Make it work

I know I have hardly said anything about my work so far. And I am sorry. But there is just so much to share and tell, I always think I work every day, I can tell you later. I finally sat down to write about the reason I am in this wonderful place.

I work at Hôpital de la Caisse. It is a partially private, partially governmental hospital. It is said to be a good quality hospital. I work in trauma surgery, which I love. But I have to admit it is different. My motto for the past two weeks has been: Make it work. Somehow.

To explain this a little more I will describe a patient’s journey. Let’s call her Mme Ndamen*. Mme Ndamen unfortunately got into a motorcycle accident. She was brought to Hôpital de la Caisse. Her right leg hurt. She got her x-ray immediately. The tibia and fibula were fractured multiple times. She was admitted to the hospital. The operation was going to be tomorrow. She was handed a recipe for all the materials and medicines for the following days: antibiotics, pain medication, wound care materials, even the sterile gloves for the surgeons. Her family was supposed to buy this early the next morning, because she was the first on the agenda.

The next morning the doctors were ready for the operation theater. But the pharmacy ran out of antibiotics. It would arrive in an hour. So we waited. The doctors waited for a patient. Never have I ever seen this before. I am used to patients asking me when they will finally be called for surgery- they have not eaten in so long. But if a patient does not arrive, they get kicked off the agenda for the day, even if it is not his or her fault! But we waited. Finally we headed to the OT. Where the hygiene standards were hard for me to grasp. No one changed when going to the OT. Not even the shoes. The cap and mask were “recycled”. They were used multiple times. Simply because there were not endlessly many. Even the coats were worn in the corridors, they were taken off right before entering the operation room, but only if there was a patient in it. Otherwise coats were even worn there. The washing ritual started with iodine soap, which was more important here than the actual desinfectant. The hands were dried with a blanket that the patient was covered with. I am used to sterile towels. After getting dressed, I prepared the assistant’s table. Since there was no operation assistant nurse the doctors shared the work and prepared everything. The operation itself was different than what I was used to also. Normally everyone has their tasks, the wound has to be kept clean and visible. For that there plenty of swabs, an aspirator and electric coagulation. I had a hard time during my first operation because I could hardly see. There was too much blood but apparently no one needed to see anything surprisingly. So, because my hands were not occupied, I just grabbed a swab and the aspirator. Not really knowing if it was my task because the first assistant was not busy either. The operation environment was not proper. Lots of blood on the table and floor, the used swabs made a pile on the covered up patient. Instruments were laying anywhere unorganized. Breathe deeply; I forced myself to calm down. To meet the stereotype I missed the structure I was used from Germany. But I knew the reason for this mess was simply because they had to make it work somehow. When the operation assistant nurse is missing, of course there is chaos. When there is not the right material you improvise.

After the operation the patient was brought to the ward. The following day she complained about left sided stomach ache. It might be the spleen. No one thought to make an abdominal sonography right after the accident. It was made after two days. Luckily the abdomen was fine. The patient recovered well. Except the wound bothered her. It was infected, albeit antibiotics. This was not uncommon. A lot of our daily work included wound care of infected wounds. So we made another recipe for more materials. At this point I have to talk a touchy subject. Sterility. When first assisting with wound care I was surprised how strict they were about opening the sterile swabs the right way and the disinfectant bottles not touching anything. But also them using non-sterile gloves which makes all the other measures useless. About a week after this shocking experience, I was brave enough to ask why they were not using sterile gloves. I did not want to be the foreigner that came to judge and improve- I knew they all did their best in those situations. The answer to my questions was – of course- sterile was too expensive. The patients do not really understand the necessity of sterility. They see that they have to pay the same price for 100 non-sterile gloves or a five pack of sterile ones. I asked some of the doctors if they were aware that their strictness with sterility was useless if not really working in a sterile environment. Yes, they said. “But this is the best we can do”. “There is a lot that has to be changed here, in the system and in the mindset of doctors and patients”, told me the chief physician who had been working in Europe. He said he would love an opportunity for his students and doctors to get a chance to go to Europe to broaden their knowledge and let them know that there are things that have to be changed, starting in their heads. The problem is that they don’t know any better, so they don’t feel the need for change. This was exactly the impression I got while working. I was glad he put it into words, because I would never want to come from a more privileged place and start judging.

I found it surprisingly challenging to work this way knowing what it was like in Germany. It was frustrating for me sometimes, because I felt like a lot of complications were preventable, even with little money or with money that was absolutely worth spending. I have to admit, I thought I would cope better. But these problems adjusting gave me more energy. In the operation theater the physicians noticed quickly that this was my element. They let me assist frequently which I think was mutually pleasant, since they told me they enjoyed my assistance and my love for a proper work environment. In wound care I often asked to handle some patients myself. After a while I was going off alone managing wounds and removing stiches. In that case I also tried my best to “make it work” but not somehow, every day I tried harder. I always asked for sterile gloves, sometimes I got lucky. I cleaned the wounds to my best knowledge, admitting a little different than the customs were here. I used more swabs and ran through all the materials quicker. I always cleaned my instruments thoroughly before using it. (It did not come already sterile and washed unfortunately). I do not by any means want to say that I did someone else’s job better than them. I simply want to say that what I did was satisfying and challenging and rewarding.

After a week at la Caisse Mme Ndamen was released. She was off the medicine, but had to return every other day for wound care. I do hope her wound will heal. So I do for everyone. But until then we treat them and make the bandages with a smile on our face so that theirs can return.