Training the Trainers: So Far, Some Good (Sabra Aquil)
Sabra Aquil is a medical professional from Somaliland who volunteered with M2H when we visited her home country. Below, you will find an email exchange between Dr. Sabra and Dr. Geelhoed.
Dear Professor Glenn,
It’s wonderful to hear from you and your excellent trip so far. Things are getting slow here as we are in the fasting month of Ramadan. Everybody is preparing for the celebration of Eid at the end of the month, so elective cases are getting less common. I supervised residents Ismail and Siddiq for appendectomies, and we did one open vesicolithotomy for a 7 year old boy and taught senior resident intestine repair for ileal perforation due to typhoid fever. We also performed an excision and inguinal lymph node dissection for melanoma earlier this month. I was very unsure of whether I should do it or not since I don’t have proof of sentinel lymph node, but my professor from Pakistan advised that I shall do it just as the axillary lymph node dissection was part of MRM (Modified Radical Mastectomy) before sentinel lymph node techniques were invented. Looking at the huge size of the melanoma, we performed it. It was enlightening to see the melanin deposit after I opened up the specimen.
Today I had a case of ovarian tumour with ascites and mild pleural effusion, her ca-125 was 135. I taped the ascites and sent for histopathology. It reported as mucinous ovarian carcinoma. I revised her CT scan with the radiologist and the mass was having good planes, good thing no paraaortic lymph nodes were involved. I scheduled her for our surgery list today and called my senior surgeon colleague to join me so that we could do staging laparotomy +/- debulking. After taking a proper informed consent from her family explaining all the risks and recurrence rate, they signed it. To my great disappointment however, the anesthesia team reversed all that we did by telling the patient’s family that an operation is pointless since the disease is cancer! The family then withdrew consent and opted to go for some traditional medicine. My heart was aching the whole day and my mind just got shut down. Sometimes with such incidents I feel like I’m being drained to death; on the other hand, some grateful smiles of patients restore hopes again.
Dr. G’s response:
Very much luck and a whole lot more!
You did exactly the right thing, since I have often put the mesh and split thickness skin graft even on bowel with peritoneum involved from overlying neoplasm and such patients have done well, even with the higher probability of obstruction from adhesions, no doubt, but that is a far superior risk to their malignant threat of loss of life. You did just what I would have done and probably did it better! And thanks to your Syrian surgeon colleague for backing you up and tell him from me!
I want to say how much I would like to encourage you further in your daily struggles, and want you to know that we are backing you a hundred percent and can’t wait to get there again which will be in a matter of months. I am currently on “African transect three” this year through remote Uganda with the mobile surgical units in full operation.
Thanks again for your persistence and for your expertise, and Full Speed Ahead!
Sabra’s email to Dr. Geelhoed exemplifies our core mission to bring sustainable healing to the countries we visit. Join passionate volunteers like M2H Sabra and apply for a mission with us here.