November 2012 - Week 5 - William Schecter

Eveline Shue finished her one month clinical rotation with us last Friday and returned to the United States on Monday, November 19.  Unfortunately, one of the senior faculty members died last week and therefore the operative list last Wednesday was cancelled so that everyone could attend the funeral.  Therefore, the operative load was lighter than in previous weeks.  However, we helped one of the young faculty members complete the first laparoscopic cholecystectomy since SAGES held a course here several months ago.  They are very keen to develop a laparoscopic program here and UCSF has the potential to be a great help.

We finished the week with two challenging cases:  one was a large right colon cancer invading the abdominal wall associated with a large abdominal wall abscess.  Unfortunately the patient had carcinomatosis but we were able to get the primary out, do a primary anastomosis and she is already eating.  Hopefully we won’t have any complications and she can enjoy what time she has left.  Tragically, she is only 22 years old.  The second case as a large adenocarcinoma of the rectum.  Lawrence had a major role in the APR which included an enbloc resection of the posterior wall of the vagina.  The young Tanzanian faculty members were very kind to invite me to help them with these cases which also gave good exposure to our residents.

One of the problems we had was that Jessica and Eveline were rotating at the same time which means that they had to share the operative cases.  On the one hand it was a good social experience, especially since Jessica is fluent is Swahili.  Eveline managed to learn a great deal of Swahili in one month.  On the other hand, it cut down on their individual case load.  Nevertheless, they were both exposed to all the cases.  Lawrence is now the only American resident on the service and I hope he will do more cases although he and Jessica will attend a meeting of the Central Eastern and Southern Africa Surgical Congress in Addis Ababa, Ethiopia, later this month.  I think that meeting will also be a great opportunity to learn more about Surgery in Africa and network with more African surgeons.  However, it will take away from the clinical experience but I think it is an opportunity not to be missed.  I will stay in Dar Es Salaam and continue to represent UCSF to Muhimbili so that they see that we do is what we say we will do. 

On a personal level, relations with the Tanzanian faculty and residents appear to be excellent.  I have been invited to several homes and am continually consulted on challenging cases from both Firms even though I am officially attached to Firm 1.  We attend all teaching conferences religiously and stay in Theatre continuously on our assigned days so we are scrubbed most of the time.

Case List

Disease                                                           Operation
Squamous cell cancer of anus                       EUA and biopsy
Ca of esophagus                                            Rigid esophagoscopy and biopsy
Extrasphincteric fistula in ano                       EUA, placement of Seton
Fibroadenoma of breast                                Excisional biopsy
Perforated gastric ulcer                                 Repair of gastric perforation
Splenic/Liver Laceration                                Splenectomy & repair of liver laceration
Splenic Laceration                                          Splenectomy
Strangulated Ing hernia                                  Small bowel resection, ing hernia repair
Degloving thigh wound                                  Thigh wound washout and closure
Cholelithiasis                                                   Laparoscopic cholecystectomy
Right colon cancer                                          Right hemicolectomy
rectal cancer                                                   Abdominoperineal resection