Post-op care and MMC Follow-up

A lot of my work at CMMB focuses on the preoperative portion of MMC, with scheduling dates for circumcision, creating promotional flyers for mobilization, and coordinating community events to educate and promote MMC. The other part of my job is spent behind my computer imputing data, doing quality assurance checks, and reporting. This means I don't always get to interact with our patients, see the surgeries, or assist the nurses in their daily activities. I definitely enjoy the work I do and recognize it's importance, but sometimes its just fun to get out in the field and interact with some patients! Luckily, last week I was able to go along with one of the teams doing follow-up visits for a group of patients they circumcised 3 days prior. This is standard procedure for CMMB to check the healing progress of each patient 3 and 7 days after surgery. We traveled to the clinic and reviewed each patient that had been circumcised 3 days prior. Each boy had obviously read the post-op instructions we provided them that gives instructions on how to clean and care for their wound, because none of them had any problems with infection or removed sutures. The most common problem we saw was slight swelling due to patients not positioning their penis upright.

 

    After conducting all the follow-up reviews we were told about another patient who was circumcised several weeks ago and is now having a problem. We called the patient and received directions to his house in order to assess the problem and provide treatment. We eventually found our way to this boy's village, stopped to ask some locals which house this boy lives in, and found the boy at home with his grandmother. There was no electricity in the house, so our nurse had to review the patient from the light coming in from an open door. We discovered the boy had wound dehiscence, which means a rupture along the surgical suture line. This is commonly caused by infection, frequent erections, or excessive tension at the suture line. Our nurse was able to provide treatment and medication to help alleviate some of the boy's pain. We promised to return the next day to assess the healing and left the boy to rest with his grandmother. It is not often that we see complications like this after MMC, but they do exists. Currently CMMB's rate of complications is less than 1%, likely due to the amount of follow-up care we provide our patients and the instructions we give them before, during, and after their surgery. I'm happy to say the boy is now completely healed and has returned to school. Although it was an unfortunate occurrence, I'm glad I was able to witness our nurses in-action caring for and treating our patients.