Working in a resource poor setting is very much an all hands on deck type of experience. But as a medical student, I am often aware of my limitations. It’s strange. In some ways I am awed by how much I’ve learned. I know that I would be totally overwhelmed if I had come here as a first year or even a year ago. And yet, I wish that I were an attending or resident or a nurse or respiratory therapist- someone who can speak with confidence about something…anything. Currently I’m an expert at cutting tape and memorizing molecular pathways.
But the truth is that we all have something to contribute. Even me. And not just placenta catching! Besides having a bit of derm knowledge (which came in handy today…more about that in another post), turns out I am one of the more experienced suture-ers on the team. Which means that I got to teach a bit (!!) and that when he had a knife fight victim…it was up to me to sew his laceration. We called an ear, nose and throat specialist because the cut extended to his lip but the surgeon was unimpressed and told me to do it. I did it and heaved a sigh of relief that it looked OK…
And then the “other guy” (his victim? His attacker? Who knows) came in with a huge laceration on his ear. It was in a very difficult place to sew. My resident turned to me “this needs to be closed. I haven’t done these since med school. If you really, really don’t feel comfortable we can always just try to steri-strip it (like surgical bandaids) and have him come back another day.” I knew that it would be very difficult for this 17 year old street kid to come back (and to not get infected in the meantime) so I took a deep breath, got the smallest thread we had and sewed his ear with the help of my EMT friend. It was for sure an all hands on deck situation.
I should note, however, that I would under no circumstances condone someone performing any sort of procedure that they wouldn’t be comfortable doing at home. I have sutured quite a bit during medical school both in the ED and in the OR (although this may have been one of the more tricky sewing jobs). Developing countries are not the place to “practice” or “play doctor.” That being said, sometimes necessity is the mother of invention and you need to step up to the plate and have confidence in your own ability to use what you’ve learned.
Of course, it was sort of a bittersweet moment. I was happy that I accomplished my task but less happy when I realized that these two kids had been fighting over the right to wash a car for a dollar or two. And that neither had the money to pay for antibiotics or a tetanus shot.
I wish I had taken a “before” photo but I was otherwise occupied.