Operation

The clinic I came to Peru to work in doesn't really have the number or variety of cases I was hoping for...i.e. there's not that much interesting to do here. It's also further complicated by a crazy nun who finds it her life mission to fight with all clinic staff and generally resist progress in the clinic at all points. Fortunately, I found my way into the regional hospital a 10 min walk away. There I've been seeing all sorts of interesting stuff, such as heart valve disease from rheumatic fever, fulminant hepatitis, tuberculosis-meningitis, parasites, and really advanced tumors. I've also been getting to scrub into and assist in surgeries, which is awesome.

Yesterday I was told I could come at 8 for a quick colectomy to remove a colon cancer. Apparently the patient had had a CAT scan and the radiologist had read it as a benign hepatic (liver) cyst. Given that a hard mass the size of a grapefruit could be easily palpated in the patient's left abdomen (the liver is on the right), the surgical oncologist (rightly) said that was bullshit and that the patient probably had colon cancer. We then get to the OR and cut the patient open, only to find a normal colon adhesed to an enormously distended stomach mass. Oops, the patient has stomach cancer, not colon cancer. This was a really cool surgery, but I was shocked that the diagnosis had gone from liver cyst to colon cancer to stomach cancer in a matter of minutes. You don't usually just go into a surgery and realize that you're planning to operate on the completely wrong organ. It's just absurd. Apparently they don't have the ability to do colonoscopies to confirm (or in this case disprove) the suspicion of colon cancer. (And obviously, no one is getting preventative screening for colon cancer in Cuzco).

Which also brings me to another interesting topic in Peruvian medicine: stomachs. Nearly every patient at the clinic has chronic gastritis and heartburn. Even people in their 20s. They usually get prescribed a hefty course of omeprazole, and sometimes some get intravenous ranitidine for good measure (usually a treatment for ulcers, not plain gastritis). Funny coincidence, there's also an unusually high incidence of stomach cancer in Peru. Funnier coincidence, the usual cause of chronic inexplicable gastritis, and a high risk factor for stomach cancer, is infection with H. pylori. There's a breath test you can do to test for this infection, and then you take a very specific combination of medicines to clear the infection, thus healing your painful and annoying gastritis and protecting you from future stomach cancer. However, this infection is never discussed with patients as a potential cause (one day the doctor told everyone with gastritis that they had too much stress and should see a psychologist) and the test is never recommended. Nor is the specific treatment ever prescribed. Apparently the test is quite expensive, and patients have to pay up front out of pocket for every lab test, so the cost is a barrier, but even rich patients don't seem to be made aware of the option.

For the most part, things in the hospital where I'm working are quite modern. They have a brand new ultrasound machine and all the complex anesthesia equipment you would see in a US operating room. However, I have to raise my eyebrows at other things. For instance, for bedside procedures no one puts on their sterile gloves correctly. By the time they have them on, they've been touched all over and are far from sterile. Outside of the OR, hand-washing is also a rare activity. During operations, I often see surgeons become unsterile but just continue anyway. This was once punctuated by a comment by the senior surgeon that "Peruvian patients don't get infections." Interesting point of view. However, 2 of 3 patients I operated on last week came out with severe post-operative pneumonia. Suspicious.