Surgery is an interesting discipline to venture into. In Africa its practice is like the rest of the globe. There are some fine surgeons who do not shy away from doing big operations and the number of surgeons is increasing with each passing day. The journey of a surgeon starts with those anatomy lessons that are characterized by cadavers on the table. These are used purely for the purposes of learning and students gain massive knowledge on the anatomical organization of the human body. Later in medical school, surgery becomes a discipline on its own, and students have to satisfy examiners in order to be bequeathed a degree in surgery.
Internships in Africa
Internship is a crucial step in learning surgical procedures, be it minor procedures like excision of a lipoma, fixing a chest tube or inserting suprapubic catheters. Aggressive interns learn how to do major procedures such as appendicectomy, prostatectomy, herniorrhaphy, hernioplasty as well as gut resection and anastomosis. The beauty about this part is that you are under supervision of a qualified surgeon who instructs you on how to go about everything. Such internships are more commonly known as medidal electives and in most cases are available to student doctors by private specialist organisations that offer a range of elective programmes in countries of the developing world.
Eventually a time comes when one is allowed to do surgical procedures alone without much supervision. To specialize in surgery requires that one goes back to school to study surgery as a discipline. It goes without saying that these are strict years whereby the registrar strives to acquire all the knowledge a surgeon should have together with the skills. Anatomy is definitely refreshed if not mastered. Once you are qualified as a surgeon you are posted out there to help the suffering public.
Surgeon’s Life in Africa
The life of a surgeon in Africa is characterized by standing in theatre in an attempt to correct things which are amenable to surgery. Surgeons have operating days whereby they do the cases which have been booked for that day. A theatre list has to be prepared before the day of the operation to enable theatre staff to prepare adequately for the cases. The list can be short or long, depending on the cases. Some procedures are short while others are long. Most surgeons stand the entire day without much fuss. They are very passionate about operating.
When they are not in theatre, they are in the wards. Surgeons do major surgical ward rounds at least once in a week. This is a forum that is enriching as far as knowledge is concerned. It is attended by clinical officers, interns, nurses and medical officers. The consultant surgeon heads the team and makes the decisions after listening to the history and examining the patients. The wards have patients suffering from a wide range of diseases, including intestinal obstruction, tumors, prostate enlargement, prostate cancer, burns, diabetic feet, head injury and appendicitis just to mention a few.
The surgeon gives the way forward with regard to patients with complex disease process. Some special attention is given to post-operative patients, for they have needs which are unique to them. For example, a patient who has undergone prostatectomy needs to have the bladder irrigated using a 3 way catheter until the urine clears. Surgeons are always on the look out to ensure that the catheters do not block. In the same way, a patient who has undergone gut resection and anastomosis remains nil per oral for a couple of days, making it necessary to replace electrolytes such as potassium from the third post-operative day to avoid electrolyte imbalances which might result in serious complications.
There are surgical outpatient clinics which are run by surgeons. Here people with different surgical problems are seen. It is from here where patients who require elective surgeries are seen and booked in a diary. If there are any investigations they are requested for here. Should there be any special preparation needed before surgery the patients are informed beforehand.
There are minor theatres where procedures which can be done under local anesthesia are done. This is where small lesions are excised, patients with cut wounds are sutured and biopsies taken. Other procedures like hydrocelectomy, circumcision and sub-capsular orchidectomy are also done here.
Surgeons practicing in Africa have a wide population to take care of. Procedures like orchidopexy, herniorrhaphy and thyroidectomy are done routinely. Facilities with good intensive care units are able to do kidney transplants and open heart surgery, but such delicate procedures are reserved for specialists who are highly experienced.
This post was written by Ben Jones. Ben Has be in medical recruitment for 4 years now and spent three months in Tanzania for his medical elective. Ben likes to cycle, kite surf and spend time with his kids.
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