Tuesday (day 6): two surgeries and a stick shift
Spirits are high as we head to the clinic area. We have our first two surgeries of the week today. The rest of the week we'll do three surgeries per day, but seeing as it's the first day we want to make sure that everything works well.
|Foure, our first VVF patient of the week in Danja!|
When we arrive, Mariama (one of the local midwives working with us on the ward) tells us that our first patient, Foure, is all showered and ready for surgery. The OR team quickly heads off to starting prepping the OR. On the ward, Mariama, Hannatou (one of our translators), and Sarah and I pray with Foure, then walk her across the courtyard to the OR. Before Foure enters we have her step in a bucket of water to rinse the sand and dirt off her feet. Everything in this part of Niger is so sandy that your feet are always filthy, and the water bucket was Sarah's brilliant solution to that.
So she's off. Now we settle down to wait the several hours before her surgery is finished. We have plenty to do--go chat with the ladies under the tree, play with the adorable kids, and even a little nursing work making a plan for when Foure comes back from the OR.
In a western hospital setting, after surgery the patient goes to a recovery room (aka post-anesthesia care unit or PACU) for about an hour to be closely watched (think blood pressure checks every 5 minutes!) while the anesthesia wears off. After the recovery room the patient arrives on the ward where we check blood pressure every 30 minutes for a while, then hourly, then every 4 hours, and so on. But this is Africa, and this is not a hospital--not yet anyway!) Hopefully the hospital will be completed in the summer of 2011.) So the patients will come straight from the OR to Sarah and I on the ward. We ARE the recovery room!
Dr. Steve previously instructed us that our whole time in Niger is meant to be laid back, and he's given us the freedom to do what we feel is right and appropriate on the wards. We both have a lot of experience with VVF patients, so he's also trusting our nursing judgment to guide our practice. In light of this, Sarah's and my sophisticated plan for our post-op patients is this: check her vitals signs when she comes to the recovery room, aka ward. If everything is fine, we'll check her again later. If there's trouble, we'll check her again sooner. We're both confident (arrogant?) enough in our assessment skills to be able to catch any trouble before it actually becomes trouble.
|A VVF patient is transferred from the OR to the ward.|
After a while we hear people outside the ward, so we investigate, hoping Foure is out of surgery, which she is. She's being wheeled across the sandy courtyard on the stretcher, Greg the anesthesiologist at her side. We settle her into bed, and I check her vital signs according to our plan. And she's fine! Our recovery room plan is working brilliantly so far.
|Foure back from surgery and doing well! (And I'm nursing in a skirt and a cap... Florence Nightingale would approve!)|
|The recovery room peanut gallery.|
After dinner, Sarah and I drive back down to the ward to check on the ladies once more before we go to bed. Everyone is doing well, and we tell everyone "se anjima" ("see you tomorrow") before we head back to the car. Again, this is a very non-western hospital occurrence, where nursing shifts are 24/7. I've never left a patient before and just gone home. But there are some local nurses on overnight, and our team has a cell phone so we'll each take nights on-call.
I climb into the driver's seat. I've never driven a stick shift, but I've always wanted to, and now's a good time to learn. One of the unofficial policies Dr. Steve has is that everyone has to be able to drive on the compound. So Sarah talks me through it, I let out the clutch while pushing in the gas, and...success! I manage to stall a few times, of course, but for the most part I love the challenge and it feels surprisingly natural.
So... as the stars start to come out in the inky black sky, I am in the middle of Niger learning how to drive a manual car. Who would ever have guessed?
Just another chapter in this wonderful, wild adventure that God is walking me through!
tomorrow (Wednesday): I think I want to go home