11 October 2007
No VVF surgery today as the doctor who does it is still gone. It appears that he has trouble with his papers and had to go to Johannesburg to get them in order. They are very stringent with allowing foreign workers here as they are trying to make sure that the jobs in any field go to foreigners only when there isn’t a qualified South African available.

Well, no matter about the surgery since the theatre was open only to emergencies because we had no linens. All the drapes and gowns and essentially everything are made of fabrics that are reused and so require washing. There as been some problem with the laundry and we ran out of linens yesterday. They keep disposables on hand for emergencies but truly hold them for that. I have to say lack of linens wasn’t something that I had thought of for reasons that might limit surgery. So our new list of requirements to do surgery (in addition to qualified surgeons and anesthetists and nurses) includes electricity, water, linens and anesthetics. I can picture myself laughing in the future when I have a case delayed for a short time for some minor reason. The linen appeared after 10am and the theatre reopened.

The young women we operated Tuesday did not have a good outcome. She had mild anemia and low platelet count before surgery and things went badly after that. She turned out to have HIV and although this likely has nothing to do with the ovarian tumors it probably caused all her other problems. Her muscle swellings are probably HIV myositis although they could be lymphoma which is much more common in HIV pts. HIV patients can also have these low RBC and platelet counts from a variety of reasons. They have a particular problem with a TTP like syndrome which causes destruction of the blood cells and that’s what happened to her I think. It’s possible this will all be related to lymphoma but it seems less likely. She died this afternoon. She was the oldest still living in the family and was acting as head of the household of all her siblings as their parents had died. Her 23 yr old brother will now take that role. It’s a sad situation but one that is way too common here with HIV.

Today after work, Megan and I were feeling a little down as we both had a difficult day. We managed to find enough ingredients to make oatmeal cookies. It’s rather fun to find a way to make recipes work in way less than ideal conditions. It was fun to do and nice to see that it lifted her spirits. Now we had a birthday gift for Caroline! It was a good way to end the day. And we didn’t even lose power until after the cookies were done and then only for a short time.

Tomorrow, I will go with Ed and Caroline to Sani pass. It is in the mountains on the border with Lesotho. (I can hear those atlases coming off the shelves unless you are of the age to go for mapquest!) It will be quite a drive but it should be beautiful. I hope we have some lovely weather although I know it will be cold in the mountains.