I spent today in the actual operating theatre observing surgery and it was quite an experience! Although this does mean that today's blog is mostly boring surgical observations unfortunately. You have been warned...
Every case starts with the entire surgical team gathering around and praying for the patient on the table. Although a nice touch, the unfortunate thing is that these prayers often seem highly necessary.
By far the biggest difference was with the anaesthetics side of things. There are apparently only about 15 anaesthetists in the whole of Tanzanian and Machame is certainly not home to any of them. Instead, the role is performed here by a single nurse, who performs exactly the same duties as a consultant anaesthetist would in Australia, by cannulating, intubating, anaesthetising and monitoring the patient. Except with far less equipment and access to far fewer drugs than at home.
I discovered the challenges of dealing with these sparse resources within about ten minutes of being there when the mechanical ventilation equipment broke before the operation had even started. Luckily the patient hadn't been put to sleep yet! It eventually got repaired with a piece of tape and the show went on. Who says gaffer tape can't solve anything?
As mentioned above, all ventilation is done by hand by the nurse, who has to do this throughout the whole operation at the same time as doing all the other important things to stop the patient from dying. Not ideal. She probably works the hardest out of anyone at the whole hospital (Mr Mushi aside). Also, there is only the base basics of monitoring equipment, with the only information available being O2 sats, blood pressure and heart rate. Very different to the space-age gadgets available in Australia!
For a general anaesthetic, pentathol is used as the inducing agent and halothane gas is used as the maintenance drug. There is no separate analgesic given, so the doses of halothane have to be really high to get a semi-decent pain relief effect.
The other big omission is that there is no oxygen cylinder to give the patient. Instead, there is a great big machine that is designed to concentrate the oxygen in room air, but even this can only give a maximum of 50% O2.
Luckily at the moment, there is an anaesthetist from Canada visiting the hospital and he has been very friendly. He looks exactly like Lloyd Christmas from Dumb and Dumber, complete with the hairstyle. We've met his wife too, who is clearly a massive Jim Carey fan. Luckily, he's quite a bit cleverer than Lloyd and his expertise is highly valued, so much so that at one point in the operation he had to rush off to see another patient and I was left to monitor and manually ventilate the patient with about only 5 seconds explanation about how the machines actually worked. I was very glad those prayers had been said!
From the surgical side of things, it was all fairly similar. The main difference was that they had to be really frugal with everything and there is far less waste than back at home. For example, all the sterile equipment needed for the week's operations (such as drapes, gowns, packs and so on) are not individually wrapped but placed in supposedly sterile big stainless steel containers in the corner of the operating theatre. Then, before the start of the procedure, what is needed is taken out using a pair of 'sterile' tongs and put on the tray. It would seem that the risk of cross-contamination of the remaining sterile stuff is very high.
I had a chance to look through the sterilising room before we began and was able to take my scrubs fresh out of the autoclave. Unfortunately, there are only about fifty pairs of scrubs for the whole hospital, so sizes are extremely limited. I wore XXXL pants and an XXS shirt and looked like my top half was being squeezed out of my legs.
At the end of the operation, there is no count of the instruments used, which is brilliant because here the scrub nurse doesn't spend half the procedure counting things, like at home. Instead, all the packs have long a long blue cord on them, so that it is (hopefully) clear when one is left deep inside the body.
Similarly, there are no dressings. The wounds are just covered with iodine antiseptic, covered with a couple of pieces of gauze and taped down. There were also no drains inserted and the sharps are disposed of in a yellow cardboard box.
It was quite an eye-opening experience today to just see exactly how so much is done differently here when compared to back home.
Things that went wrong: Day 10 edition
- I initially tried to do the paediatric ward round again, but found out that the doctor had briefly come in really early in the morning to see a couple of patients by himself and had now gone into town for the day. Worst. Doctor. Ever.
- In fact, a lot of things don't really happen here. Going to theatre was about Plan E for today, but it seemed like nothing else at the hospital was actually happening. There were no patients in the ICU, so I couldn't go there and the pathology lab, which I thought I might check out, was not open. I then went to see if there was a ward round in any of the other wards (general men's, general women's, surgical men's, general women's and obstetric) to no avail. I was beginning to wonder if there were in fact any doctors working today when I stumbled upon someone in a white coat. He was going to operate, so I came along too!
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