Honeymoon is over!

september 29, 2008

They say that time flies when you are busy – well, in Port Harcourt time is supersonic…
I promised to walk you thru a day at work; why not start at the major source of work? On our daily bike-spotting on route to Teme we yesterday spotted a bike with six passengers – a single bike accident here can render more victims than an average bus accident at home!

We arrive at the hospital around eight and immediately start rounds. We are eight medical expats (five doctors, three nurses, and one physiotherapist) and we join forces at the hospital with national doctors and nurses. First the emergency room (ER) to see what has happened during the night; sometimes nothing (once!) but usually quite a lot. Next is the Intensive Care Unit (ICU), which is a little different from the ICU at home. To be honest, I don’t quite understand what is so “IC” about it, but there are more nurses around and they do their best to regularly take the vital signs of the patients. Sometimes corrective measures are initiated, but sometimes those actions are slightly suboptimal.
We next proceed to the wards; there are around 75 beds in three wards, separated by level of infection (green, blue and red). I do my best to assess pain and to adjust pain medications, but the work is sometimes just overwhelming. Besides, we have the current operating list to attend to (usually more than ten cases each day), and I must prepare and check the two operating theatres (OT).

For almost a week I was blessed by the company of dr Albert (we all go by first name here; I don’t even know his surname), a Canadian anesthetist whom I was replacing. The work didn’t seem so bad at the time, but when he left, and Paulinus (a local anesthetist nurse) was off duty for three days, I got thrown into reality. Please see the picture for the daily operating list; twelve patients of which four gunshot wounds (GSW) and the rest road traffic accidents (RTA). The fractures are typically quite complicated and many/most are open (with bone penetrating the skin). I won’t shock you with nasty pictures, but instead show a typical X-ray (maybe equally nasty…) of the lower leg after a gunshot. There have been a few days when we have not had any traumatic amputations…

Operating list

Gunshot wound

Most of the cases are done in a spinal (injection of local anesthetic in the back to anesthetize the lower part of the body), or sedation (which here is actually full blown anesthesia but with ketamine and thus (almost always…) preserving airway control). Complete anesthesia with intubation (airway control) is rarely needed (maybe once daily). Ketamine takes some getting used to (about half a day with the workload here…); the patients are in a dissociative state and can look up and sometimes talk (incomprehensible), but there is no pain or awareness, and the airway is relatively intact.

Well folks, that’s all for now! Next time I think I’ll tell you about my first laparotomy (abdominal operation) and how the OT is like.