Wednesday, October 14, 2009

Bush Thoracotomy

I know we charge 100 Kina ($35) for a bush thoracotomy, but hadn't seen one in my 2 yrs here, that changed today. A thoracotomy is surgery of the chest. A bush thoracotomy is surgery of the chest done in the village (bush) by someone who has no real medical training.
The patient today was from Enga province, which is apparently the hotspot of bush thoracotomies. The story I got was 15 years ago his wife stabbed him in the chest. After this, he had blood and pus in his chest which had dried. He was doing ok for 15 years, when all of a sudden while chopping firewood, he had some chest pain. He didn't have fever, cough or shortness of breath, just chest pain while chopping firewood. So they illogically concluded that the blood and pus from 15 years ago was causing his pain, so they took him to a local doctor to help him. This local bush doctor, after collecting 150 Kina, decided to make an incision into his chest (pic on R) to drain this blood and pus. The family says that he went in a little, but not very far because he said that if he went in farther, he might die, so they needed to take him to the hospital. This was the only logical thing they did, but a few days too late.
We still don't know when he had the thoracotomy done, one day, 2 days, 4 days ago - the story kept changing. But, we do know he came to us with a pyohemopneumothorax. I called Jim to see if he wanted me to send him to Hagen, or if we would take care of him since he was from longwe. After taking off his homemade banana-bamboo brace, we put the chest tube into the same hole the bush doctor into his chest cavity, and closed off the hole into his chest. We put him on a bunch of antibiotics and are praying that he will get better without requiring further surgery.
The sad thing about this case is this is an iatrogenic illness. He didn't need the bush thoracotomy. The pain he felt was not related to being stabbed 15 yrs before. Why people think someone in the bush knows something about medicine and they are willing to allow them to cut into their chest is beyond me.