Alex Gross - Medicine in Togo
The main hospital was on strike the week I was due to start my placement so I had to go elsewhere. I walked into Regina Pastis with the Director from Projects Abroad. Its calm and a few nurses and patients chat beneath the hut in the yard. We go upstairs and meet the Sister, a wise-looking and warm person. I explain my experience with Orthopedics and special tests. She says they can use me and can start tomorrow. I get excited and feel satisfied that there will be stories when I return home tonight.
My medical placement
The next morning I head to Physical Therapy, a little room in the back of the clinic partitioned by a thin wood wall. M’Boga, a stout guy with a permanent grin, is there already working with a hemi-paraplegic. He’s excited and we begin working together immediately. Its muscle re-education time and he spouts a litany of useful French medical terminology. He demonstrates the use of the theraband on the legs and arms and I think of home - biomechanics at the University of Oregon.
To my surprise, he hands me the band and asks me to perform some reps with the patient! Something is different, no way could I interact with patients at this level in the US…I dive in. M’Boga likes how I work and asks me to show him some special tests. I go through the Gaenslen’s and Faber’s Test then fumble through a few others. His face lights up as I explain the diagnostic aspect of the test. The patient is amused by the unusual procedures the interruption to the normal course of treatment. We discuss the case and then the visit is suddenly over – hygiene time. We joke and talk about where we are from, making small talk as the next patient makes her way in.
Meeting Togo’s only Neurosurgeon
It was 4 weeks before I ran into the only neurosurgeon in the country, and it was midnight. We talk about the problems in the health system in America and Togo. There are many and we discuss a few. It’s already a lengthy conversation and I see he’s tired so I we stop there. As he heads for the office I drop the question, “Can I watch you work?” It’s a long shot but I’m only here once. Yes. YES! It doesn’t happen quickly, no, no.
Operations here are riddled with faults; some are inhibited because of some difficulty or another: money, family support, availability of the one surgeon in the country. The day does come, though, and he calls me to the block and tells me to get dressed in scrubs. I arrive and get a hair guard and mask – no scrubs. Where is the surgeon? No sooner do I ask myself this then he arrives, with Clemence and Juillet – two pre-meds from Lyon – in tow. We meet, get our scrubs, and chat with the Head of Urology in the dimly lit, open air entrance to the block.
Taking part in my first surgery
We set out from there to the operating room and Clemence tells me to inform the nurse it’s my first surgery. I get nervous and start realizing what I am going to see is not a sight for the faint of heart. We enter and the patient is there, tranquil and prone, as if waiting patiently for the doctor to say, “Ok, here we go”. Oh, that’s just the anesthetic. The surgeon prepares the site quickly by marking, disinfecting, and bordering it by sterile cloth. INCISION! Wow, very smooth. Oh. My. That’s quite deep. So that’s what it looks like there.
I get uncomfortable but I have to watch, must see the work. I watch the Laminectomy and he takes the vertebral spine of L4 too – it’s almost completely degenerated and detached from the vertebrae. It takes a while, but the debridement is well done – no sign of the anomalies shown by the X-Rays. Now it’s time for fixation, but it’s been 4 hours! If I don’t leave now I won’t be able to find a moto-taxi home. Ah, but fixation – it’s kind of the best part. I can’t get stuck here though – maybe on my next trip to Togo.