Cut to Cure

Many of you have probably heard of the book "Where There is No Doctor."  I think there should be a second volume entitled "Where You are the Only Doctor (and trained in one specialized field but are expected  to treat everything and anything)".

Thankfully, I have the internet (some of the time) and Primary Surgery- a book I brought with me to Africa that I will likely use daily and learn to love. It is a surgical manual for "for non-specialists doctors....in the developing world" and it came in quite handy yesterday evening.

The "Bible" of operating in rural Africa- the "low-priced edition" :)

There is a wonderful woman here who will prepare "take-out" food orders and deliver it. Its awesome. She was delivering food to our compound yesterday, but she couldn't use her right hand to carry it. So, Luke brought her over to see the doctor -me. Thankfully the problem was surgical- an abscess! Pus! Paronchyia to be exact. The end of her finger was twice the size of the rest of her finger. Its a little tricky trying to evaluate redness against dark skin, but she definitely had lots of pain and a fluid pocket.

Paronchyia (an infection at the side or base of the fingernail or toenail) isn't something that I encountered much in surgical residency. I guess the ER doctors, or family medicine doctors, or hand surgeons usually treated it. But, I have drained plenty of abscesses!  And I had my Primary Surgery- Volume One handy...so I used it for the first time.

It had lots of good advice. She hadn't slept for two nights. The abscess definitely needed to be drained.

It had nice diagrams- I went for the incision in diagram "O"

After gathering up some supplies, I did a digital block. Thankfully, I had practiced digital blocks this summer on a different kitchen table. She didn't even flinch when I injected the xylocaine. The block worked great...her whole finger was numb with "babu ciwo" (no pain). She was so happy at that point just to have some relief!

Yay for digital blocks!

Then, I incised the finger and out came pus- yay! It was a lot of pus to be stored in the tip of a finger. No wonder she couldn't sleep. Draining an abscess can be so satisfying. She should be able to sleep now. She was very grateful and even taught me some medical Hausa during the procedure!