Suture and meds on back table.Daily I develop an appreciation for the westerners who have sacrificed much to stay here for many years. They have learned to cope with the many inconviences of living in an impoverished country where water and electricity are inconsistent. I am also slowly understanding the difficulties that the Nigerians must overcome in their day to day lives. Keeping that in perspective helps me to be patient as I try to do my job at Evangel. I try to recognize my obstacles as challenges and not get too frustrated.
One of the larger challenges Evangel Hospital is the disarray of equipment and supplies. Items that are considered “consumable” or “disposable” in America are reused here in Nigeria until the life is truly gone out of them. This is because the hospital does not have the budget to restock the items. Fortunately we are throwing away used tape, gauze, gloves and needles. Other items, however, like plastic tubing for ventilators, breathing tubes, suction canisters, electocautery cords and wands, cloth towels and gowns are reused. Bottles of lidocaine (numbing medication) will stay on the shelf gathering dust until every last drop is used out of the bottle.
The utilitarian waste-not-want-not mentality translates to the “durable” equipment as well. Otoscopes, suction machines, surgical instruments, are all kept, whether they are functional or not. An instrument is not thrown out, no matter how much rust is on the instrument. Many of the instruments are made of a lesser grade stainless steel and were designed for one time use or are simply of poor quality. In the mindset here, something is better than nothing. Rarely is an instrument or piece of equipment thrown away, no matter how rusty or unusable it may be to me.
One of the larger challenges Evangel Hospital is the disarray of equipment and supplies. Items that are considered “consumable” or “disposable” in America are reused here in Nigeria until the life is truly gone out of them. This is because the hospital does not have the budget to restock the items. Fortunately we are throwing away used tape, gauze, gloves and needles. Other items, however, like plastic tubing for ventilators, breathing tubes, suction canisters, electocautery cords and wands, cloth towels and gowns are reused. Bottles of lidocaine (numbing medication) will stay on the shelf gathering dust until every last drop is used out of the bottle.
The utilitarian waste-not-want-not mentality translates to the “durable” equipment as well. Otoscopes, suction machines, surgical instruments, are all kept, whether they are functional or not. An instrument is not thrown out, no matter how much rust is on the instrument. Many of the instruments are made of a lesser grade stainless steel and were designed for one time use or are simply of poor quality. In the mindset here, something is better than nothing. Rarely is an instrument or piece of equipment thrown away, no matter how rusty or unusable it may be to me.
Home-made unlabeled sterile saline in the middle bottles. Add to this the random storage method. Sutures of like kind are not necessarily kept together. Specialized instruments or attachments are not necessarily kept together. Topical use sterile saline (salt water) for irrigating wounds is home-made and kept in unlabeled bottles. Duringsurgery, there are no needle counts or sponge counts.
The ENT instrument and supply cabinet in the operating room.One of the obstacles in staying organized is the lack of suitable storage items. There are few adequate storage cabinets. The cabinets that are here are wooden with warped doors. There are also open wooden shelves. There is no climate control in the hospital. Even the operating room has open screened windows for ventilation. The air is very humid in the wet season and dry and very dusty in the dry season. Most of the shelves and cabinets are made of inexpensive wood which is susceptible to the elements and insects. The wood either warps or is eaten up.
As I organize and rearrange, I am trying to think of ways to help my Nigerian colleagues sustain the order and hopefully be more efficient in the future. This is in hopes that they will be able to better care for more patients in the future. I know things probably will not be maintained in the way that I would keep them. I am hoping however that I can do things like acquire better storage cabinets and containers so things will be a little cleaner and easier to find in the future.
The Plastic instrument tray with clean sterile insruments, just opened.
Michael Mitchell, MD
No comments:
Post a Comment