Donde esta el equipo?

Just a quick update on our doings so far... sorry, but don't have the energy to write a long, detailed description. Afraid that would wind up reading like so many of my previous posts anyways.

No matter how many times I do this (directing my third project here in the past 15 months), I always seem to be surprised and caught off-guard by the inefficiencies in our process. We only managed to do two of our own operations on Monday - I guess I should be pleased since that included the entire unpacking process as well as seeing about 25 surgical consultations through the day.m We may have already booked as many cases as we can realistically do for the entire week. This at least gives me even more reason to turf anything gynecologic to the next guy (whoever he is, I hope he knows how to wield a speculum).
The end of the day got especially frustrating when we were asked to stay and help with an emergency case with the local surgeon (specifically, to do his anesthesia). As we were preparing for this, a woman in labor was falling to progress as well and we nearly bumped the emergency bowel case to do that, but then we heard a baby crying in the delivery room, so things must have come out alright. Jim (Sindard - surgeon) and John (Klatt - anesthesia) stayed and helped with the bowel case (a sigmoid volvulus from Chagas' disease - a parasite spread by the kissing beetle) before finally making it back to the hotel around 9:00.

Today went a little better, but was still full of frustrations. They did not have our instruments (equipo) sterilized for the first two cases, so we didn't get started until 9:30 or so. The cases themselves were not easy: the hernias are larger, the gallbladders are rotten, the goiters are larger and all the while the lights are too dim, the instruments too short or too dull, the gowns and drapes too few, and no one seems to habla the same lingo. Everyone is working very hard, both our team and the local staff, yet inefficiency and miscommunications seem to be a given. There is a fine line between pushing to move faster/ get more done and seeming unappreciative/ pushing people too hard. I pray people will forgive me when I cross it.
In the end, we managed to do seven cases (three hernias, three gallbladders, and a thyroid lobectomy). I am pleased with that, but I know we cannot even maintain that pace before we exhaust our supply (specifically drapes and gowns) or the local ancillary staff. Shoot, we might even be out of beds in the hospital already.

Tomorrow brings another day. We will be contacting our friends in Santa Rosa to see if they can lend us their gowns and drapes. I have promised the instrument processing/ laundry staff that we will try to let them off by 5:00pm (and I will confess some selfish interest in that goal as well). OK... gonna go for a walk with my super-helpful wife around the hotel grounds here. She really has been a godsend this week (though she informs me that I will NOT be allowed to radio commands to her in the walkie-talkie once we return home).


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Location:San Carlos, Bolivia