When a thing is wick...

Today’s blog is split into two sections, with a large gap between the two, meaning that you would have to be very persistent and scroll waaaaaaay down to see the second part. Why have I done this, you might ask yourself? Because I realize that not everyone who reads this blog is accustomed to the sights of the OR, and today I did two orthopaedic cases that I thought were good examples of things you would almost never see in the United States. So, if you think you have the stomach for it, feel free to traverse down to the second part. But don’t say I didn’t warn you ;-)

What I wanted to do today, though, was to introduce those of you who may not know of her, to one of my favorite fictional characters. She has, in fact, surpassed Dagny Taggart of Ayn Rand’s Atlas Shrugged and might be eclipsing Ayla of the Earth’s Children series by Jean Auel. The reason I want to do this? Because when discussing my trip with a friend of mine who is also a fan of this character, she told me I was going to have to step up and be Sassenach while I was here. The thought both amused and flattered me.

Picture an Englishwoman, in her twenties, fresh from having been a battlefield nurse during WWII. She is on holiday in Scotland when she encounters a set of standing stones (think Stonehenge). Unbeknownst to her, the stones can serve as a time portal at certain times of the year, but only to certain people. She, fortunately (or unfortunately), is a traveler and is overtaken by a strange humming sound as she nears them. She grows fainter and leans against the stones for support and wakes up in the 18th century. **SPOILER ALERT** Many odd adventures happen over her lifetime, the least of which is traveling back and forth from the 18th century to her own natural timeline. During a stay in her own time, she becomes a surgeon. During a period in the past, she discovers a notebook of a physician of the time. She mixes her modern medicine (circa late 1960s) with the remedies of the past to try to care for the people around her.

Her name is Claire Beauchamp Fraser, and her story is the Outlander series by Diana Gabaldon, of which there are now seven books (Outlander, Dragonfly in Amber, Voyager, Drums of Autumn, The Fiery Cross, A Breath of Snow and Ashes, An Echo in the Bone). Sassenach is a Scottish term for a British citizen, which becomes a term of endearment betwixt Claire and a certain Mr. Fraser.

Wandering around the Kisumu Museum last weekend, it struck me that Kenya is a place where modern medicine (circa late 1960s) and folk medicine are co-existing… ;) I’m being a little facetious. Their equipment is perhaps circa 1960s, but their knowledge is up to date, at least here at the provincial referral hospital.

However, back to the museum. They had a brief display on traditional medicine, but more intriguingly, they had signs posted in front of a number of different trees, outlining the medicinal uses for each. I share that with you now.

It was really more a display of the various instruments with which to bleed someone!

Scientific Name: Albizia coriaria
Luo Name: Ober
Medicinal Uses: The steam from a decoction is used for sore eyes. A tea made from the roots is used to cure venereal disease. A tea made form the bark is used to treat threatened abortion
Google says: nothing else

Common Name: Nightshade
Scientific Name: Solanum incanum
Luo Name: Ochok
Medicinal Uses: An infusion of the leaves is used to treat ear ache. The juice of the fruit is spread over the skin for skin disease (rash?)
Google says: It is used for fungal disease of the skin

Scientific Name: Makharmia lute
Luo Name: Siala
Medicinal Uses: Treatment of measles
Google says: nothing else

Common Name: Aloe (but not aloe vera)
Scientific Name: Aloe genus, various species
Luo Name: Ogaka
Medicinal Uses: Treatment of stomach ache
Google says: watch out, some are poisonous

Common Name: African milk Bush
Scientific Name: Synadenium grantii
Luo Name: Fang’afa
Medicinal Uses: Treatment of herpes. A dried leaf powder can be applied to cuts made in the skin to relieve severe backache or swelling on joints. The burnt ash can be licked to cure sore throat.
Google says: A whole bunch of stuff, mostly that it’s very poisonous and shouldn’t be grown around children or cattle

Common Name: White Raisin Bush
Scientific Name: Grewia bicolour
Luo Name: Powo
Medicinal Uses: Initially, I thought this had a medicinal use, because it said it was used to treat cattle that miscarry. Then I read further and because of its “anti-evil spirit properties”, the cattle were actually caned with its branches!
Google says: no medicinal uses I can find, a lot of “evil spirit” mentions, though

Common Name: Kassod tree
Scientific Name: Cassia siamea
Luo Name: Oyieko
Medicinal Uses: Treatment of stomach aches and childlessness
Google says: Questionably touted as an anti-oxidant that can help prevent colorectal cancer.

Common Name: African senna, Popcorn cassia
Scientific Name: Senna didymobotyra
Luo Name: Owino
Medicinal Uses: Use the leaves in the bathing water of children with scabies. The stems and roots, when boiled, are a purgative. A decoction of the leaves can be drunk to cure gonorrhea and backache in women.
Google says: Now growing in South Florida!

That’s it for my foray into alternative medicine. Though I will say, one of my favorite stories about how drugs get their wacky names, has to do with an “alternative” medicine. A certain compound was extracted from a bacterium found in a soil sample taken from Easter Island (Rapa Nui). That compound, now purified and manufactured on a grand scale, is the transplant immunosuppressant, Rapamune.

Tomorrow should be a fun blog, I’m heading out to do some manual labor (no worries, I volunteered) at a village near Kisumu. Until the next time!

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So, you made it. You’re not one of the queasy ones. Not that there’s anything wrong with that. Wanted to share two cases I did today. The first was a little boy with chronic osteomyelitis. That is a long-standing infection of the bone. This is something we see in the United States in diabetics with poor podiatry care, but is certainly not a frequent disease of childhood. Unfortunately, the population here has a significant number of people with sickle cell disease (~35%… It has a survival advantage in that people with sickle cell are unlikely to catch malaria and so the trait survives.) These kids can develop areas of necrotic bone from thrombotic events (clotting). This young boy has had a problem with his leg for the last 4 years and has only now come to have it treated.

We did a lateral incision, removed the infected sections of bone, put him in a cast and on antibiotics. Now, we just wait and see.

This next gentleman is an exhibit of the multifactorial problems involved with managing trauma in this country. He suffered a bad roadside accident (we call them MVA – motor vehicle accidents or now MVC – crashes, they call them RSA) approximately 8 months ago, suffering fractures of both legs and left arm. Because he and/or his family was not able to supply the plates that could have helped his injuries heal initially, he was treated “old-fashioned”, in that the fractures were aligned, a P.O.P. (a cast, plaster of paris) was applied and fingers were crossed. In his left leg, fortune smiled. While it is not a perfect union, it is functional. However, his left upper arm fracture was completely unstable, and upon removal of the P.O.P. his right tibia was protruding from the skin. Cut to eight months later, when the family has saved enough for another P.O.P. and the hospital has been given a generous donation of internal fixation rods. His humerus (upper arm) still needs a plate, which is still outside his financial capacity.

We treated the arm “old-fashioned”, in that we tried again for an alignment with P.O.P. For the right leg, we were able to rod it, so that he should be able to bear weight on it for the first time in 8 months.

And just as a parting glimpse, to those in the surgical field who are used to racks and rooms full of suture material. This one cabinet holds the entirety of the hospital’s supply. Patients are told what they’ll need for elective surgeries, and they buy suture from local surgical supply stores. The hospital provides any the surgeon may need on top of that.

That was my day. And now, back to one of my running internal debates, To drink boxed wine or not to drink boxed wine. I feel I should try Kenyan wine, but it's all in boxes! Though some of them are small and cute like juice boxes ;-)