Elisabeth Hesse’s Blog

2-3-09: Birth control in PNG

Today, being a Tuesday, was our day to be in the operating theatre
(although lately, with all the fractures we’ve been setting, we’ve
been in there quite a bit).  We had a fairly full schedule set up for
us: a skin graft, re-plastering of the fracture from a few days ago
(post-reductive films showed that we, once again, failed to reduce
the fracture), a tubal ligation, and a vasectomy.  The tubal ligation
and vasectomy were both iffy, for different reasons.  As far as the
TL, both the husband and the wife wanted it (she just had kid number
seven or eight a few days ago), but both sides of the family were
against it, for reasons we couldn’t quite understand.  They wanted
the couple to use “custom” birth control, of which some methods I’ve
heard are drinking a tea made from the bark of a tree, burying the
placenta from the last birth, and hanging the placenta from a
tree.  I don’t know what those are supposed to do to prevent future
pregnancies.  Dr. Ovoi jokingly suggested doing a study on the
effectiveness of the placenta-hanging method of birth control.  For
some reason, I don’t think it would be that effective.  The couple
decided, in the end, to go with their families’ wishes, and decided
against the TL.

Our reasons for the vasectomy being iffy were completely
different.  None of us have ever performed one before; I’ve never
even seen one live.  However, Ovoi felt confident in her abilities to
do one, based on having seen it done, and having the surgery book
open to the vasectomy chapter.  We were going to do it, but then we
couldn’t find the right instruments.  Someday, someone else will have
to be Ovoi’s guinea pig.

The skin graft went fairly well.  I was feeling pretty confident
going into this one, since I did a month of skin grafting while doing
a rotation in the burn unit.  Skin grafts in American and PNG are
different, though, mostly because at home we have fancy equipment for
preparing the skin of the donor site, removing the skin, and
preparing the shaved skin for grafting.  Here, we “prepared” the skin
of the donor site by having me pull it taught, and Ovoi removed it
using an instrument (I don’t know its name) with a razor blade
attached, and we prepared it by taking the tip of a scalpel and
dotting it with skin.  We wrapped it up pretty tightly and told the
mother to make sure she doesn’t walk on it (its a 14-year-old girl,
and the graft was on the top of her foot) for a couple of
days.  Hopefully it’ll take.

As far as the fracture reduction, well, we had three guys holding
traction while Manar did the anesthesia, Ovoi did the plastering, and
I held the fracture in place.  Hopefully it worked.

Since we couldn’t do the vasectomy, we were getting ready to go home
when we heard that the brother of one of the CHWs was chopping a tree
when the sap, which was white and watery, squirted out into his eye,
burning his eye, so we grabbed stuff to do some emergency
ophthalmology, including anesthetic eye drops, flouresceine (to see
if the cornea was damaged) and antibiotic eye ointment.  And we read
the chapter on eyes in the surgery book (good thing Ovoi had it out
in preparation for the vasectomy).  I’m assuming the sap was alkali,
which is the worst possible thing for eyes.  Well, we gave him the
anesthetic drops, then the flouresceine, and the entire eye lit up,
which is bad–means there’s a lot of cornea damage.  So the only
thing we could do at that point was put in the ointment, cover his
eye, put his name in the book to the see the ophthalmologist in March
or April, and be thankful that his other eye was spared.

After our morning in theatre (I still enjoy writing that), I headed
back home to do some cleaning.  I’ve had this infestation of little
green bugs at night (like on X-Files, only these don’t eat flesh when
the power goes out).  I’m able to kill them pretty effectively with
the bug killer I have in the house, but then my floor is littered
with millions of little green bug carcasses, which is kinda
gross.  So I borrowed a broom and swept them away.  Hopefully they
don’t come back tonight, because they’re really getting on my
nerves.  After that, I “enjoyed” a very hot afternoon, without much
of a breeze, so not even sitting on the veranda was much
relief.  It’s cooled down somewhat since then, so hopefully it won’t
be too hot for sleep tonight.  I can use a good night’s sleep.