Adam Fox spent 2 weeks on a surgical mission in The Gambia, here are some of his observations.

Greetings.

…this international work is continuously fascinating to me.

To give you an update about my recent travels

-just got back from my 2 weeks in The Gambia.  was quite an experience…much different than my previous 3 trips to the Philippines.  It actually caught me somewhat off guard with the significant differences that i encountered.  It sort of made the places in the Philippines look 1st worldly

-pulling up to the “hospital” I was greeting by the veritable zoo that lived on the campus…dogs, chickens and goats were the main inhabitants plus the occasional donkey….all cute and i got some really good pictures but never imagined this for a hospital

-electricity for only a few hours during the day, which may or may not change soon given the new solar panels that were just installed…

-bucket showers…not always my idea of fun, but at least i had the opportunity to shower

-realization that there were so many obstacles to patient care the way we know it…your chest tube story struck a cord…..could not be done in my institution either …no suction, no pleurevac/bottles or chest tubes for that matter…

-without mechanisms by which to do things, I realized that the knowledge base about the “next step” was limited both among the nursing staff and the new medical students that I dealt with….every time I gave a lecture I found myself backtracking to some extremely basic concepts….a military guy from our group commented to me one day after I realized that I could not really teach the basics of trauma (via primary assessment/treatment through an atls model) that what the people of this hospital need is a wilderness medicine class…cant say that I disagree with him

-had my first deaths during one of these trips….one that nothing could be done about ( 90% + total body surface burns (partial and full thickness with inhalation component)) and one that probably should not have….was very disturbing to me….50 ish y/o female admitted for an  epigastric hernia that they would not let me operate on because she had 4+ glucose in her urine….IM docs (from Cuba) were consulted to help get her sugar under control…found her one morning obtunded and turns out that they had given her a long acting oral agent and not really checking her sugars frequently…after I provided the requisite D50 and started her on D5w drip, she was transferred to the medical ward where she became hypoglycemic again, seized and died…..me and my colleagues were very disturbed by this….

-realized and confirmed what you had told me when we spoke….education may in fact be the most valuable thing we can provide….the surgery is always fun but they are truly lacking education….it seems to me that curriculum should be developed for places like this that provide for basics (like a wilderness survival course on steroids)

-the local cultural stuff was great

All in all, I’d have to say it was a great trip…made me significantly reevaluate how I should be going about things on my future trips…..