Day 9)

                Well, I feel like I’m on a roller coaster when it comes to the Samfya District Hospital OR.  Every time is seems like we’re making progress, we hit another dip.  When Holly and I got to the OR this morning, we were exceptionally pleased with the amount of work that was done by the hospital staff Saturday afternoon and some yesterday.  Everything was moved to the proper places, and looked like it had been cleaned.  We started putting the final touches on everything; Holly learned how to start the generator if power went out, the suture boxes and other disposable items were sorted for easy access, and we accessed and downloaded some practice standards guidelines regarding sterilization procedures and verification.  This confirmed that the presence of a chemical indicator within the sterilized surgical pack is “best practice” to confirm sterility.  That’s when the dip came….

                Dr. Lushiku showed up and we started telling him about the indicators.  I started sensing some push-back, as he said that the current state of this OR (particularly re: cleanliness) is better than any he has ever trained or worked at in either the Congo or Zambia, and that we just needed to trust him that we should proceed.  I suggested that we find out if any of the top “level 3” Zambian hospitals used the internal indicators to make sure they were not standard of care there.  None of the hospitals we contacted were currently using them. 

                I realized that the “American standard” can’t necessarily be the expected Zambian standard, and we just have to do the best we can with what we have.  Ironically, that very issue was the topic that was assigned by Mike for me to lead tonight’s bible study/debriefing session for the team.  It was built upon Phil 3, v 3-4 that we are to accept and humbly serve others with a loving heart, and not push our own agenda without thinking of others first.

                We all agreed as a team that we would accept the Zambian standard, and felt good again, but then the OR nurse from Mansa showed up.  She will be with us the rest of the week to assist with any cases, but more importantly train the Samfya general nurses in OR practices.  She examined the surgical packs and discovered that about half were still wet, indicating a potential problem with the autoclave machine or cycle.  We started to trouble shoot them and saw that they were not able to generate the appropriate temperature or pressure required. At that point the power went out and it was time to quit. More trouble shooting tomorrow.  We are going to closely watch the temperature and pressure gauges during a couple of test runs.    

                One really cool thing happened today: we used the ultrasound that Mike brought for the first time clinically on a full term pregnant patient.  She is the first woman EVER from Samfya to see an in-utero image of her child.  She kept wanted to see the images between contractions.   

                Mike and Shannon went to Chipako, a village 1 hour down a bumpy dirt road, with a drama team from SCCP that put on an HIV sensitization program that drew a crowd of about 200 people.  After that program, free HIV screening was offered and 30 people wanted to get screened.  4 were positive, which is just about the district prevalence.  Mike and Shannon then saw about 90 patients in 6 hours, and even found me a couple of potential surgical patients.  They looked very tired.