The Two Camps

By the end of medical school, most students fall into one of two camps.

The first are the budding surgeons: practical, hands on people that like to get busy. The medical problem is usually straightforward but takes great skill and finesse to rectify. It's a fast paced world of acting first and pre-empting disaster. Once the abdomen is opened there's no knowing what you might find. Patients rapidly destabilise. Plans are changed at the last moment.

In the other camp are the budding physicians. They would rather use their brains than their hands. They have a knack for juggling complex diseases and medical problems often involving multiple organ systems and pathologies. It's a rob Peter to pay Paul game of balances and compromises. It is seldom straightforward.

Of the two, I seem to fall in with the latter.

World Vision recently opened a project in the Luweero area and decided that all their sponsor children would be screened for hernias and have them repaired. I'm not entirely sure why they chose hernias. Perhaps there's a big hernia problem in the Luweero area. Armed with pen, paper, chappatti and calipers, a small task force was sent out from Kiwoko hospital to survey the proposed project. Children of all ages and sizes were lined up and processed - a production line of pint-sized African abdomens being prodded and pressed.

This happened to coincide with my week in theater. Operating Theatre in Kiwoko bears a passing resemblance to theaters back home but the likeness isn't overwhelmingly striking. For someone who prefers X-ray meetings and pharmacokinetics to actual operating, the difference is particularly pronounced. Plain simple soap, rather than povidine, is used for the 'scrub'. Ether is used as an anaesthetic. The ventilator consists of a man pumping a bellows. There is no positive pressure air circulation. No diathermy to halt bleeding. An eggbeater is used to drill in the skeletal pins. At times, the lights flicker on and off. During the week we ran out of sterile operating gowns but the show did go on using normal, unsterilized clothes.

Consequently they have developed a complex algorithm of thou shalts and thou shalt nots to prevent contamination.

It was amongst this museum of surgical relics that I met Moses. Unlike most of the local staff, he is not Bagandan. He comes from a more remote tribe in the untamed North. Consequently he can't act as translator during my pre-op assessments. Drawn together by our mutual lack of Lugandan, we formed an instant bond.

He patiently demonstrates the correct procedure to maintain a sterile field in the midst of non-sterility. After scrubbing I touch several things I shouldn't have and promptly return to the scrub bay. Once I finally make it past the scrub trolley, I manage to drape the drape over the wrong part of the patient. It gets turfed straight to the sluice. Trying to find a task in theater I can't stuff up, he shows me how to use gauze to stop bleeding at points in the

operation. First you gather the sterile gauze with the tweezers. Then you dip them in saline, swivel on the stool, move away from the scrub tray and drop them gently into the patients abdomen. With great skill and dexterity I transfer three swabs from the tray to the floor and one from the tray to my crotch. Moses smiles gently in a way that suggests that I, who was in every way to blame, was in no way to blame.

And so I crawl back to the comfort of the medical clinic, ego only moderatley bruised. I know where my talents lie or rather where they don't. The truth is, I'm something of a liability in theatre