Taking a Step Back in Time

Yesterday is gone. Tomorrow has not yet come.
We have only today. Let us begin. ― Mother Teresa

At Haydom Lutheran Hospital (HLH), there is a set routine to things. You get up in the morning, go have breakfast, then go to the doctors meeting at 7:30am, followed by Sala (which is a morning prayer and general announcement session attended by all in the hospital), then the radiology meeting and finally clinical duties (which typically starts off with ward rounds).

At Sala newcomers and guests to HLH introduce themselves. I did this last Monday and I basically just said who I was, where I was from, how long I was staying and what department I was going to be working in. If you're really organised or already know a lot Kiswahili, it makes a really good impression if you say it in both English and Kiswahili.

While there is a large overarching routine to things, a lot of this falls away at the immediate practice of medicine. Having done several ward rounds now I can honestly say they have been of variable experience. One the fundamental issues is a lack of organisation at times, which seems to make ward rounds last a century. Secondly, rather than a single nurse in charge of a patient there are multiple. This might sound like a good thing, but the problem is each nurse only does one task (e.g. insert a line, be at the ward round, send for x-ray), and they don't always communicate with each other or the doctors. But for now I play the foreign medical student role and see how things play out. No one likes being told what to do, and if it works for them who am I to say otherwise.

In my first observed operation at HLH, I was able to get a reasonable picture of how all operations are done at HLH. We were very fortunate to be in the lucky theatre with a pulse oximeter (other vitals were just done at the beginning). I couldn't help remembering from SMACC whilst I watched, that the pulse oximeter is the world's first time machine, taking you a step back in time.

Some quick facts of life with Surgery at HLH;

• Typically no vitals. BP cuffs work on a hit and miss basis.
• Nearly everything that can be reused will be reused (e.g. ET tubes).
• Saline is produced on site.
• Anaethetists are not Doctors, but trained technicians. They are still very good at the job, considering they often have to deliver drugs and manually ventilate at the same time.

Our time machine came into play later in that first operation. In HLH oxygen is provided to patients during surgery, however since there is only one machine that makes oxygen, up to four patients can be plugged into the same box simultaneously. During our operation the patient started desaturating (/was already desaturated), and we had to problem solve. Ventilation was all good, patient was not losing any blood, and probe was correctly attached. So next step was for the newbie medical student aka me to do, go clamp off the oxygen lines to the other patients so that ours could get more. Our patient steadily recovered and it was then my task to go tell all the other surgeons that we had cut oxygen off to their patients (as far as know no once suffered an adverse consequences).

I expected that my time Haydom would take me into a different world of medicine and clinical practice. As often is the case though your preconceptions, can differ from reality. There were aspects, I could not anticipate, and scenarios that I thought would exist, that have not yet materialised (and I doubt will). I thought working at Haydom would be like taking a step back in time. However, I now think it's something rather different, it's about going back to the basics. Sometimes doing things there in the moment, not knowing how it's going to play out further down the track. Many people doing the best they can, with the limited resources available, to make a small difference.