Today we ran three surgical rooms for three surgical teams. We started at seven and ended twelve hours later. Procedures included fistula repairs–connections between the mouth and nose–that interfere with eating and speaking. Another case involved the removal of a hemangioma from the face with a skin graft.
We had to be creative with medications: today instead of morphine we were given fentanyl to use for post operative pain control. Quite a lot of dimensional analysis ensued while the nurses and I crafted a dilution that we could more easily dose based on micrograms per kilogram of body weight. In US hospitals, most drugs come premixed and measured from the pharmacy as an additional safety precaution; today was a reminder that the metric system and algebra are always important.
No matter how different things are, however, they are often the same. Here, as in the United States, anemia is a problem. Some children were unable to have surgery because their hemoglobin levels were too low. Hemoglobin is the measure of red cell concentration in the blood. The red cells carry oxygen to the body tissues, and red cells need iron to make that transfer. A child with anemia can’t tolerate surgical blood loss and recouperate. The team plans to return next year, but that’s a long wait.
We’re using the same Hemacue machine here that we have in the Walnut Creek office, and I find myself giving some of the same recommendations I give at home, only in Spanish: wean children from the bottle at one year of age, limit the amount of milk consumed, eat high iron foods: beans, meats, and green leafy vegetables like spinach, collard and kale.
After surgery, the children stay overnight, usually four children in a room. The pediatric ward is very pleasant.