Suturing in the dark

Tonight was my first time ever suturing someone by myself. It was a rush. I’ve sutured dozens of times since being down here but only under the supervision of another doctor or with the assistance of a nurse. I’ve done scalps, feet, ears, arms and bellies. I’ve done running stitches, interrupted stitches, vertical and horizontal mattress sutures. All of those times, it was always the doctor who injected the lidocaine and prepared the sterilized suture set up. Tonight, however, I was on my own. I was the only medical person around and the cut would only take about 8 stitches. I had one of the boys assist me with collecting the necessary supplies; a sterile drape for the table and another for the boy, syringe, gauze, lidocaine, alcohol swabs, size 8 sterile gloves, forceps, scissors, nylon suture, needle holders, antibiotic ointment, a clean bandage and some tape. Since I was on my own, I had to run through all the steps in my head to make sure I didn’t miss anything, things you take for granted when you have a nurse prepare everything for you. 1. Wash the wound with cool water and clean out any dirt and dried blood. Make sure not to suture if the wound is more than 12 hours old and or shows signs of infection. 2. Prepare sterile setup with all needed supplies 3. Inject the lidocaine little by little, slowly progressing around the wound so that the patient feels nothing more than the first poke (this I learned from Dr. Drew, a dermatologist who visits a few times a year). 4. Make the first stitch in the middle of the cut and tie it closed; one loop to the left and two loops to the right. 5. Continue stitching until you’ve closed the wound entirely. 6. Change dressing daily and leave stitches in for two weeks (the hands and feet take longer to heal). Everything moved smoothly except for the fact that we lost electricity in the clinic and I had to do it all with a headlamp. All in all, it was a cool experience.

Now, the prevention part of me couldn’t help but to ask a dozen questions. How did you get the cut? Where were you when you got cut? Why weren’t you wearing shoes? Where is the glass now? Did anyone pick it up? Do you have shoes to wear? When did this happen?For a while, kids were coming to the clinic with huge gashes in their feet almost daily and sometimes several times a day. I came to figure out, that they were all soccer players and had been playing barefoot in the same field. Rather than scoping the field and removing all of the broken glass, the children continued to play and continued to get cut up. I had the public health team go to the field, close it down for the day and search for all the broken glass. After that simple cleanup, it’s been almost a month since I’ve seen a kid come in with a cut like that. This boy had been running around at night barefoot and came upon a piece of glass. The glass was removed, but as a precaution, I’m going to have the team scope the area tomorrow for any remaining pieces. The obvious answer to this question would be to have all the kids wear their shoes all the time, but down here, that’s a joke. The children keep their shoes for school and for church. Playtime almost always means barefoot unless they’re fortunate to have an extra pair of shoes or sandals. For that reason, the most effective way I can prevent these unnecessary cuts is to educate the children about what to do when they see glass and to make sure that the grounds are kept clean and safe. Easier said than done.