Making Things Work

Everything is old here in the hospital.  I suspect everything has been donated in a gently or not-so-gently used condition.  The patient beds look like they we made in the 40’s and 50’s, their wheels are often rusted over and don’t work, the pain has long worn off exposing rusting metal.  The OR beds only partially bend the way you need them to.  The anesthesia machines are clearly decades old with many functions often not working.  The problem is that when anything electronic breaks down over here – which is frequently – it usually gets tossed into a corner somewhere.  I have seen old OR lights, fluoroscopy units, bipolar units all get stranded and gather dust.  Since my last visit the scrub sinks outside of the neurosurgery OR have stopped working.  It has been months apparently.  As a result we usually have to wander a few ORs down and scrub up there and then walk through the halls to our OR.  I am not sure why things don’t get fixed.  I have asked, but nobody seems to know, or seem to care.  It may be a lack of skill and knowledge or maybe a paucity of motivation (too many things to fix, too little time).  Truthfully, I suspect it is a combination of the two.  It surprised me when I first came to Ethiopia years ago. I expected to see innovation in the face of adversity.  Afterall, that’s what they show on TV all the time……..

I expected to see cervical collars been woven out of grass, electrical units being rewired,  piecing one component of one system with another from a separate system and making it work.  But, that has never been the case.  Instead, broken pieces of OR equipment become decorative artwork in remote corners and hallways everywhere.

Western Store Bought Cottonoids

I was pleasantly surprised on this visit to find that some things may have changed.  Firstly, the neurosurgery charge nurse has gotten organized.  Equipment and supplies – no matter how scarce, now sits in neatly organized cabinets.  The former storeroom – which previously I could not even enter because things were strewn all over, is now neater than my closet at home.  Well, maybe not quite, but close.  The C-arm has been rewired with a LCD screen allowing for pictures to be viewed.  In the corner during the cases when they are not busy nurses are sewing cottonoids or micropatties by hand.  These are small pieces of fabric – usually similar to felt – with strings attached so that they can be placed in tight corners of the surgical field and allow us to safely suction up pooling blood without sucking up the brain.  You can appreciate the importance of these little squares.  The strings ensure that they don’t get inadvertently left in the surgical field when close.  The nurses sit with small pieces of special OR gauze, cut up into small squares, and stitch threads to them by hand.  The new patties then get sterilized for use.

Ethiopian Cottonoid Sewing Kit

I am not sure which has caused this switch in mentality but it gives me some hope.  Perhaps it is the new coat of paint in the hallway which so easily transformed the dreary hallway into something bright and even sterile looking – just what you want to see in any OR.  Perhaps it is the new recovery room.  A collaborative effort, I am told, between 3 different institutions who independently had been working here for years effecting little change but together have created a post-anesthesia care unit in less than 1 year that finally approaches those available in the developed world.  Previously, patients recovered from their anesthesia while being driven back to their rooms on their OR stretcher, accompanied by their dutiful, although not-so-well-trained porter.

Wirknish Making Cottonoids

Regardless of the cause, I am encouraged by the switch which gives me hope that there has been progress.  System-wide progress.  As the old axiom goes – bring a man a fish and he will eat, teach him how to fish then……… That is the whole reasons why I believe as much as I do in these trips.  But if he learns how to make his lures, fix his broken rod and freeze his fish then……………