The patient limps through the door and eases himself into the chair by the surgeon’s desk. I’m sitting in on a private orthopaedic clinic. I’ve only been here ten days, so my Amharinya is limited to things like ‘thank you’, ‘coffee please’, ‘no’, ‘yes’, and that strange sharp intake of breath that means yes.

This man is obviously in pain though, and the pelvic x-ray tells me why. He has avascular necrosis of the hip – his hip bone is wearing out.

I listen to the surgeon taking a history, pointing at the x-ray. The patient nods, shakes his head, looks tired. Eventually the surgeon produces a pad and writes out a sick note. I peer over his shoulder.

“He needs bedrest.”

The patient nods, takes the note, limps out.

“Bedrest?” I say. This is nothing I’ve learned before.

“Sure”, says the surgeon.

“Of course what he really needs is a total hip replacement, but he can’t afford it. He works as a security guard, so all I can do is tell them he needs bedrest, and at least then he can take the stress off his hip and he’ll be in less pain.”

Bestrest, not surgery. Just a single moment, a tiny glimpse for me. Here, a daily reality.


Moved to Tears

In Addis you have to take internet time as it comes. Today’s Daily Prompt was to “describe the last time you were moved to tears”. I initially missed the end of that sentence [by something beautiful] in my haste to get everything done before the next power cut. So here there are rather more tears, less beauty.

Yesterday, following my Ethiopian surgeon friends on their ward round, I realised that – until that moment – I had never seen someone really, truly in pain.

After surgery on a joint, perhaps a knee or an elbow, it’s important that the patient starts to move it again so that the joint doesn’t stiffen into one position.

Picture yourself standing in an operating theatre watching a boy’s leg being sawn in two. And then imagine, the next day, seeing him literally screaming in pain as he’s told he has to move it, swing his knee over the bed and kick it back and forth. You know exactly what’s under that bandage. You can only imagine what he’s feeling.

I realised I’d never witnessed that amount of pain before. It was worse than blood or needles or seeing someone cry or be sick or fall.  I didn’t know it would be that visceral, immediate, personally excruciating. I didn’t know it would make me want to faint, vomit, and be moved to tears.

On learning to love surgery

“The way these things usually go wrong”, says the surgeon, muffled through his green mask, “is when you don’t take out enough bone”.

Several months ago in the deepest darkest English winter, I decided that I wanted to have an interesting summer holiday. To do something useful, something exciting, maybe have a bit of an adventure. Some emails, a grant application and some disorganised packing later, here I am. In the CURE paediatric orthopaedic hospital in Addis Ababa, Ethiopia.

CURE is a private hospital. Operations are performed mainly by local Ethiopian doctors trained at Addis medical school, but funding comes from external donors – national and international. The hospital is relatively small and quiet, the equipment is good and there’s plenty of time. The waiting list, though, is long.

Children come from all over the country for specialist operations they can’t get elsewhere. One very common presentation is clubfoot, a congenital condition that means the foot (or feet) turn down and inwards. At home this would be treated early using combinations of foot supports, braces and special shoes, but here the kids have no choice but to walk, and years of walking means that the bones deform. If they’re lucky enough to get to CURE they can have corrective surgery. Much of the problem with clubfoot is in the tendons and ligaments, so they have ingenious surgeries such as Achilles tendon lengthening, posterior medialis release or anterior tibial tendon transfer. If the bones are deformed they might have a triple arthrodesis, which involves cutting out a wedge of bone in the foot, tearing out the cartilage with pliers and letting the bones fuse in a new position.

I’ve been known to be squeamish about surgery. Hey, this is the blog of a medical student with needle phobia, right? I was fully prepared to come here, the strange medical student from the UK, and faint in the OR while watching something hilariously minor. But I’ve been fine. Actually I’ve watched some of the most gruesome things I could have imagined: a little girl with osteogenesis imperfecta having her femur sawn in two and rejoined with a metal rod; a total hip replacement; a 13 year-old boy having his entire back opened up to remove 11lb of lipomas. I even helped sew a skin graft onto a little boy’s hand, metal rods drilled into each tiny finger to keep them straight – and for some reason I’m just fascinated, and awed.

Surgery here seems simple, and necessary, and utterly life changing. I can see exactly why some people like it so much.