just realised i'm not sure how to spell abses in english. no matter. for this post i'll use the afrikaans spelling. i apologise to the purists.
when i was still a registrar (kliniese assistent) we used to warn our house doctors about the bombay gas abses. where the name comes from i do not know. why bombay i also do not know, but that is the name taught to me when i was pre-grad and that is the name we propagated when we told our juniors about it.
the bombay gas abses was actually more a joke than anything else. we would warn the juniors to be careful about an 'abses' that presented in the groin. they would often have an intermittent history and usually be painless. mostly, they could be pushed back into the abdomen. often they had audible bowel sounds in them. occasionally they would suddenly become very swollen and painful and could no longer be pushed away. here there would usually be signs of concommitant bowel obstruction. the stern warning we gave to our juniors was not to drain this particular form of abses, because more often than not gas would come out and it would continue to drain for many a long day. we would all then have a good chuckle and go on with our daily activities. i never actually heard of a case of a bombay gas abses being drained, that is until....
recently we got a transfer in from one of the peripheral hospitals. the history was that an abdominal wall abses had been drained. the wound, they said, continued to drain for a few days and now they noticed it was bowel content coming out. i tried to imagine what sort of hernia would present as an abdominal wall abses. spigellian maybe?
anyway, the child arrived. the call doctor took the patient to theater, but phoned me to join him. the patient lay on the table, already asleep. there was a cut over the inguinal area, not merely abdominal wall. fecal material was freely draining from the wound. the first bombay gas abses that i'd actually seen!!! the entity did exist! somehow when you see it, it's not so funny any more.
so we did a lap. the caecum was perforated. there was soiling in the right paracholic gutter. there was a bit of necrotic material in the area. so we did a right hemi, debrided, rinsed and closed. i felt uneasy about an anastomosis in what was essentially a week old abses bed, so i pulled out stomas for later closure. the patient did well.
this story is such a picture of present day south african medical state care that it really makes even the stout hearted want to cry. interns and community service doctors are scattered across the country with absolutely no senior backup. where such an inexperienced doctor in most other places should be able to ask a senior opinion, these doctors do not have that priveledge. they do what they think is right, but quite often bungle on without even a clue they are totally screwing up. i fear that if i go into the reasons that these people are without supervision and how the government of the day systematically destroyed a system that was quite functional 15 years ago only to replace it with...well nothing, i may sound a tad bitter and full of resent. i'm even likely to be accused of unpatriotic behaviour and the trump card, racism. i therefore think i'll just touch on it for now.
but what really gets me is these beurocrats still sit in their offices, actively engaged in the destruction of any remnant of service that remains. they are like generals in great battles, sending the masses onto the waiting muzzles of enemy rifles. not only are the poor and destitute without good medical care, but these poor clueless doctors are thrown into water far to deep for them to handle. they will also be dammaged and many a good healer will be lost to the profession. they will kill by their ignorance. when this happens, some will not be able to recover from the fact that they are responsible for the death of someone else, even if totally unintentionally. that is a difficult thing to get beyond.
today's post was a spot emotional and i suppose the bombay gas abses was just a catalyst for how i feel. i've decided to post it anyway, because it is how i feel at the moment and this is just one event of many. to be in what can only be likened to a battle where regularly one sees death and suffering which is quite avoidable must have an effect. i don't like to lean to the melodramatic, so maybe i'll seriously edit this later. until then...