Day 10/11/12

                Well, the last 3 days have been very busy and quite an adventure.  The autoclave and sterility issues have persisted, but that did not prevent Dr. Lushiku from abruptly scheduling an emergent c-section.  It was definitely a chaotic event.  I started my second IV of the trip and then scrubbed in and assisted as best I could, only having seen a few c-sections.  Seeing a child being delivered (despite the hardships he will face here in Samfya) always brings a smile to my face.  The smile quickly turned into concern and panic, as the nurse who was given the child was more concerned about weighing the baby and not that he was blue and not breathing.  We had set up an Ambu bag to assist with breathing, but she had moved it, getting the mother’s “home linens” ready to swaddle the child, and couldn’t find it.  I quickly broke scrub and found the bag and started resuscitation.   The baby’s pulse was initially about 60, but came up after about 5 minutes of bagging and suctioning. 

                After the case, we started again on trying to figure out the autoclaves, but could not get an adequate result.  We decided yesterday to take our surgical instruments to Mansa district hospital, 1 hour away, and use their autoclave machine and get equipment we needed to perform 2 hernia cases and a lipoma resection scheduled for Thursday.  We left for the hospital in Dr. Lushiku’s car, but then turned around because he forgot gas money.  We then got a third of the way to Mansa, when he said he forgot to stop and get gas before we left Samfya.  I guess there is no gas available anywhere on the road to Mansa.  I just assumed that he knew of a stop along the way.  We were at the point of no return and would have run out either direction, so I suggested that we call Carmen (yeah Carmen!), who rushed out 10 liters of “petrol” to us on the side of the road in a tiny village called Mibenge.

                In Mansa, nothing really went right.  The autoclave guy did a hurried, shotty job and we still got some wet packs.  We then got the” pleasure”, unexpectedly, to accompany Lushiku on his weekly grocery and clothes shopping, as well get his spare tire fixed.  We then had to drive home in the dark on the unsafe road over 2 hours later that we expected.  Needless to say, Holly and I were not happy, not to mention Mike and Shannon who could not get into the lodge rooms since we had the keys.  Holly then told me Lushiku had put his groceries on top of the “sterile” surgical packs.    The team got into a huge discussion about how we should proceed and decided that we would advise Lushiku we were not comfortable proceeding with operating Thursday and should concentrate on training the nurses on OR techniques and Lushiku on how to use the electrosurgical generator I brought. 

                We arrived finding the OR in disarray with blood everywhere this morning.  I guess Lushiku did another C-section in the middle of the night with only 2 general nurses.  We had an easy out for not proceeding with surgery today.  While the process of decontamination proceeded, Holly and I made signage for the OR and created instrument cleaning, OR cleaning, patient pre-op, and patient post-op checklists with the help of the OR nurse from Mansa. These will be used to train the incoming nurses in some proper OR processes.  I also did a training session (on a chicken thigh) with Dr. Lushiku on use of the electrosurgical generator.  By the end of the day, we thought were ready to proceed with a few small cases tomorrow and allow the trainees to see the checklists in action.

                When we got back to the lodge, we saw a great example of why the lake is called Benguolu, which means “where the water meets the sky”.   There were no clouds, but you couldn’t distinguish the horizon. (Sorry, but I couldn't get the picture to rotate)