Cobras to kiss

This blog has become a way for me to review the day and try to make sense of it. I apologize in advance for this post, as I am planning to write a lot of medical stuff, but I promise I won't do this often.
I spent the day in the operating room ("theatre") with Theoneste, a senior resident. We began by looking in on the recovery room patients to see if anyone could be transferred out. The recovery room was filled, because the wards were filled and no one could begin operating until we cleared some space. The candidates for discharge were a two year old with a snake bite wound debridement, a 6 day old with a birth defect discovered on exploratory surgery (intestinal atresia,) an "old" man, 57, with GI bleed and metastatic cancer in the abdomen, and a 31 year old woman still intubated after repair of TMJ arthrosis (unable to open her mouth due to "frozen" jaw joints.) We chose the woman, extubated her and watched her for awhile, then she was discharged.
At about 9:45 we finally started our first case. A seven pound 2 month old having his fourth abdominal surgery. His mother appeared to be a teenager, but I didn't detect any fear in her demeanor, only resignation. The anesthetic technicians are very slick at starting tiny IV lines in these scrawny infants. We filled plastic gloves with warm water and laid them around the baby to keep him warm. At the end of the surgery, I asked about a commonly used drug to counteract the muscle paralysis that we use in surgery. I was told "we don't have." An ampule of this drug, Neostigmine, probably doesn't cost more than 25 cents. The baby was hand ventilated for about 20 minutes while we waited for the relaxant drug to wear off!
Next, a two year old with hemophilia who had a bleeding wound on his lower lip--he was the easy case. Lastly, a preteen girl with a malignant muscle tumor of her shoulder (rhabdomyosarcoma) with metastatic disease in her lungs. They took off her arm and shoulder blade, with the tumor, which had been there only 7 months, weighing about 6 or 7 pounds. She has no options for cure, but this surgery was to relieve pain and give her comfort for what time she has left.
The patients I've seen so far have extreme disease, mostly because they don't come to medical attention until late in the course of their illness. The explanations for this include fear, lack of money, spending time with traditional healers, and something as simple as lack of a vehicle. Also, surgery here is often a means of diagnosis, so the term "exploratory" surgery is literally true. Without CT scan, without endoscopy, without even the ability to perform basic blood tests (no test for electrolytes in the hospital lab) the surgeons are forced to do operations just to figure out what is wrong.
I am challenged and also inspired by the attitudes of the doctors, nurses and patients to their appalling situations. They are saddened, frustrated, moved to tears and yet continue courageously plunging ahead with their work. I can only hope I would be willing to stay here if I didn't have that plane ticket home and my American passport. I would like to serve the residents and staff here in a way that eases their load or at least shares it by being a witness to their reality.

On a lighter note, I have been delighted by the African figures of speech I am learning. Did you ever consider how meaningless "the tip of the iceberg" would be in a landlocked country close to the equator? Here, if you wish to speak of something large hidden beneath the surface, you speak of the "ear of the hippopotamus." And as I commiserated with the surgery resident about the many blood vessels to be avoided during the shoulder disarticulation, he smiled and said "Yes, we have many cobras to kiss this afternoon."