As of this past Monday, I was supposed to be learning lots of surgery-related things this week in Kep, (a very poor rural area by the water, near the border with Vietnam) with the Children's Surgical Centre (CSC), a charity started by a Canadian which offers free surgical services mostly for children, as well as training Cambodian surgeons (who now do most of the operations at the centre). The only foreigners are the founder and guest specialist teams that come for short periods to do the really extreme cases and train the local staff on new techniques. And the medical students on international electives. (The place is a bit of a magnet for plastic and cosmetic surgery hopefuls since they do world-class cleft-lip and palate and facial acid-burn reconstruction. And it looks good on a resume, which is why I was there, in preparation for a career of itinerant liposuction and life-saving boob modification.)
CSC was sending a team to Kep for the week. I had applied to do a full 6 week rotation there before but was told that there was no room. On Monday I went back to ask about working the week-long camp in Kep (which I had found out about when I was touring the health centers there the week before -and realizing just how stupid and unethical my proposed research project, which had seemed like the sum of all wonders on paper, actually was). This time I got to talk to guy who runs the place (quite the character, you will likely read more about him in my next mass update) and he got me to start right away and told me to stay for 6 weeks (which is great but kind of ruins my already collapsing research plans).
So I spent 4 hours on the road to Kep yesterday in a white Toyota Land cruiser with "DONATED BY US EMBASSY" on the side in big blue letters, right next to the emblem of US Pacific Command next to which was a logo for ROSE which is the mother NGO of the CSC. I was happy that kidnapping of foreigners was not a big problem in Cambodia since I could not have been trying harder to make myself a target (specially as I had just shaved my head the day before and was, as usual, wearing a lot of beige). Semi-coincidentally I was going down there with this US army surgeon and his senior resident (the CSC team had gone down the day before).
I got put on gopher duty for the afternoon until they warmed up to me a bit, and this morning got to actually poke and prod people with sharp objects (small ones) which was a good start. And since we had 10 cases of roughly the same operation booked the surgeon hinted that I would be getting to scrub in and close the middle cases and by the last couple of cases (i.e. the healthy adult patients), if I had kept up my end in the pissing contest, he would have the resident walk me through doing the whole case (i.e. I would get to cut people). I was excited.
But lest there be too sudden a change in my status, I started the first case on glorified monkey duty. Got to start and IV and then got to be the scrub nurse, squirting stuff into sterile bowls from a distance and other such tasks. In the middle of the first case the generator died, and I became combination human-light-stand and scrub nurse. We were told the generator was beyond repair but as soon as the case ended they managed to get the provincial hospital's generator (next door) and so we had power again. They set-up a second table in the room so two surgeons could work at once and started to do the older patients just using local anesthesia (i.e. just an injection of freezing. We only had one Anesthesiologist). So I was promoted to assist one of the Cambodian surgeons (the best-tempered surgeon I have ever met) with the older patients. About half-way into the case the Army doc said: "In about two minutes I am going to get you to come here and help C-- (the resident) close, and we'll switch places". I was excited. About a minute and 29 seconds after that they made an incision which required, as the next step, to have the blood vessel rich edges electro-cautherized. Less than a second after THAT the second generator died, taking with it the electro-cauthery and my hopes of learning how to fix a hernia. The little patient now needed a more complicated suture job to replace the cauthery, made more difficult since I was no longer able to hold the flashlight. A small portable generator was found to keep the anesthesia machine going for the baby. Meanwhile, in the back of the room, farthest from the windows I was watching and trying to assist in mild disbelief (with the Army doc grumbling about the power behind me) as the Cambodian surgeon finished the hernia without a flinch and without really being able to see anything.
Two generators down, no maintenance person in town. Camp canceled and we headed back, 4 more hours, this time on a bus. Apparently this is the first time they have had to cancel a camp in several years of operation. They have never had a single generator die, never mind two. Just my luck.
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