we're not in kansas anymore

Warning- to following may contain medical images that those faint of heart may wish to avoid. 

Yesterday, I saw about 33 patients in clinic...patients with hypospadias, skin grafts, nasal polyps, typhoid perforation, chronic leg wound (started with a worm), huge/necrotic right thigh sarcoma, post-op prostatectomies, elbow dislocation, big toe infection/gout, fractures, external fixators,  young boy with hip osteomyelitis (starting with infection after quinine injection), a keloid, obstructive BPH, abdominal TB, hydrocele...and the list goes on. 

Sometimes the problem, to me, is quite impressive and even shocking. Despite my best efforts,  I'm sure that my face sometimes reveals my surprise while I think to myself, "Wow, I"m really here in Africa and I am really seeing this...now I have to figure out what to do!" I usually figure out what to do with about 2/3 of the patients. The other one third I have come back in the afternoon when the more experienced surgeons are in clinic for consultation.

Clinic. We have a wonderful translator, and light box, an ultrasound machine...and a seemingly endless supply of patients.

Here are a few examples...what would you do?

broken for two years, pus draining from open wound for 2 months

His X-ray

65M with obstructive BPH (prostate enlargement) and a painful, draining big toe x 2 years. He has had a catheter for 2 months and he wants his prostrate removed and his big toe amputated.

50 y/o lady, worsening cough 2 months after mastectomy...and a non-healing right leg ulcer for 2 years.

Names and stories may be altered to protect identities