16 October 2007
Our surgery day was shortened because one patient didn’t pass the anesthesia ‘fitness test’. They found she had mild heart failure and would need to be evaluated by a physician. I’ve learned that physician seems to be their equivalent of an internist. They don’t seem to understand when I refer to internal medicine. The patients are rarely seen by anyone except the surgical doctors. So my day ended a little earlier than usual.

I was back early enough to wash clothes and get them outside to dry while there were still a couple of hours of sunshine left. We went to dinner tonight at one of the nice restaurants here. There aren’t many and Caroline really wanted to go to this one while we’re here. It is in a nicer area of town in a large old home remodeled to be a restaurant. Because we live in the housing near the orthopedic hospital, we are also near some of the poorest areas. Admittedly there is mostly an assortment of degrees of poverty here, but there are a few nice areas like where the restaurant is located. My clothes were almost dry when we returned.

We spoke today about trying to get the gyn department to the point of being able to do laparoscopic surgeries. They have the equipment but the technical aspects of making this happen seem daunting. If I find that they actually have enough instruments to start, I am still hesitant because of the shortages of everything. The other side of this is that the benefit to these patients of being able to avoid a laparotomy is so great and it would really save health care costs. When a patient is scheduled for a tubal, she is admitted the night before and surgery is done through a standard laparotomy. She will be in the hospital for at least 2 days. The wound infection rate is significant. There are many reasons to make this transition but until the hospital infrastructure is improved and stabilized I don’t know if it can be safely done. It seems that the staff has given up in fighting for these changes because of how little it has helped in the past. The community is so poor that they have a huge problem with theft from the hospital as well as everywhere else. When we came to the hospital the first day they had a guarded security gate as we find almost every where. (The restaurant we went to tonight had an electronic gate controlling its entrances.) The hospital is different. There is no check on the way in, but on the way out they inspect your vehicle to be sure there isn’t hospital property inside.

We notice more things the longer we are here and each of us has different experiences that help explain what we see. Tonight we discussed how few people smoke here. I have also noticed that very few of the patients drink alcohol. In some of our poor populations the use of drugs, tobacco and alcohol are quite high. The students were discussing risk factors for pregnancy complications at one of their tutorials. When one of them suggested drug use, the others were a little critical stating that this is a rare problem. I asked them more about it and they find that very few people use drugs and cocaine is extremely rare here. Even alcohol is not common. I don’t know how much is the culture and how much is lack of access or even that they are so poor.