So, continuing on here:
Day two, we started doing surgery. We had 2 OB/GYN surgeons and 2 General Surgeons as well as 2 Nigerian Surgeons, so, a lot of surgery was going on in that room. There was no pre-operative area, so the patients, dressed in blue surgical gowns sat outside in a line, and waited.
We mostly did minor surgeries. Hernias, ovarian cyst removal, lipoma removal and the like. We hoped to actually do more tubal ligations. Nigeria has problems with child mortality both post birth and before age 2. One of the biggest problems is that large families are valued. Children are a huge insurance policy, to help care for parents as they age. Unfortunately, not spacing children can lead to both poor health for the children, but also the mother. Nigeria has been addressing this:
but without huge success. Many women showed up asking in stead for a surgery that would enable them to become pregnant!
Most of the surgeries were perfeomed with a regional nerve block. It's the same anesthesia I had when my hand was pinned this month, however, I also got sedation! Nerve blocks are very safe because they don't compromise breathing. I think our patients were quite brave!
You can see this guy is wide awake for his hernia repair! Also note our high tech OR lamp, the flashlight! As patients came into Post Op (formerly the mens ward) The local Nurses seemed unsure of what to do. There had not been surgery in years at Ituk Mbang. In addition I learned that they had not been paid for 6 months! I decided it was surprising they showed up at all, later I found out how they financed their lives. It turned out that Nigerian Surgeons ( at least ours) did not value recovery post surgery either. Patients began arriving with no orders, they were dumped fairly unceremoniously into my ward. This is a low quality photo (my camera lense got smudged) but its how the ward looked.
While the open ward was bad for infections control, it was great for moral support of the patients. Although English is an official language, a lot of the older women spoke only Ibibio, so sometimes neighbours would do translation for me. Persons who were one-two days post op, would encourage people just coming from surgery. It was pretty neat to see the community there.
While the regular nurses barely lifted a finger, I found the Students to be highly interested and more than willing to
learn. I always marvelled at how white their uniforms stayed!!! They use
American textbooks, but have rarely had a chance to use equipment because there is none. I found them to be very competent and a huge help to me. My favorite was the girl second from the left, Margaret. I hope something good has happened for her.
As the days went on, strange things started to occur, I started to hear and see patients each morning with IV's discontinued, no pain medication for 12 hours through the night. It turns out the Night nurses were asking for payment for these services and discontinuing them when no payment was given. While the behavior is shameful, It can be understood a bit, as we realize that everyone has to make a living and the government was surely not keeping up their end of the bargain. After working with the Night Nurses, they sort of agreed to continue IV's etc. I learned to tape vials of medications to the patients charts and tell the patients that the vials were for them. This helped somewhat, some non-monetary gifts such as T-shirts and such also helped, as well as a discussion of what is right in which the Nurses concluded their behavior was indeed not the best. I still got nervous leaving at night. I proposed staying the night, but that was forbidden. Already during the day we had a police escort:
While they look a bit intimidating, they were really lovely men.
It continued to be a battle to get the Surgeons to evaluate their patients for complications, or discharge. Because all the patients recieved Antibiotics IV after surgery (the conditions of the OR of course weren't really sterile), it took a while for me to finish after all the Surgeons had. After a few days, this started to annoy the Surgeons. At one point one of them came to me and very assertivelt told me she wanted to leave by 8pm. Exhausted by the heat, the work, and the incredible shortage of supplies, I said, Sure we'll leave, but you'll have to stop operating a lot earlier. I continued to pump in antibiotics, and I saw JS in the corner of my eye, sort of looking mildly surprised. He wasn't used to me being anything but utterly respectful of Physicians.
Here is an early Morning Shot of the OR in full swing…really different from what it looked like empty:
The next day, when we did pediatrics, all of the grumbling about that picky nurse in post op would end…
but because of the trouble posting, I'll again split this one up. I wish the photos were of better quality!