By Sarah Woodrow, MD
Cooper Neurological Institute
This is part eight in a series of updates from Dr. Woodrow’s mission to Ethiopia. View additional posts from her on the Inside Cooper blog by clicking here to view all posts tagged “Ethiopia.”
Things come to a head on Wednesday. It is our designated operating room day, but because I am operating by myself, it becomes a challenge. Between the language issues and the limited equipment, negotiating the OR becomes a nightmare.
They have scheduled me several small cases anticipating difficulty. They underestimated the problem. The first child arrives without any blood crossmatched. Given the size of the procedure and the age of the child significant blood loss is likely. I argue with the anesthetist that in the interest of efficiency the child should not be sent to the main laboratory to wait in line to have his blood collected. Instead, we should collect the blood there and have someone take the sample for urgent crossmatch. Eventually, I win the argument, but not before I have already managed to get someone to call for the next patient to come to the OR so we can start her case while waiting for the blood. My plan is quickly foiled when that second patient arrives also without a crossmatch. Before I can call for the third patient the blood for the first patient magically appears and we head to the OR – already 2 hours behind schedule.
In the end I only manage to get two of three cases done before the OR shuts me down. If you haven’t started your last case by 1pm they won’t let you go ahead.
I struggle to keep my composure throughout the entire day. It is a balance of enthusiastically advocating for better patient care and constantly thanking everyone for all their help so they will not impede the process any further. All the while I keep a smile on my face to hide the frustration. Like many ORs worldwide, other than the surgeon, there is no incentive for people to work and get cases done.
Most of the OR staff are shift workers. The wages at the University Hospital are lower than anywhere else in the city, so motivation is not exactly high. The less they have to do the happier they are. I see this exemplified on those days when our cases finish early and am told quite openly “this is better” and they “cannot work so hard every day.” Even the anesthetists are on shifts. None of them takes any ownership of the patient or patient care. How can they? They don’t see how many patients we have backed up the wards awaiting surgeries, let alone the hundreds waiting at home for a phone call to come in for admission and wait some more. Many of the cases they do see are salvage cases – too little being done too late. They have no concept that if things could move along more quickly how much more of a difference could be made.
It is a system problem, I know. One grounded in the resource limitations of countries like this and no doubt fueled on by the bureaucracy that seems to pervade. If only I had brought along a magic wand.