Tuesday, 27 September 2011

Operating on the wrong patient

Operating on the wrong patient

23/9/11 :

Found out the three year old with ?rabies died yesterday afternoon :(. Very sad and no one here was expecting her to deteriorate so quickly; in many ways probably for the best though as rabies can be a very long drawn out painful death which would have been more distressing for both the girl and her family. Still very sad though.

Quite a few interesting cases/scenarios today:
1. Saw an x-ray of a 6 yr old male who swallowed a 200tsh coin (the widest coin here - about the width of a 50p but circular) and as shown by the x-ray, it was lodged in his throat. X ray was pretty amazing to look at as you can see below!

- A 200 tanzanian shilling coin stuck in the oesophagus of a 6 year old.

2. Saw 2 patients who had been suffering from a hydrocele (a fluid filled sac surrounding the testicle resulting in swelling of the scrotum) - one had been operated on and one was still awaiting an operation.... Turned out that the patient who had originally been booked in for the operation was the one who had not had the operation because the doctor had got confused and when he saw another patient with the same condition, who was about the same age, assumed it was the right patient without checking the name! Good thing it was at least the same condition so the treatment was correct I suppose - otherwise the second patient probably wouldn't have been too pleased to have an unnecessary op. on his testicles!

3. Saw a patient who had needed a splenectomy due to trauma. The spleen is an important part of someone’s immune system so in England patients who have had a splenectomy are put on impaired antibiotics for life to prevent increased infections due to its removal. The other medical students bought this to the doctors attention and although initially he said lifelong antibiotic treatment was not possible here, he did in the end decide to give the patient a 3 month course of prophylactic antibiotic which although far from a lifetime (hopefully!) is better than nothing I guess!

4. A 15ish year old boy who was semi conscious, had massively increased muscle tone, was having small seizures and his mum said he seemed to "be fighting off monsters" during the night - hard to tell if she meant he was awake and having hallucinations or was having nightmares which he was acting out. He also had a wound on his foot. Doctor’s diagnosis? Cerebral malaria or "mental case". Lovely. Though they classify epilepsy as a mental illness here (which is another rant entirely!) and I suppose that is one of the possible differentials though probably not the most likely.

5. A patient with poisoning which no one seemed to know whether was accidental or intentional. Could have been a suicide attempt, could have been a murder attempt, and could have been an unfortunate accident. But the doctor stated the patient was epileptic so he had probably taken the poison accidentally because he was confused... Reduced alertness is a symptom of epilepsy (e.g. during or after a seizure. In one form of epilepsy the seizure does not involve convulsing but just a period of reduced alertness), but confusion where the patient can still move and do things like take a poison? Not a common symptom of epilepsy as far as I'm aware. Epilepsy is a very stigmatized condition here.
6. A MALE patient with ?Cancer of CERVIX written in his notes. Stunning diagnostic skills as ever! Apparently they probably meant prostate. Hope this was an English language fail rather than an anatomy knowledge fail!

Well I will say one thing about the average day here, it's never dull!

Halfadoc x


  1. Hasn't patient number 4 got tetanus?

  2. Yeah thats what we suggested as our first differential, the doctors disagreed and said the convulsions were not the form you get with tetanus and the wound was too clean .. He is on metronidazole anyway (they give everyone here metronidazole regardless of whether they think they need it) which is the preferred antibiotic for treating tetanus and they do not have the tetanus immunoglobin here, so even though they do not think it is tetanus he is actually getting treated for it... So hopefully the treatment might work!