Starting to settle in

oktober 13, 2008

Hello again!

Last week’s description of the OT is not at all the weekday daily routine. It’s actually quite organized and not too unlike home. We finalize the operating list in the morning (and then modify it endlessly during the day…) and then set off to the OT. On a normal day it’s me and Paulinus and we take one theatre each, and do the cases as they come. The patients are delivered to the corridor outside the theaters on stretchers by an army of stretcher carriers; no trolleys or elevators at Teme!

For many cases I opt for a spinal and then try my best to explain to them what is going to happen. I now found out that my efforts at informed consent were largely in vain, and I’m better off pointing to my own back saying “injection” and then to their legs saying “no pain”. That seems to do the trick and they are all without exception extremely cooperative and even relaxed – I don’t know if I would be equally relaxed if I were in their place; badly wounded and with strangers that don’t talk your language to trust with your life. Anyhow, once the spinal is in place and the pain is relieved, most immediately fall asleep. The surgeons then do their thing; mostly external fixations and debridements (from minor to beyond major!), but we also do internal fixations and general surgery. When working on the upper extremities a ketamine sedation/anesthesia will often work, but in some cases intubation and airway control is of course inevitable.

At home there is a red button on the wall. If I’m in trouble I’d press the button and then take cover as within seconds a steady stream of world class anesthesiologists would pour into the room from every available door. At Teme in Port Harcourt there is no button. I use my skills and knowledge. We work as a team and finally we do a good, safe standard of work for a population tha would otherwise have no-where to go!

PS. I attach a picture of the wall of the OT; which emergency tool (the fly swatter or airway bougie) do you think is most frequently needed?

OT emergency tools

OT emergency tools

PSS. In my next post I think it’s time to describe our excellent living conditions (really!) and equally exceptional food!

PSS. It seems my mission is extended four weeks – great!