I walk the line

You know when you arrive for theatre, aka the operating room, and the doors are locked and no one is around that your day may not get up to the speed you were hoping. That was us, up early, all geared up in our scrubs, hockey bags full gloves, sutures, dressing and instruments with the goal of being as selfsufficient as possible and we couldn't even get in the operating suite. A lone woman in her street clothes was present as well and identified herself as one of the nurses. When we had no information to give her as to what was happening she wandered off, never to be seen again.

Our original plan was for three of us to each run an OR at Mulago. One burn OR and two trauma and recon rooms. The fourth went to do a microsurgical procedure at Corsu hospital, a private facility in the city that also provides limited government funded care for pediatric patients.

With the burn OR seemingly not happening we went to the main operating theatre (they use the acronym: MOTH) to see the status of our other two rooms. Things were a little more lively but a strong atmosphere of indifference soon became apparent when we asked when we would be starting. "We don't know, there is no anesthesiologist". We asked if the person in question could be called. The lady simply shrugged and went back to her conversation pointing at a contact list on the wall. After about 10 minutes of negotiating we had confirmation that anesthesiologist was on his way. But we needed two. One problem at a time.

Our two ORs were actually two beds in the same OR. Now all we needed was a second anesthesiology machine

I feel it is important to discuss the "Line". The line is a red strip on the floor of the main OR entrance that carries with it the power of death. Nothing that goes beyond the line AND touches the floor can ever leave due to contamination policy. The problem is that no signs or people tell you any of this. I walked in, crossed the line with my street shoes. BAM: the shoes can never leave. They live here now. Shocked I put down my bag to get an explanation. BAM: bag detained, sentence: life imprisonment. I picked up my bag quickly which proceeded to brush my pants. BAM: Pantless. Fortunately I caught on before I was completely naked. Unfortunately half my belongings were now imprisoned under the most brutal fascist OR regime ever known. I temporarily surrendered with what was left of my clothes, and pride, and got changed. I should mention this is a hospital with dead people stacked up in random corners and hallways and enough dirt on the floor to grow vegetables.

Beware the red line and all its wrath.

Believe it or not, both rooms did start that morning, though about two hours late. The anesthesiologists were clearly out of their element with our younger patients, some as young as 3 months, a potentially high risk age for a general anesthetic and challenging even for the most experienced. At one point one of them asked us (The surgeons!), pointing at their monitor screens, if low voltage PVCs (an irregularity on the EKG feed) were normal in a young child. We explained it wasn't our area of expertise (it should be theirs though) so they shrugged their shoulders and decided it wasn't a big deal. The child woke up at the end so I guess they were right.

Our anesthesiologists meant well and were very hard working and helpful. It was harrowing though to see them frantically flipping through a tattered text book in the middle of giving the gas.

I can't really complain though when comparing anyone to the nurses, most of which milled around doing very little. We did most, if not all of the set up. No special cleaning...or any cleaning was done between cases. At one point they all quietly left. I didn't even really notice until one of the Uganda doctors came back in and informed us that the nurses had gone on strike. We asked what for, and he couldn't say why but explained that we would not be able to operate tomorrow if this wasn't resolved. It was a shakedown, extortion, clear and simple. One of our surgeons asked them what it would take to get them back to work. They said nothing until he offered to have a catered lunch brought in every day. I suggested we could manage without them but the deal was made. These individuals didn't care about delaying surgery or the patients it would affect, there were foreigners working in the hospital and these nurses wanted a piece of the pie.

One of our surgeons treating a very complicated forearm injury in a child. Note none of the people in this picture are nurses. They are gone.

By mid afternoon most of the other surgeons in the group had bailed on me to go have lunch in the "Doctors Canteen", more recently renamed "Nandoos food point!!!" which was essentially a glorified cafeteria. Looking for a meal myself, one of the Ugandan interns, Jude, I'd been working with, similar to a first year resident getting their General practitioners license, lead me to the common room in another area of the OR wing. Various nurses, cleaning staff and residents were sitting at glass tables. I said high with a goofy smile. No one flinched. One of them got up quietly and grabbed a small bag from a pile and handed it to me. "Would you like something to drink?" and opened a fridge loaded with sodas. I opted for Orange Fanta. The bag had a nice snack of flat bread, not unlike a roti, banana and a dry cake/brick thing. I learned form the intern that these "strikes" can be common when foreign doctors are working in the hospital. Sometimes the entire hospital has its water shut down, only restoring it once the targets in question pay off the utility bill for the facility. I asked him if he thought it was right and he explained, but not rationalized, that people looked at us as a part of the health ministry that they could get more out of, in a heath system that pays very little to its employees. I could appreciate the perspective but the concept still left a poor taste in my mouth.

Ive left this picture high resolution on purpose to show a label that is on many items, including doors, because of the rampant theft and selling of government property. People are stealing DOORS and selling them on the street. DOORS!

The temperature of the OR was brutal. It was Bikram yoga surgery. Sweat dripped down my brow and back. The itchiness driving me nuts with no option to scratch while scrubbed in. After each OR my scrubs were completely soaked. We worked all day into the evening, finishing after 8pm. We managed to finish everything we had set out to except one case. Not bad considering how we started. By this time the nurses had all left and only the anesthesiologist remained. We transferred the patient to the recovery room and hoped someone would take him to the ward eventually. Tomorrow's OR schedule was even more packed.

We got changed and I spied my belongings in the OR office. I stole them and ran for it. Viva la revolution.

I'll be in touch.