our patients made an artificial leg for himself. A bit clumsy, but it works.

Others do not have that capacity and therefore we always do our outmost to save a limb.

This unfortunate man was as drunk as the Swedish Marxist-feminist NR 1 when she urinated on the red carpet. He fell asleep outside his hut and woke up in the middle of the night as a hyena was having a good meal on his leg.

In the operating theater all dead muscles and other soft tissues were cut away and the wound cleaned thoroughly (wound debridement and revision).

Not much was left. However the anterior muscles kept the foot in (dorsal) extension so there is a substantial chance of getting the patient walking on two feet

After some days the large defect was covered with skin graft.

It looked promising on the latest picture.

The patients disappeared although he was told to return for follow up.

Maybe a lucky hyena got a full and undisturbed meal later?

100 000 Swedish Crowns would pay for 500 cesareans saving 1000 human lives.

The free champagne could keep Aira Hospital going for 100 years.

Priorities are indeed different in this world.

Elephantiasis is a disease which can be treated conservatively with good result (see page “ELEPHANTIASIS”)

We know all too well that the result of surgical treatment is not promising in the long run – something which I am being reminded repeatedly by people engaged in the podoconiosis programs around.

But what do you do when a young man turns up at the OPD with a huge deformed leg asking for an amputation? Just chop it off?

I personally cannot resist helping and trying to save his leg. The surgical treatment is rather simple but time consuming.

The principle behind the surgery is very simple:  if there is no subcutaneous tissue there will be no subcutaneous edema. So cut away all subcutaneous tissue! The method was described by Dr Thompson and the procedure carries his name.

Start to harvest skin from the leg with a handheld dermatome.

Excise all the affected subcutaneous tissue from the leg down to the fascia.

Then transplant the skin back on the bare fascia and elevate the leg in traction with a pin through the calcaneus

The result might not be cosmetically the best, but the patient is happy and relieved.

The special form of elephantiasis called podoconiosis which represents almost all of the cases seen here in Ethiopia is caused by small mineral particles from the red soil which penetrates the skin and blocks the lymphatic system in people walking barefooted. It could be easily and simply be prevented by protecting the feet with shoes. Poverty prevents that.

The problem caused by podoconiosis is enormous. There are a lot of patients suffering from the disease, but except the beggars in the street you do not see them easily. They usually hide as it is considered a shameful condition - a curse. 

One researcher has calculated that the overall financial lost in Ethiopia from this disease widely overshadows that caused by HIV/AIDS!

A young girl went to the local mill to help her mother grinding maze. While working she stumbled and fell into the mill. Both her legs were caught and crushed in the machinery. She was brought to a nearby hospital where she was treated for about two week’s time before being referred to Aira Hospital.

The wounds had been dressed nicely and were clean so it was only to catch on with stabilizing the open tibial fracture, covering the bare bone and skin graft the granulating wounds.

First the wounds were cleaned properly

Then the fracture was stabilized with an intramedullary nail and the bare bone covered with a local muscle flap – a gastrocnemius flap

Finally all the wounds were grafted with meshed skin

The primary result looked good…..

….and the girl was happy that the leg was healing

In fact you seldom see any grievances in spite of whatever hardships people here are exposed to. That makes life as a surgeon here a lot easier.

Look at the boy from the previous post on the blog. He lost a leg, but knows that we did our best to save it. He is able carry on - to smile and meet the world as an amputee.

The Eye Department at Aira Hospital has a longstanding good reputation. The service rendered by our skilled ophthalmic nurse since decades - and now by our ophthalmic surgeon - is widely appreciated by the patients for the excellent quality. The whole range of eye diseases and traumas are dealt with in a first class way.

That a small entity like Aira Hospital could be an ophthalmic centre is not easily accepted by supporting agencies who stick to the universal – but wrongly - thinking that a center for advanced medical treatment must be in a large city such as Nekemte – the regional capital. Everywhere in the world same mistake is repeated by giving first priority to the physical buildings, followed by the equipment and lastly the staff, when the right thing is to give priority to the human resources first and the buildings last.

“It is not the building which makes a hospital – it is the spirit”

As a surgeon I am not at all involved in eye surgery except when patients present themselves with advanced malignancies, such as this lady who had a squamous cell cancer of the orbit.

Complete excision and evacuation of the orbital content is followed by a local muscle flap from the nearby temporal muscle to fill up the empty space.

After a couple of days with dressings the muscle is granulating and no signs of infection is noted…..

…….and a free skin graft is used to cover the raw muscle.

Not so very esthetically looking, but then this is life saving surgery - not a luxurious plastic surgical procedure.