Surgeries, teamwork, teaching in Cange

Bev Small, RN, works with Haitian nurse Yanick Michel.

Before the earthquake, the hospital in Cange did eight, maybe nine operations a day, recalls Yanick Michel, a 26 year old OR nurse who’s worked here for a year. Almost immediately after the earthquake, the surgical caseload doubled. At the same time, donated equipment poured in to furnish the two operating rooms, including a new anesthesia machine.

To handle the influx of patients requiring surgery, visiting surgical groups, like this group from Children’s, are rotating through the hospital. As well as helping ease the patient load, the specialized surgical teams (orthopedics, plastic surgery and urology, for example) educate the local staff how to handle difficult cases they may never have seen before. “Although it’s been busier, it doesn’t feel hectic,” says Michel. “We adapt. I feel very comfortable because we have such a good entourage and we’re all trying to do the same thing. It’s all about the teamwork.”

There’s no guarantee clinicians operating together speak the same language here, so communicating without spoken words is important. For Pat Lisle, an OR nurse at Children’s, that kind of communication is actually quite common within surgical teams. “If you’ve worked in an OR for awhile, you learn what to expect, what’s coming next, and you can anticipate it without language. And there are always hand signals—everyone knows the hand signal for forceps and scissors.” Meara agrees: “Once you understand your role and your job for the case, it’s a lot easier to work without relying on words.”

Meg Weake and Bev Small in the OR.

For the Children’s team, operating in an environment without all the bells and whistles they’re used to (like an overhead paging system, safety belts to keep the patients on the bed and a code button for emergencies) is an eye-opening experience.

“There are all these resources that we’re privileged to have, that we use without even acknowledging,” says Meg Weake, a Children’s OR nurse. On the second day Weake was in Cange, she assisted in her first amputation, a patient with a gangrenes right foot. She reflects on the experience:

I had been doing wound rounds and someone  popped their head out of the OR and said “we need a scrub nurse.” By the time I got in, they had already begun. They don’t have any automatic saws here, so they were using a gigli saw, a sharp wire on two handles. In the states, these are rarely used for large orthopedic surgeries. The tourniquet had a hole in the tube so it was releasing pressure, and the patient was bleeding a lot. We jimmy rigged it with some adhesive tape, and glue that we found. As I’m watching, I asked for more detail, and the nurse said, “I’m really sorry, I’d like to give you a full report, but all I can tell you is that she’s an untreated diabetic in her fifties or so, with a gangrenes right foot.”

So here I am with two surgeons I’ve never met before, a Haitian scrub nurse who can’t speak my language, a OR nurse who can’t give me any patient information and a tourniquet that’s not working properly. I felt anxious. In the United States, we have trouble shooting options. We have more than one saw battery. We have more than one of the same type of instrument. Here, troubleshooting is not with getting more equipment but finding things like tape and glue to fix the problem.

But, I just adapted and got to work. This is the way it is. And I was surprised by the relatively big surgeries they can do here in a safe and sterile manner, with the resources they have on hand.

Tuesday was another full day of surgeries, including a hand surgery, orthopedic surgery and a surgery to create an eyelid for a boy who was burned five months ago.

scizzorsAn example of what’s sometimes called “the disease of poverty” was exemplified in the last case of  the day. An old man, (when asked his age, he said that if you knew the date the first bridge was built here, you would know his age,) had stepped on a rock some months back. Instead of going to the doctor, where he would likely be charged for care, he kept walking on the wound. Over time it became swollen and infected. Now at the hosptial in Cange, he would need an operation and a skin graft to fix. “It’s so sad, you know,” says Johanne Jocelyn, OR nurse, who stood by his side while the doctors talked about his case. “If he had received care, this would just have been a minor injury. Now it’s a serious one.”