End of my second day as a surgical nurse. Anita and I are on different schedules. I now eat at 7:30, go to work at 8:00 and get off about 4PM—4:30 today. I miss my former schedule of getting to work at 7:00 when it's quiet, breakfast at 8:30 or so with Anita and another couple and getting off 1-2 PM. We had lots of freedom in how we did our jobs and no one bugged us because the patients were always ready for surgery on time. Now someone else determines my duties and there is a lot of “hurry up, get ready and then wait around” whether it’s waiting for surgery to start or during surgery, there is a lot of down time for the nurse doing the paperwork (circulating nurse—and that’s me)and not assisting with the actual operation (scrub nurse are the ones who hand the dr instrument). I do have to say, there's lots less paperwork here!
Coming from a place where you can’t put stuff on top of the cupboards because it might fall on someone, there's lot to comment on. The oxygen is in large tanks that are standing, upright, unsecured along the operating room wall. You need to watch the gauge like in the old days and change the tank when it’s out. I’ve never seen an anesthesia machine that looks as old as the one we use, but it sure looks simpler than the ones at home that resemble an airplane cockpit. The suction we used to evacuate blood and saliva is so loud, I sit behind the doctor and he kicks me to shut it off because I can’t hear him say, “off”. People walk in and out of the surgery suite as the operation is going on. Yesterday it was a couple missionaries, a couple nurses from Aberdeen, UK, a couple doctors that are here to do urological surgeries, and one philanthropist. Our anteroom is where all OB patients go through on their way to the operating room for c-sections, of which today, we had two. (Only high risk pregnancies ever get to the hospital and many come in after many hours of labor in their homes with midwives or in remote village.) To empty the suction cannister between cases, I had to walk through an operating room where a patient's abdomen was cut wide open! No one paid any attention to me.
During surgery today, the electricity went off twice for about 5 minutes each time. The doctor wears a high intensity headlamp that allows him a good view of the patient’s mouth and throat during cleft palate surgery. All that could be seen during the power outage was the surgical headlamp shining in the patient’s mouth! Surgery just goes on and you hope you don’t need anything that requires electricity during that time! After the power was off, one of the fluorescent lights started flickering and one of our nurses managed to get someone to come up right away to change it. They brought a ladder, replacement tube, and he started to pick up the dirty gown the doctor had just taken off and started to put on—at least he knows you can’t go into surgery without one! I told him it was dirty and he said, “no problem”, I said, “no it has blood on it”, he said,” it’s OK; I just need it for changing the light”. The doctor at this point said, “ no, do not put on a dirty gown especially with blood on it.” Finally I got him an old paper one, he replaced the bulb that required unconnecting two live wires and reattaching them. He+ left oblivious to the danger of exposing himself to someone else’s blood!
One of the staff told me that she was going to the toilet and I started laughing and got out my camera to take a picture—she had rolled up her scrub pants, had on the clogs she wears in surgery and had a flashlight. I have deliberately never used the toilet! Part of my orientation was viewing the bathroom and the reminder to take a flashlight. The long scrub sink where the doctor scrubs before surgery, was a urinal in its last incarnation.
That’s the “OMG, it’s so third world”, but the other side is that the actual surgeries turn out fine, the patient’s are happy—more grateful than most patients I’ve seen at home--, the doctors and nurses seem to carry on no matter what the equipment or facilities are like. One of the nurses told me that these operations at home would have more bleeding and more complications! ” I asked our philanthropist visitor how much nurses make and she said they start at the equilevant of $100/month and in private practices, where everyone aspires to be, they can make $200-$300 with experience. We’re just here for a month tolerating working conditions that are unbelievable to me and most Westerners, but there is a group of dedicated doctors and nurses who are college educated here in the Gambia—in fact, the campus of the University of the Gambia Medical and Nursing Schools are on our street—that live with these conditions every day and they don’t get to go “home”.
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