The Theatre

15 October, 2009

Today was a long and taxing day emotionally, and physically as usual. We wanted to get to the hospital for morning report, which starts at 7:30 every morning, so we left the house at 6:50. Morning report is just a chance for doctors and nurses to discuss patients and cases that may be peculiar. During the report, the power went out, and all the doctors and nurses just ignored it and continued on as planned. I thought to myself about the chaos and panic that would ensue if a hospital back home lost power; so many lives would be at stake. But here, there is no life support, and nobody relies on electricity to stay alive.

After the meeting they told us there were three scheduled surgeries today, but they needed to wait for the generator to be repaired, which would take about an hour. So Whitney and I went up to the medical ward to watch the Dr. go on rounds through the HIV inpatient wards. This was the one part of the hospital that I thought could completely break me down, so I had to somewhat leave my emotions at the door. As we watched, we couldn’t understand the conversations (and some of the patients could barely speak), and I felt like I was just looking at these people who had been battered and beaten by the disease that Whitney and I have been trying to fight and prevent, and I realized just how much worse the fight is going in Africa. We are in a whole different ballgame now, and are going to be pushed to our limits. Seeing these patients was a very humbling and motivating experience.

After rounds we moved downstairs to the surgical unit, which is called the “Theatre”. While we were waiting for the room to be prepped, we helped fold gauze pads because they come unfolded in bulk here, and then they autoclaved them to sterilize them; the generator also shut down a few more times and I kept thinking about how primitive all of this seemed. Once the room and the patient were prepped, we prepared to enter the “Theatre”, which consisted of changing our scrub top, putting on designated shoes, caps, and masks, and that was it. There was no scrubbing or washing or anything, we just walked into the operating room. This particular patient had a baseball-sized goiter on her throat and was in for a thyroidectomy. I kept thinking back to physiology and we pieced together possible causes of this ladies goiter; college is finally coming in handy.

The following are some of the shocking events and sights during the surgery:

- They left the door and windows open and the window screens had holes all over and a fly was buzzing around the OR.

- They had no tray for the tools and the surgeon just layed the used ones on the cloth covering the patient. Several tools were dropped and everything seemed very unorganized.

- While operating, the surgeons cell phone went off and I could not even imagine trying to concentrate with a scalpel in my hand while my phone was ringing. One of the nurses answered her phone during the procedure as well.

- The tools were not shiny like on TV, and the sheets, table, scrubs, and room all seemed very worn and patched up, but they save lives in that situation everyday. These professionals are amazing at making due with limited supplies.

- To wake the patient up from anesthesia, the nurse started smacking the lady in the face, as if being operated on wasn’t enough physical shock.

- I asked when they were starting the second of three surgeries, and the nurse told me that the other two had to be postponed because if they tried to sterilize the instruments in the autoclave that they would blow out the generator.

This surgery was my first ever, and it blew my mind. We have been raised in such a germophobic society that thrives on sterility, yet people die of nosocomial infections every day in American hospitals. Here, they are much more relaxed about sterility, and success rates in surgery are very high. The operating room is called the “Theatre”, and now I can see why.

Written by Zach

15 October 2009

This morning at the hospital we went on rounds with one of the doctors in the inpatient HIV ward. It was my first real emotional break since we’ve been here. I am not quite sure what it was, but I think the doctor had more to do with it than anything. We went through each bed and the doctor briefly filled us in on symptoms and asked us what we thought the diagnosis might be. We came up to a bed of a man who looked like he might be about 30 or so with skin lesions all over his body, bad thrush, and was severely malnourished…clearly HIV, and bad. The doctor told us that yesterday, when we was admitted to the hospital, he had 18 t-cells. He was only started on ARVs when he arrived. He was laying curled up in bed with a blanket covering him and was wearing a winter coat and hat. The doctor shook him awake and told him to sit up (although I could not tell exactly what he said, the tone was not kind). He rather roughly started taking off his covers, hat and jacket and began showing us the lesions on his back and the thrush in his mouth. I just stood there thinking how much I wanted to help him gently sit up and take his jacket off and give him a hug and tell him to “hang in there just a little longer and the medicine will start to kick in!” His wife (or girlfriend) stood next to his bed looking both sad and stressed. I had been blinking back tears since the first patient on rounds, but this one sent me over the edge. I went out into the hallway where a bench lining the wall was full of people. I stood with my back to them, looking out the window and trying to wipe my tears as inconspicuously as possible. We wear lab coats and scrubs to work so hospital staff knows we work there, but to the patients we look like doctors. I could not be disguised as a distressed relative, so I’m sure it did not look good for the “doctor” to be outside the HIV ward crying. I stood there for several minutes trying not to move, but I just wanted to go home. Unfortunately it was only 9am and it just wasn’t really an option.

Later we went into a surgery and observed a thyroidectomy, but I was weepy all the rest of the day and into the evening. I only tried not to think about it.

Written by Whitney