Day one with the full first shift team began at a typical 730 morning report. Usually, morning report can be a very long experience of presentations from medical students with very little focused on orthopedics. However, today the conference flew by fairly quickly. There were clinical conferences and testing for medical students to follow. Nice!
Several cases were scheduled for Ortho on Wednesday. We were looking forward to a supercondylar femur fracture, ankle fracture, and elbow medial condyle fracture repair in a young teenager. Finally, there was a spine case that had Dr. Ani particularly intrigued.
Now reality starts! Nothing can prepare a surgeon for their first experience in this type of environment. Everything is different! The instruments, the bed, the lights, the nursing, the anesthesia, the x-ray availability, and even the temperature control in the room. As expected, the teams’ first experiences were mixed, trending toward discouraging. The distal femur injury was four weeks old and was going to be a difficult case. Upon entry at the knee, they found significant signs of infection, which completely changed the tenor of the case and rendered the fracture not amenable to repair today. Unfortunately, this also creates the need for a deep clean and local surgeons estimated it would be approximately 3 to 4 hour turnover.
With this in mind, we headed out for lunch at Bestie’s Burger. Shahnoor and Ashir, two upper level residents, joined us towards the end of lunch for good conversation and laughter.
We went back into the OR finally to get started on the elbow. We knew this would be a hard case and were intimidated by the overall instrument availability. We had some struggle. The end result was excellent, but it certainly was difficult with the new instrumentation. The combination of jet lag and new experiences/struggles left Dr. Josef and Dr. Ani somewhat frustrated after a hard day. A good nights rest will certainly help.
Our second day together in the hospital went great! First, we visited the teenager with the elbow fracture. He was all smiles, and doing quite well! Most importantly, his arm postoperatively was great with minimal swelling and excellent hand function. Second, Dr. Ani joined the spine case that had been rescheduled from yesterday and was a heavy participant. He was pleased with the overall knowledge base in the room and felt things went quite well. Third, our second case was a humerus fracture pinning in a pediatric patient. We surprised the hospital with our donated power system including a new drill. This made everyone very enthusiastic and certainly made the case much simpler. Overall difference in morale after day two was palpable. Smiles follow us all the way through dinner!
After spending the morning working on soap, Jennifer found time to collect some flowers and bright cloth from a local market to decorate the house and make it feel bright and cheery. Our jet lag is fading, our confidence is improving, and we are excited for tomorrow! A new addition of our team, Dr. Patt and his daughter, will arrive tomorrow. They hope to get the lay of the land in the afternoon, so that they are ready to help at the hospital first thing Monday. Our weekend includes a overnight safari for most of the team, while Jennifer and I are going to stay more local for a visit to Arusha national park.
It is interesting to think about volunteers arriving at a hospital and immediately taking on a lead or authoritative role. I can only imagine how I would feel if the situation was reversed and foreigners came into my professional world to tell me how I could do things better. It certainly is a delicate dance that must be followed. I am very proud of our team and how we have begun to build some trust with several of the residents. An awesome moment occurred this morning when the young resident who joined us on the elbow case that left us so discouraged onthe first day enthusiastically told Dr. Ani that he had learned a lot and looked forward to being in the operating room with him over the next month! These are the moments that we are all here for – to see these young surgeons get excited about learning and improving their skills!