The OR

Monrovia Travel Blog

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Dr Tony and Mary operating

So I want to give you an idea what happens aboard this ship, or at least what I do.  So I'm working in the OR.  We have 6 ORs (or theatres- I'm working with a lot of british people), but we only use 4 of them.  The other 2 are used for storage for right now, cause the hospital is over one of the generators and is too loud and vibrates really bad.  In 2 months when they are in dry dock, they are going to try to insulate the hospital to decrease the noise, becuase not only is it causing 2 ORs not to be used, but we can't use one whole patient ward. 

We have 3 Maxillofacial surgeons and one eye surgeon this week, Dr Leo and Dr Tony are going back to the UK tomorrow :(  We also have 4 anesthesia providers- we're losing Dr Tim tomorrow too, but we gained another 2 this week.

OR 6
  Theres also 9 nurses.  Its a wide range of cultures, the UK, the US, Holland, Germany, Scotland, Australlia, New Zealand.  It makes for some interesting conversations during the day. 

Our day starts with a gathering at the board, anouncements and a quick prayer before the day starts.  Each room has about 2-3 cases scheduled, but like any hospital, the schedule is not set in stone.  We are constantly rearranging the order, which surgeon is doing what case, cancelling, adding, etc.  So once we find out what we are doing, we gather our supplies.  Its a grab bag of goodies to pick from.  Everything is donated and so we use whatever pack we have, the other day I did a cleft lip reconstruction with an knee arthroscopic pack.

The OR corridor
  We remove what we dont need from the pack and resterilize them for later use, and add things that we need.  The trays of instruments are pretty basic, criles, mesquitos, allis, kockers, army-navys, addsons, mayos, etc, what we would find in a minor set.  There are some speciality instruments mixed in as needed.  One of the big changes that I've adopted right away, is that we dont have to wear masks in the room, unless we are at the field.  Its so nice.  We reuse everything, suction tubing, ET tubes, suction cannisters, drugs.  We've used the same bairhugger and SCDs on every patient.  Nothing gets opened onto the field unless they will use it right away.

When we are ready, we call the ward and send for our patient.

Catrin and Wendy in SPD
  The ward nurse will then bring the patient to the waiting chairs outside the OR.  I'll go meet them there, go over their chart, make sure its the right patient and then we'll pray before I walk the patient back into the room.  Usually they speak english, but their english is so accented, that its almost like they are speaking another language, so sometime there'll be a translator- a native woman.  Once the patient is asleep, the scrub will prep the patient and then drape usually before the surgeon (its been Dr Gary) gets there.  Then we'll get going.  I have one page of charting to do, basically its who was in the room, what sugery we did, our counts, types of dressings, drains, catheters, and the surgery times.  It makes it very easy.
Eye Marathon
  At the end of surgery, I'll call recovery who will then bring a gurney, we'll transfer the patient and wisk them off to PACU.  Then we use a blue basin filled with bleah water and wipe the bed and surfaces down before starting another case.

So far its basically maxillofacial surgeries, the ship has been here for about 9 months now, so most of the massive tumors have already been removed and so we are doing reconstructive surgeries, bone grafts to the mandible and maxilla.  Nomas are a big issue here, a disease that usually affects young children and causes their skin and muscle on their face to literally 'melt' off leaving them horribly disfigured and shuned by their community.  We had one girl who lost her nose and upper lip to a noma and we took a piece of rib from her and used it to rebuild her nose and maxilla.

PACU
  Its far from perfect, and she'll need further sugery to reconstruct her nostrils, but its a fondation for the future. 

In OR 5, they do an eye marathon.  They have 2 beds set up in there and do 2 patients at once, since its a local anesthestic procedure.  While one is being numbed, the other is having their cataract removed and sight is restored.  Its so fun to watch them work and how they just turn from one patient to the next. 

Next week we will be starting VVF surgeries, women who have developed vaginal fistulas and are incontinent, unable to birth children and are thus shuned from their communities.  I'm looking forward to doing these surgeries.  When the women are discharged, they are given a new dress to symbolize their new life. 

There's probably a whole lot more I should tell you about the ORs, but I can't think of anything right now. 

wanda2475 says:
Jen,
Thanks for sharing all that you do! It is interesting to hear about your instruments. I would think that people from different countries might call some of the basic instruments by different names. We have a new OB/GYN from Lebanon, and he has a couple of different things that he calls his Kelly's and his spongsticks. His lap sponges he calls something else. It wasn't hard to figure out what he needed, though. It sounds like your surgeons don't have "American" attitudes?? That is good! Wanda
Posted on: Oct 15, 2007
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Dr Tony and Mary operating
Dr Tony and Mary operating
OR 6
OR 6
The OR corridor
The OR corridor
Catrin and Wendy in SPD
Catrin and Wendy in SPD
Eye Marathon
Eye Marathon
PACU
PACU
Monrovia
photo by: Bluenose