In the OR

Yesterday I saw a young man who came in drunk with a nasty cut on his head. HE said he was robbed, which I might also if I just got drunk and fell down. Today I went with Dr. Charles to the minor operating theater to suture it up.

First difference between the US and here: the patient walked from his bed to the OR. He got slapped on the shoulder by Dr. Charles for walking into the sterile area with his boots on. He laid himself down on the operating table.

Dr. Charles is the equivalent of a fourth-year medical student. But since he's sutured over 30 scalp lacs in the past few months, i didn't try to pretend like i knew more than him.

The sterile towels weren't ready. So the nurse took a pair of sterile gloves (the same kind we use in our ORs) and opened it up. The inside was sterile, and she opened a few packs side-by-side and called that a sterile field.

Yes, there are all kinds of problems with this. Not the least of which is, what a waste of expensive sterile gloves. In some ways it's a metaphor for the problems of poor countries in general: you don't have enough resources to develop efficient infrastructure, so when something needs to be done urgently you end up spending a lot more than you would have.

Charles and I got to work debriding the wound. When we looked up to get more gauze, the nurses were gone. We were both sterile and couldn't touch anything, and they had the radio playing loud in the next room. After a few shrill blood-curdling screams from me, we got a nurse's attention. She walked in with a one year-old baby on her hip and grabbed the orange biotidine cannister from the windowsill, sloshing it into a metal emesis basin. Then she grabbed the sterile tongs (still carrying the baby, who was rightly fascinated by all this) and plucked out a lump of gauze to dunk in the antiseptic.

Then the nurse sat down against the wall and started breastfeeding. I could tell she was kind of annoyed by having to wait around for us.

Let's be clear: the same kind of thing happens in our ORs in the U.S. It just typically involves talking on cell phones, and playing the radio, rather than suckling an infant. And which is more practical?