Moi Teaching and Referral Hospital, Thursday, Feb 12

Susan here. I have now spent more time at the hospital including a day in the operating room. I can't begin to describe how different it is compared to the US. And the pictures don't do it justice either, but I will try to hit some of the high points and the rest, well, if you want to hear more, we'll need to sit down with a Tusker beer some time and talk about it. This picture is between two of the patient wards.
The grounds of the hospital are beautiful with flowers, and there is laundry hanging about here and there. It is so nice to walk from hospital building to hospital building outside in the warm sunshine. At work in the US, I usually don't see the light of day from the time I come in in the morning until it's time to leave.


The operating room customs here are so different. First of all, there's this thing about shoes. Just inside the door to the theatre building (that's what the OR is called here...very British), there is a short bench where you take off your shoes before swinging your legs over the bench and then going into the locker room to change clothes and put on OR shoes. So...there is this area with everybody's shoes tucked under this bench. Once through the locker room area, there is a large open pre-op space. All patients are admitted at least the day before surgery and when it's time for their surgery they are brought to the pre op area. The picture above is in the OR where we did ENT cases today. There are a lot of medical students, about 10 or so. And the room is quite dark, especially since one of the OR lights doesn't work and there is only natural light from windows on the other side of the hallways, no other lighting in the OR. It is also quite warm in the rooms, since there is no air conditioning, only the open windows (yes, open windows in some of the ORs, but not the ENT room). There are screens on the windows though.


Before starting the cases this morning, I gave the students on ENT a talk about cricothyrotomy and tracheotomy. I didn't have a computer or projector for my power point, so I just talked. They very diligently took notes and asked some questions, so I think it went okay.


This picture shows Dr. Cohen at work with his counterpart, doing a cleft lip repair. Their OR was across from ours, so we couldn't look across to each other's rooms and see what was going on. Their room had windows.


Each OR is named after someone and the room ENT usually works in is named for this fellow, a Masai chief. His picture hangs over the door to the room. The equipment used in the OR was quite unbelieveable. It is so old and in pretty bad shape. In addition, there are very limited instruments available. It is amazing how these doctors make do with such instruments and equipment. In a couple of the photos above, you can see the little table with instruments on it; well, that's it. Those are the instruments for the whole case. Even the smallest case we do in the OR has a much larger instrument set. They also re-use nearly everything (for example the bovie wand), whereas nearly everything we use in the US is disposable and thrown away after each case. As for the ENT concepts, we are on the same page as far as knowledge about various diseases, but the management is very different, mainly because of such amazingly limited resources. We were supposed to removed the giant tumor today, but it got late (4pm) so they delayed the case until tomorrow morning. TIA! (ie "this is Africa" That was our little saying whenever things just didn't happen the way they should or didn't happen at all or didn't make any sense. We used that acronym a lot when I was here in 1993, and we're using it a lot this trip.)