Hello Everyone,
Our second day in Mbarara started with a team meeting to organize data onto spread sheets. Dr. Joseph Ngonzi is an Obstetrician at Mbarara Hospital and our Ugandan collegue in the International Outreach Program (IOP). Some of you may remember Joseph from his visit to Brantford in the fall of 2009. He extends his best wishes to the nurses of Labour and Delivery and Dr. Stephen Bates.
Jessica Fry, from the Quality, Planning and Performance Improvement Program at St. Joseph’s Hospital in Hamilton is helping the team to create a database and input data so that we can monitor maternal mortality and our strategies to reduce peri-partum bleeding. She has been a great help to all of us in the collection and transference of data to a manageable system and this has helped us to focus in on key management issues in Labour and Delivery, using the PDSA cycle framework as well as other quality improvement tools and techniques.
Later in the day I joined the anesthetic team in the OR. The surgical team was removing a large kidney tumor from the abdomen of a three year old child. The surgery had already been delayed a week because the cautery machine had to be repaired. Preoperative lab work was unavailable as the parents could not afford to have blood work drawn.
Pediatric surgery is hampered by the lack of pediatric equipment. In Canada we would have considered an arterial line to monitor her blood pressure and draw blood to assess blood loss; but today an adult BP cuff was applied to the child’s leg. We had the luxury of Normal Saline and whole blood but these were given via adult IV tubing which made it difficult to control fluid delivery in a child who weighed only 15kg. The surgery ran for 3 hours and the tumor was removed in 2 hours. The tumor weighed approx 2.5 kg. The incision was closed with two types of sutures as they had to use the smaller pieces not used earlier in the case. Currently sutures and gauze are at a premium and families must purchase their own if they don’t want their case cancelled. At no time are the sponges and needles counted during the case.
Once the incision was closed the surgeons took off their gowns and layed them over the child to keep her warm. There is very little linen and blankets are supplied by the family. The OR lights were pulled down closer to the patient tohelp keep her warm as well. Once she was awake and extubated she was carried to her mother and wrapped in a blanket provided by her mother. The child will be held by her mother until awake and then taken to the pediatric ward. There are usually no monitors with the mother and no staff available to care for the child, although staff are close by if help is needed.
Today was a successful surgery and I greatly admire the skill of the team working in Mbarara. The surgeons skillfully excised an extremely difficult tumour in roughly the same time as we could have done in Canada with all our bells and whistles. The anesthesiologists used their clinical acumen to deliver a safe anesthetic, adjusting to the limited equipment available to them. I admire the continual ingenuity of the team to perform under conditions we would find almost impossible to imagine. I am also reminded of all we have to be grateful for in Canada and despite the problems we deal with at home, we are blessed with an abundance of resources that we should not take for granted.
Until tomorrow,
Saramin, Jessica, and Marnie.
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