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All the training is certainly paying off :: A LETTER FROM
BURUNDI Kelly Dilworth is an anaesthetist from Perth. She is working in Makamba, the southernmost province of Burundi. This is her first mission with Médecins Sans Frontières. Life is pretty busy for the surgical team, especially the night call-outs, which mainly involve the obstetric patients. To do or not to do a caesarean, that is the question! I have rapidly re-learnt the art of spinal anaesthesia in wriggling pregnant patients with contractions. I am fortunate in that the anaesthetic equipment at this hospital is pretty good and with a few modifications here and there, the anaesthetics are coming along quite nicely. You are on your own to a large extent, so all the training I have received from past anaesthetists is certainly paying off The surgical programme here is predominantly emergency cases. We receive mainly patients with trauma, and patients with acute and chronic complications of a multitude of infectious diseases. Unfortunately the patients often present to the hospital after having been at home for a considerable time before deciding to seek medical treatment. It is pretty sad to see the kids with chronic osteomyelitis/arthritis in whom the bone or joint in question has been completely destroyed. Luckily Chris Carter, my surgical colleague, is an orthopaedic surgeon back in Canada so these patients are certainly getting expert surgical attention. He has previously worked in Vanuatu and South Africa so has seen many of these complications before. I ‘lead’ the meconium aspiration team (who leap into action even before the umbilical cord is cut) and the neonatal resuscitation team. Last week we resuscitated two premature twins. The first baby weighed in at 1.6 kg, the second was a complete surprise, he weighted just 1.2 kg and needed 2 hours of resuscitation. I perched him on top of a cardboard box on the incubator (since the radiant heater tends to be a tad feeble), put a peripheral IV line in, administered IV dextrose/adrenaline/aminophylline, and gave him intermittent CPAP/oxygen via my trusty T-piece/facemask. We didn't have the camera there at the time but I will try and get a picture of these little chaps before they go home. They are both breast-feeding happily and seem to be growing OK (not that I have any growth charts to plot them on). At work I have to speak French with the hospital staff all day, which is often somewhat interesting for all of us (comme ils ne parlent rien d'Anglais!). I am therefore acquiring a rather strange French vocabulary - all the anatomical terms, the names of diseases and operations, and the instructions for post-operative care. I want to blow some big kisses the way of Médecins Sans Frontières Australia for their Xmas parcel which was a huge buzz for me when it arrived last week. I'd had a bit of a rough day for some reason so it was perfect timing. Vegemite on toast for breakfast the next day was one of those unique moments of my life. Strangely enough, I have been unable to persuade the French contingent that the black nectar that us Aussies grew up on is; a) essential for one's body and soul, b) the most appropriate filling in a cheese sandwich, and c) potentially a natural source of Viagra. Anyway, cheerio until next time. A plus tard! December 2003
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