Hope all is well for you folks in the USA. Tyronza and I are doing well. I have been having problems with my back, but Tyronza found a lumbar belt for me and helps a lot. We will be coming home in just under two weeks and I thought I would tell you about the filth involved in third world medicine.
Most of you have never been to a third world hospital, so let me tell you the two hospitals in Cape are very clean and well maintained. The hospital here is less than two years old, but seem to be well worn already. If anything is broken, it takes forever to get repaired.
The floors are usually filthy, even though they are dry swept twice daily and wet mopped two-three times a week. The patients are mostly barefoot, and most of the feet are caked with mud. It usually rains each evening so the mud is particularly bad early in the morning and the dust is bad in the afternoon.
The sinks in the hospital only have cold water and half of the faucets don't work. Often the sinks seem to be full of used gloves, dirty instruments and wet scraps of paper and dressing materials. There is usually a bar of soap at each sink and a used towel to dry your hands with. I have taken to carrying a small hand towel in my pocket to dry my hands with.
The counters are often cluttered with dirty gloves and used syringes. Sometimes there are ants and bugs crawling on the beds, floor and counters. I have started trying to tidy up whenever possible, but it seems to be a losing battle.
The OR is a much cleaner place, although I did see an ant crawling on the
drapes during one case. Anesthesia commented that it was probably a sterile ant! All patients having surgery are given both pre-op and post-op antibiotics, usually chloramphenacol. I have had only one wound infection so far, and it was very small. One day I was waiting for a surgery to start, sitting in the surgical lounge. In the space of 15-20 minute, while I waited, I was able to kill 50 ants and 3 cockroaches.
Surgical instruments are sterilized just like they are in the US. The hospital has two large autoclaves that are kept busy. Surgical gloves are washed in bleach water and recycled as non sterile gloves. Lap sponges are washed in bleach water and re-autoclaved. The bovie cords and grounding pads are all recycled by washing in a chemical soak and then rinsing in sterile water just prior to the case. I have been using the same vacuum extractor since I arrived. Each time it is soaked in chemical and then rinsed in sterile water. I have probably used the same device on at least a dozen deliveries. Medicines and suture material are almost always expired, but they seem to work well and cause no ill effects.
Lighting is a problem. The OR area does have good lighting, but the wards have only sparse florescent lights. I have taken to using a head lamp for most of the obstetrical repair problems and that seems to work well.
The ultrasound transducer is usually gooey from the previous exam. I have found that a roll of paper towels works well to wipe the patient off and keep the machine clean. I try to wash the transducer head with soap and water, whenever it is available.
The nurses have an interesting technique for checking patients in labor. All laboring patients are allowed to labor on their beds in the ward. When they need to be checked, which is only occasionally, the patient walks back to delivery bay #1. Each mother has her own bowl of betadine soap sitting out on the counter with her name attached. When she is examined, I put on a sterile glove, then ask the patient what her name is. I then dip the glove in the bowl with her name on it and do the check. When the exam is over, she goes back to her bed in the ward and her bowl, along with the other six or so women in labor , is left on the counter in bay #1 ready for the next check.
That's all for now,
Dr. P
pictures can be viewed at:
http://www.facebook.com/media/set/fbx/?set=a.114240695317977.19428.100001961413037&l=a20582723c
http://www.facebook.com/media/set/fbx/?set=a.114388571969856.19532.100001961413037&l=0b5634e363
