It seems often that my writings here stray to the idea of expectations and realities of working in a resource limited environment. Each week here, even with the experiences of the previous weeks, is often an exercise in managing the realities of our limitations to excel, achieve, and teach.
Week 4 has coupled the highs of operative success and the lows of medical care slow downs and obstructions.
Let’s start by welcoming Dr Jason Halvorson to the party. He is our final team member coming in as an orthopedic trauma specialist and one of Natalie’s closest mentors during her residency. As has been the case, the addition of new blood injects some excitement and enthusiasm back into the team. We started his visit with a “vacation” and traveled to Ngorongoro crater. I will not attempt to become a travel agent but I can wholeheartedly say that this is amazing location for a short safari trip. The density of animals is unparalleled. In a few hours, we saw an amazing collection of species living in an isolated ecosystem within the crater. Awesome day.
On top of that, the journey gave us a night away form the doctors compound. A close second to the animal experience was the availability of hot, high pressure showers for a night!
On Monday, we began our usual routine of morning report. Natalie has been our list manager and she has kept an amazingly accurate list of the coming and goings of the orthopedic trauma passing our doors in the hospital. With Jason’s arrival, they had mapped out a plan for rapid, efficient treatment of many of the untreated fractures on the floor. Managing expectations….
The first day was a full jump into the pool by Dr, Halvorson. On the plus side, he got 3 cases done of fairly high level trauma injuries. On the minus side, several of the injuries he had planned to fix in those patients alone had to be aborted due to various maladies, timing, and implant availability. While I was excited for his successful first day, he was disappointed with the number of cases performed and having to back off some of his more aggressive operative plans. Managing expectations….
The week has been a bit sluggish since. The local program decided at some point to include a practical exam in their yearly evaluations. This started Tuesday and has lead to a strange stagnation of cases and what appears to be a purposeful avoidance of more complex cases. In addition, the local residents being tested are expected to lead the case and answer questions from the staff attending physicians. This has obviously placed our ability to actively engage, teach, and just plain be involved in a tight spot.
I am proud of the mission of our travels – teach not do. I strongly believe that it is more important to teach a man to fish with the equipment on hand as opposed to bring a full team, displacing the local surgeons, and doing as many cases as possible. Part of this mission involves working within the confines of the program here and trying to slowly adapt local standards into more progressive health care. By working within these ideas, I do not expect the local program to stop and cater to our visit. On the other hand, when testing is scheduled during our stay and leaves us with little to do, it creates a sense of futility that all of us here have struggled with this week. Managing expectations….
Thankfully today – Thursday – has seen a return to the OR for the team and a chance to get involved and teach. As I am writing, Dr Halvorson is helping/demonstrating an external fixation technique for a pelvic ring injury. We are hopeful that it could start a process of treatment for these devastating injuries that allows for earlier mobilization and discharge from the hospital. It won’t happen after one case, but it is a treatment pathway that is available here on a reasonably consistent basis – if used by the local staff and residents. Fingers crossed, but still trying to manage my own expectations.
For a chuckle, here is a snapshot of what happens if one orders a whiskey and coke at the local bar. It’s a mix your own event with 300mL of Coke and 200mL of Jack. Exceeding expectations!!!
In closing, I wanted to continue the story of our little girl – Jamilla. Since I last discussed her case, we have been doing daily dressing changes, checking her wound, and discouraging her grandmother from applying any local salves/ointments to the wound. Today we did a final cleansing and applied a collagen matrix (fake skin) to the tissue. We hope that it will help her finish healing the wound and create coverage. The process requires weekly (not daily) dressing changes and we have given those supplies to some of the more actively involved residents here. All of us here will carry Jamilla;s injury home with us in our hearts and pray that we can see a picture of her foot someday with new skin to go with her infectious smile and laugh! The wound looked great today and we are amazed at her healing!
