63: OP#8/Malawi: day 13

Word travels.  Sister Christina was so happy with her vaginal hysterectomy that Sister Elizabeth showed up wanting one too.  But her fibroids were too large for a vaginal hysterectomy, so she underwent an abdominal procedure.   A more difficult operation than anticipated, losing about 4 times as much blood as an average hysterectomy (as is common with large fibroids). Would have been a difficult vaginal hyst.  Also, Sister Christina has a post-op infection.  For all their advantages, vaginal hysterectomies have higher rates of infection.  I brought antibiotics with me that I gave her by injection (more effective than pills)..  

The second major operation today was another dermoid, this one straightforward.

Meanwhile, the vaginal hysterectomy from two days ago ran a high fever.  I thought bacterial infection; the nurses shook their heads and suggested a malaria screen.  Positive.  She did well with medications recommended by a C.O. (I'd have no idea how to treat her). She also received 2 units of blood for a hemoglobin level of 6.6 (very low, normal range 12-14).  It wasn't intraoperative blood loss--she started with a level of 7.3.  So this may have been a malarial relapse (prior malaria would explain her chronic anemia) or a new infection.  Hospital beds have nets, but I'm not sure how often they are actually used.