Hopping Hospital

I have been in Gidel at the Mother of Mercy Hospital for about 3 weeks now. It's probably about time I gave some information about the hospital. There are 4 wards (children, male, female, and maternity) which all together have about 160 beds. There are another 10 beds or so in TB village. The occupancy of the hospital is almost always around 90%. Staff wise there is only one doctor (Dr. Tom), one nurse anesthetist, and only 2 nurses for the entire hospital.  Dr. Tom is the surgeon, internalist, obstetrician, gynecologist, orthopedist, and any other specialist you can think of. There are nursing assistants, but in general everyone is overworked. On non-operating days Dr. Tom and I round on all the patients in the hospital which usually takes 4-5 hours straight...if we're lucky.  The planned operating days are Wednesdays and Fridays with at least 6- 8 cases each day. For most cases I function as both the scrub nurse and the first assisant.
                                 

In addition to all of the inpatient work, there is an OPD (outpatient department). People are bussed in from all over or walk days to sit and wait hours upon hours to see one of the four clinical officers; there are even times they have to wait until the next day.  The clinical officers see about 200 people a day.  After all the inpatients are seen, Dr. Tom and I head to the OPD to assist in seeing patients.  Dr. Tom's perseverance is absolutely astounding.  I'm starting to get the hang of things, but still have a long way to go.  Right now my main focus is learning everything about the operating theater because the person that is currently running it leaves in January to finish high school.

I have already seen a ridiculous amount of pathology here...the largest tumors and abscesses imaginable: goiters the size of honeydew melons and abscesses that drain a liter of pus. We removed an ovarian tumor on an 18 year old girl that looked like she was 9 months pregnant.

    

It is astonishing how many people are able to have surgery and medical treatments with the limited resources

we have. The only diagnostic tool  is an ultrasound machine; the gel is precious and we often use pens to scrap at the last drops.  The only monitoring for patients in the operating theater is a pulse oximeter and taking manual blood pressures. The laboratory tests include CBC, UA, blood sugars, stool cultures, pregnancy, and malaria. Any biopsies taken are sent to Nairobi for evaluation. Dr. Tom's physical examination skills are top notch because that's ultimately the only reliable tool he has. It's all tactile fremitus  here! I know I will learn a lot from him...I already have in a short period of time.