Getting it in gear

Four days have gone by already - we are starting to hit our stride in the operating room and it's amazing how time flies when every moment is not one of frustration. We managed to get six procedures done on Tuesday: two gallbladders, a large thyroid, and three hernias. We were still frustrated by instrument and linen delays, so the six procedures kept us working until about 7:30pm and we still postponed two cases for the next day (maybe my expectations were a bit too high). I could sense tension between the instrument staff and our own team and this was only exacerbated by the language barrier and our poor understanding of their normal procedures. At the end of the day, I found Francis (he had been in Santa Cruz haggling with customs officials about an upcoming project) and had a chat with Vasilica, their head instrument tech. Found out they are down one autoclave and have to reprocess gowns and drapes in the same one as the instruments. It takes twice as long for the drapes to cool and dry and this slows down the instrument cooling time. They also have only six gowns - we will typically use three per operation. Result of conversation: We will borrow some gowns and drapes from the hospital in Santa Rosa (site of last November's project - about an hour's drive away).
Wednesday ran much more smoothly - we did seven cases (two gallbladders, a thyroid, three hernias, and a leg lipoma) and actually finished by 5pm. We didn't even have the gowns from Santa Rosa yet, but the second autoclave was back up and running and we started having the scrub tech (or whoever is functioning as such) go without a gown (gloves only) since they don't really have to "belly up" to the patient. This gave us gowns to cover two cases at once while some were still in the autoclave. We really didn't have to use many disposable supplies at all.
With the early finish, John, Jim, and Brenda walked up to the San Carlos square to get some ice cream. I saw a couple more consults with Marie and we watched the hospital staff play soccer. We actually made it back to the hotel before dark too.
Today, we did another seven procedures (three hernias, a goiter, a gallbladder, a facial debridement, and cutting and closing the web-space on a 1 year old with syndactly of his hand) and were finished by 4:30. Part of me regrets not scheduling more, but we never know how long we will have Ulysses, the local anesthesiologist. He has been more than willing to help, but he covers emergency cases in 5 or 6 towns and occasionally has to disappear for an appendectomy in Yapacani or a C-section in San Juan. Today we had him all day until 3:00, so we were able to run two tables the whole time.
I has been great to see the team gel both personally and with our work. We are also building better relationships with the local staff. Jim is really good at making small talk with the local staff and taking real interest in their background/ education/ training, etc. Brenda has been a huge help in the OR - she's taken charge of making sure the next case is ready to go, that the equipment and suture are ready, she has circulated (being the supply gopher while everyone else is scrubbed in), scrubbed cases, assisted procedures, functioned as an orderly, cleaned the room between cases, and all while receiving constant teasing from Dr. Klatt (please note: this NEVER happens in Manitowoc). Alas, she has not yet made us breakfast, but there is still one more week to go.
It has been a lot of fun scrubbing with the Bolivian docs Paola, Franz, and Sarona (a.k.a. Smurfette - Pitufina en espanol). Dr. Ricaldy, the local surgeon, has also scrubbed the bigger cases and Ulysses will even start a spinal, then scrub to assist on the larger hernia cases. There is a lot of Spanglish and laughter emanating from the OR as we all start to habla the same lingo.
Wendy has memorized the exact location of every stitch, needle, syringe, glove, dressing, drape, gown, drug, tube, or drain in the supply room. Since we have to wear a hot gown or change clothes to leave the OR area, she has been a big help in bringing us needed supplies on a moment's notice. All I have to do is buzz her on the walkie talkie and she will bring me exactly what I need right away. She assures me that this service is not available at home and that she will be hiding the walkie talkies upon my return. She has also been helping dispense and explain prescriptions and eyeglasses in the pharmacy which serves as a the main hub of activity for the team's various functions.
Between cases, I usually go over to the consult area with Marie (Nurse Practitioner from NC - and one who gives me stiff competition in the coffee-consumption department). She has usually found a few people with gallstones or hernias for me to see, and she usually has one curveball patient with an as-yet unintified parasitic disease. I hope me shrugging my shoulders helps her feel better. With very limited laboratory capabilities, we are often stuck referring the more worrisome cases to ID specialists down in Santa Cruz.
Well, one day left for week number one, then Jim, Marie, and Wendy head back to the US and it's just John, Brenda, and I as the only gringos left. Looking forward to another trip to the coffee plantation this weekend. (You can submit your orders via private message, but I can't make any promises).
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