An OR day. We arrive
at the hospital to help start cases; picking up Hien and dropping off Joe on
our way. Hien gets everyone to laugh. Four patients in the day and a
chance to see everyone at work and which ideas we have shared that have been of
interest.
On my way upstairs I noticed someone bounced out of her shoes and left them behind!
On my way upstairs I noticed someone bounced out of her shoes and left them behind!
One of the first cases was a young girl who suffered a scalp
burn that left her with a skinless piece of skull. There was no tissue or blood supply left over
the defect, so it was not going to be a good place to put a blood-dependent
skin graft. The a flap of skin was
raised and slid over it, which also left some skull exposed but at least it had
a bed of periosteum for the skin graft to attach to. Very interesting case.
Nurse Anne, superb circulator and teacher.
Scalp surgery, underway.
Without a burr, they had to rough up the bare bone with the handle of a scalpel to give the new flap of scalp a surface to attach to.
Flap slid over with its own blood supply still intact, to reattach over the open space. New space, but with a periostium and good blood supply was covered with a full-thickness skin graft from her groin.
Nurse Anne, superb circulator and teacher.
Scalp surgery, underway.
There seems to be much less attention to pre-op mental condition
of children, and they cry and carry on in a way that scares anyone in
ear-shot. There are no guerneys to
transport a sedated child, no tables to start IVs, and no Sevo for mask
induction. So it is a difficult
situation. This hand procedure was done on one of our favorite little guys, and he was very unhappy with us going into surgery.
One child came to the OR to have her knee released. Always in a flexed state, her knee does not
allow her to walk. Her procedure of
release and skin graft will offer much improvement. Only 11 years old, she opted for a spinal. She cried out a couple of times, but mostly
kept her sunny disposition. This is the child in Hien's blog also from today on my list of entries.
Everywhere we get reminders that this is a very poor
country, lacking in infrastructure and systems that work to keep the down
working. I have seen several people
carrying heavy loads (all women) strapped to their heads Makes
me hurt to watch. From the hospital
grounds to the streets, a person needs only a strap and a sturdy bag to move
mountains.
They try hard to recycle and keep everything organized.
They try hard to recycle and keep everything organized.
One must be flexible and not judgmental, because we all have
our faults…
This oxygen attachment is between a high pressure tank and the machine and requires high pressure to run it (pneumatic power). One has to remove the dial or it will blow off, and there is a step-off of pressure by using this attachment. But nothing else is compatible and it is a way to get all the connections to attach.
This oxygen attachment is between a high pressure tank and the machine and requires high pressure to run it (pneumatic power). One has to remove the dial or it will blow off, and there is a step-off of pressure by using this attachment. But nothing else is compatible and it is a way to get all the connections to attach.
The nursing students are enjoying their day and each other;
a lovely group of workers.
Infrastructure. We
take organization, work force, and financial resources for granted. How to pay for services in an area with many
people who do not have an income and live off the grid?
Home, walk and shop a bit, and off to sleep. Tomorrow we leave for Pokhara.
http://en.wikipedia.org/wiki/Pokhara
http://en.wikipedia.org/wiki/Pokhara
