Would you let this guy operate on you?

Patients

My daily outpatient clinic is quite an interesting menagerie of patients.

Patient #1
A mother in a beautiful kira and jewelery from a nearby village walks in with her 9 year old son on her back piggyback style. He cannot walk. Never has walked. He was born in the village. No history. Appears that the child has a complex pterygium syndrome and webbing behind both of his knees so he is fixed at 90 degrees. This is complex problem at home and abroad. Could be fixed with complicated operation with help of plastic surgeon but none exists. Mom requests that I might do him tomorrow. I pass for now.

Patient#2
Soldier in camouflage fell off horse yesterday. He is off duty because of a previous foot injury. He was on a horse apparently getting to his house two hours away. He has a stiff neck. Xrays are horrible quality but show no evidence of fracture. Cannot get new xrays because they closed at 1pm. He wants to be off work because of his neck. No problem.

Patient#3
Indian couple. Man in impeccable grey double breasted suit, starched shirt, red tie, gold teeth, dress shoes. Wife in beautiful sari. She has knee pain for two years. Tried traditional medicine. Tried Ibuprofen. No sports, no inuries. Her exam is completely normal. She had a battery of tests from India that are all normal. They drove 6 hours today to see me. I decided to switch anti-inflammatories. They wanted to know if they needed to come back next week for a follow-up.

Patient#4
Pleasant twenty year old cousin half-sister of a VIP colonel in western clothes. She had an arthroscopy by a previous HVO volunteer. She wanted physical therapy. No problem.

Patient#5
Farmer in old gho wearing old leather climbing boots and knee socks. Hands look like they have worked the fields for a century. Bowlegged knees and knee pain. Recent treatment with gold needle acupuncture was only moderately successful. Takes a foul smelling poultice off his knee. Knee exam reveals he has more creaks than barn door. Xrays show severe osteoarthritis. No knee replacements possible here. I prescribe a short course of Ibuprofen. Tell him to take it with his big bowl of red rice and chilies in the morning. He is overjoyed and gives me a big red betel nut smile.

Patient#6
2 1/2 year old girl in a kira with her father. Limped since age one. Born in village. No other history. Exam reveals one leg shorter than the other. Xrays show severe congenital hip dislocation. Briefly explained the treatment of a pelvic osteotomy (re-constructing the socket) and femoral osteotomy (breaking the leg bone and repositioning it in the socket). He says that would be fine if I could do it tomorrow. He will check his astrologer and see if it is an auspicious day. If not he will wait until I return in a year. Maybe I will do it tomorrow.

Patient#7
Farmer in gho, purple track suit underneath, wearing flip-flops. Splinter in his hand that bothers him during rice harvest. He has had the splinter for two years. I remove splinter and he is grateful.

Patient#8
Hospital executive in very nicely tailored gho and knee high argyle socks. Right index finger hurts when he plays tennis. Exam reveals tendonitis. Racket modifications and archery restrictions are placed and he is happy.

Patient#9
4 year old with old diagnosis of clubfoot. Never treated for it. Walks on side of foot. He actually has cerebral palsy. Mother requests some type of treatment. I explain the procedure and she wants it tomorrow since the following year has not been projected as favorable for surgery by the astrologers. We book the surgery and hope that we can get it done along with all our other stuff by the time the OR shuts down at 3pm.

Patient#10
Indian scaffold worker fell today from bamboo scaffold. Dark skin. Large brown eyes. Lives in corrugated steel shack at job site. Back pain. Xray show compression fracture of T12. He gets a release from work but wants to return next week.

Patient#11
Student run over by HiLux truck. Smashed foot this morning. Xrays show foot fracture. Placed in cast and given note to get out of exams. Wants to know if he can play football in two weeks.

Patient#12-25. Same old stuff every clinic. Monks, Nuns, VIP’s, farmers, chidren in miniature gho’s and kira’s, Indian and Nepali workers, people that traveled days to see us, new and old trauma and neglected fractures, wild pediatric cases. Lots of low back pain. Xray closes at 1pm. Clinic closes at 3pm. If you are late for either you return the next day. No complaint box. No insurance co-pays. No Labor and Industry forms. Minimal hand written medical records. Pharmacy carries two anti-inflammatory medications and both work wonders.

Child with reconstructed burned hand is doing really well Now has five moving fingers rather than a fist. Mom really happy.

Girl who walked on her hands got up on her feet today. Very happy person.

Bear mauling guy went home.

Waiting to transport two patients with spinal cord injuries to India. Peak tourist season and no one wants to give up a reserved seat. The airplane will not accommodate a stretcher and we have to remove a row. Red tape,. New helicopter service $1500.00 per hour reserved for tourists only.

Lots of chronic infections have been in the hospital since we arrived a month ago. No
discharge plan as of yet.

All in all. Pretty much business as usual.