When We Come To It

I knew it would happen. It was just a matter of when. The group arrives full of energy and dreams and then each day finds those plans slowly derailed by the inefficiencies, the inertia, the system, the routine, and indifference. It’s sapping and I guess that’s why they call it the blues.

The goal of our trip is medical teaching. We did not come with loads of “cutting edge” supplies to show off our “resource-enabled” surgical skills, instead we brought basic supplies, personal protective equipment, and a whole bunch of lectures on iPads and laptops. We aim to demonstrate and assist in the OR how a good surgery can be found even with scarce supplies and implants.

Reality check – That’s really hard!

Knife blades don’t fit the knife handles. Drill bits and awls have no edge. Screws don’t fit. Local residents seem caught up in a “that’s how we’ve always done it” mentality. And that leads to the volunteer blues. I could see it hitting my team, they begin to question why they’re here and if they’re making a difference.

For example, Natalie and I worked on a infected leg yesterday. The femur appeared to be massively infected and the thigh had an abscess next to the knee which appeared infected as well. Upon initial incision, we hit pus. And I mean, we hit PUS – over 4 Liters of pus poured from her thigh and knee joint. Unsurprisingly, this lady was sick and her hemoglobin was low. from the beginning, we knew her overall stability was poor and we worked as quickly as possible. Her blood pressure dropped and we were informed the case must be ended. Now, we had 2 units of blood available. But anesthesia wouldn’t start it during the case because “it would just bleed out” (The patient wasn’t bleeding, just pouring out pus). Anesthesia also wouldn’t bolster her blood pressure with IV fluids “It will dilute the blood” (ummm… not sure where to go with that). So we closed the sounds after a quick washout. While we helped her, we did not complete the job and now she will likely not be allowed back to surgery until she can pay. Ugh. The local resident assigned to the case was disinterested and to some extent combative with our surgical plan and execution. we left feeling defeated.

Today, however, was better. And like most journeys, the valleys are followed by a peak. Jen and I gave our team pep talks. Matt and Natalie did a great job of supporting each other. We restated our goals and reminded ourselves of long-term differences we are making.

There is a girl who may walk

There are chronic wounds and infections that have a chance to heal.

There are residents who have learned to sew – learning figure of 8 knots, buried knots, respect for the skin.

There are residents who saw their “first” Liz Franc foot fracture

The value of closing traumatic wounds primarily has been demonstrated.

The importance of respecting the soft tissue has been emphasized and partially accepted.

The value of surgical pre-op plans and discussing options for plans B&C has been identified.

And my favorite, we all make mistakes and can LEARN from them if we can admit to them.

So yes, the volunteer blues struck. But I see the peaks ahead, and know our team will see those heights. If you volunteer overseas, you will hit the blues. When you do, give a pep talk and look for the little gains that are making a difference!