I was pleased to find 2 functioning anesthesia systems. One continuous flow system (a Japanese machine: Acoma complete with non-functioning ventilator, and one year old soda lime), and the second system, a draw over set-up with a... with uh... well what do you know!? A good-‘ol OMV (Oxford Miniature Vaporizer)! How very quaint ☺
I couldn’t believe it! I’d seen drawings of them in books, but here was the real deal! And *I* was going to get to use it! But then, suddenly, I recognized a group of letters, printed all caps on the top of the dial, next to the word “Halothane.” They struck terror in my little American heart... PENLON.
Say it isn’t so! I hung my head for a few moments, there in the darkness of the humid OR, all alone, and sighed out loud. You see, back in the states, about 2 years ago, our department made the mistake of purchasing 5 new anesthesia machines made by Penlon to replace some of our older Drager machines. We started having serious problems right away... like the ventilator stopping for no reason in the middle of a case, the CO2 absorbant container leaking like it had more holes than Swiss cheese, complete re-breathing of all CO2, etc. We had a “wall of shame” in the faculty office with modified Far Side cartoons that poked fun at the Penlons and our experience with them. It was like I’d come to the ends of the earth, and yet I STILL couldn’t escape this British company’s freaky-fickle equipment. I thought, “Well, the thing looks like it’s a good 50 years old. If it’s lasted this long, maybe it’ll make it another week or so and I can get outta' here without any repeat offences.”
Room 2 was their minor sugery room, and the graveyard for donated equipment. There was a Drager 2A and a Drager AVE (I've never heard of that model). Both had seen better days, and those days were before I was born. I was told that neither worked. And even if they did, I knew that they’d need high flow, compressed oxygen to make them work. Still, it’d be nice to have at least one machine in the hospital that had a ventilator, and could serve as a back up should the Acoma fail (which was likely at some point, given its age and working condition. The Penlon, as much as I hated to admit it, was nearly fool proof and maintenance free. It had only one working part (excluding the screw cap that came off to fill the vaporizer), required no electricity, and could be operated using only room air. A mission hospital’s dream machine, really. At least it would be as long as they LEAVE the OR, and THEN use ether to dissolve the thymol residue that tends to build up as the halothane is vaporized. What I didn't want to hear later was that they opened up a can of ether RIGHT IN THE OR where electricity was flowing through a varied array of frayed wires and cables. If they can remember to take that precaution, then the hospital won’t literally be blown to kingdom come as the ether (a very explosive chemical) drifts down to the sockets, power strips and cables at floor level.
Here at Blantyre Adventist Hospital there are 2 anesthetists. They typically run one OR at a time, and either tag team doing the cases, or more often than not, help each other do the same case. It actually does take 2 anesthetists to do 1 case... one to start doing anesthesia, the other to trouble shoot all the problems that arise while the other one keeps trying to care for the patient. They do not intubate here, and there is no ventilator, so one person has to hold the mask while the patient breathes on their own. So, examples I’ve seen of second person anesthesia responsibilities are: setting up suction after a patient has already vomited, getting drugs drawn up to inject for the treatment of low blood pressure, getting the pulse oximeter to keep work, putting on the blood pressure cuff after induction of anesthesia with halothane... and cycling it once or twice, filling up the halothane because it’s almost gone, adjusting the ceiling lights for the sugeon (no sterile handles for them to do it themselves), going off somewhere to find an oral airway. No, I'm not kidding.
The anesthetist I helped out today barehanded the Tylenol suppository into this kid’s butt, THEN put on gloves to hold the mask again for continuing anesthesia. Good grief. What am I supposed to say to that? Don’t some things go without saying?! I just shook my head and wondered if I really could help this guy learn.
Thursday, April 17, 2008
Off to Blantyre
I was able to fall back to sleep as it cooled down in the wee hours of the morning, even though I had to lay awake and wonder wether or not I was coming down with malaria. I had been taking my pills faithfully since arriving in Africa, but I had been bitten about 8 times. Seems like I swell up and itch a whole lot more when the mosquitos over here bite me.
The next morning while I was relaxing on the lake shore, an ebony carver met me to sell me some of his wares. I had seen ebony only once or twice in my life, so it took some convincing before I believed he had ebony and not just wood that had been colored by Kiwi shoe polish (a well known trick used in Africa). A little sanding and scraping with my Swiss Army knife convinced me it was for real… along with a consult from some locals. I traded my sandals and some US$ for several good sized blocks that I will carve on my own back in the states.
I got to visit with Iqbal and his family again, exchanging ideas and experiences on all kinds of things. One thing I remember them telling me is that their DVDs have 16 movies per disk! I don’t understand how they could pack that much onto one disk. However, it would stand to reason that if it is truly possible, it is probably something that was designed and engineered by the same Africans that put 26 people in a 16 person mini-bus.
It was about this time that I got a chance to shower and shave for the first time in days. The mosquitos the night before were bad enough that I had sprayed my whole body with 30% DEET, even though I was under a net. They had gotten underneith the net the night before because I had let one edge rest over top of my suitcase, rather than flat on the floor, or tucking it in under the mattress.
The final day arrived for us to be at Lake Malawi. We said good-bye to Iqbal and all his family, inviting them to come stay with us some day. The drive to Blantyre was, as usual, over the three hour prediction, and was yet another bladder testing experience. As we neared the city, past president Bakili Muluzi past us in his motorcade. He’s starting his campaing for next year’s election, and is running for his UDF party’s primary election, in 2 days (not that anyone else is running for the UDF). This guy’s an average corrupt politician, of whom I may tell you some more later. For now, let’s just say I was ammused to see how little armed guards and private security was with him on the roads.
After settling into my guest flat at Blantyre Adventist Hospital, I relaxed and did some reading. I felt a bit dizzy, kinda funny, and fatigued. That night I woke up in a hot sweat, and decided to get checked for malaria the next morning… after all, I was at a hospital, how hard could it be? And, it had been 3 days since the last time I woke up like this. Seemed like it could be P. vivax (a type of parasite that is the cause of malaria), since the best I could remember was that P. falciparum was a every 4th day fever/chills. If I had it, I just hoped the cure wasn’t worse than the disease.
The next morning while I was relaxing on the lake shore, an ebony carver met me to sell me some of his wares. I had seen ebony only once or twice in my life, so it took some convincing before I believed he had ebony and not just wood that had been colored by Kiwi shoe polish (a well known trick used in Africa). A little sanding and scraping with my Swiss Army knife convinced me it was for real… along with a consult from some locals. I traded my sandals and some US$ for several good sized blocks that I will carve on my own back in the states.
I got to visit with Iqbal and his family again, exchanging ideas and experiences on all kinds of things. One thing I remember them telling me is that their DVDs have 16 movies per disk! I don’t understand how they could pack that much onto one disk. However, it would stand to reason that if it is truly possible, it is probably something that was designed and engineered by the same Africans that put 26 people in a 16 person mini-bus.
It was about this time that I got a chance to shower and shave for the first time in days. The mosquitos the night before were bad enough that I had sprayed my whole body with 30% DEET, even though I was under a net. They had gotten underneith the net the night before because I had let one edge rest over top of my suitcase, rather than flat on the floor, or tucking it in under the mattress.
The final day arrived for us to be at Lake Malawi. We said good-bye to Iqbal and all his family, inviting them to come stay with us some day. The drive to Blantyre was, as usual, over the three hour prediction, and was yet another bladder testing experience. As we neared the city, past president Bakili Muluzi past us in his motorcade. He’s starting his campaing for next year’s election, and is running for his UDF party’s primary election, in 2 days (not that anyone else is running for the UDF). This guy’s an average corrupt politician, of whom I may tell you some more later. For now, let’s just say I was ammused to see how little armed guards and private security was with him on the roads.
After settling into my guest flat at Blantyre Adventist Hospital, I relaxed and did some reading. I felt a bit dizzy, kinda funny, and fatigued. That night I woke up in a hot sweat, and decided to get checked for malaria the next morning… after all, I was at a hospital, how hard could it be? And, it had been 3 days since the last time I woke up like this. Seemed like it could be P. vivax (a type of parasite that is the cause of malaria), since the best I could remember was that P. falciparum was a every 4th day fever/chills. If I had it, I just hoped the cure wasn’t worse than the disease.
Friday, April 4, 2008
All's well
Hi all,
Just a quick note to say I'm fine. Internet access in Malawi has not been as good as I was told it would be. I will try to post again, after typing things out in a Word file, for a quick cut and paste job.
Bye for now!!
Just a quick note to say I'm fine. Internet access in Malawi has not been as good as I was told it would be. I will try to post again, after typing things out in a Word file, for a quick cut and paste job.
Bye for now!!
Tuesday, April 1, 2008
Lusaka to Salima
We got up the next day at about 0430 to make it to the bus station by 0500, for the 0600 bus. You can reserve a ticket the night before (which we did), but you cannot purchase a ticket early. I’m told it confuses them. Their system of selling tickets is out of a carbon copy notebook. There are no computers anywhere at the bus station. In fact, the Juldon bus company’s “office” is a press-board shack with a tin roof. The dimensions are roughly 4 feet wide, 7 feet high, and 8 feet deep. I couldn’t tell how the guy got in there. We bought our tickets and pressed through the crowd of advertisers to squeeze towards the bus. See, as soon as you drive into Lusaka bus station, you are inundated by people shouting the praise of their bus company, and desperately urging you to buy a ticket from them, and not their wicked competitors. The first time I came here, it nearly frightened me... now that I understand what’s going on, it’s tolerable.
8 hours later we arrived at Chipata. The Mwami hospital mini-van that was SUPPOSED to meet us was no where to be seen. Was I surprised? Nooooooooooooo! Jim called on the cell phone. No answer (no surprise). He sent a text, no reply (no surprise). 1 hour later we hired a taxi to drive us there. How long will this take,” I asked. Of course, I already knew how long. I had ridden the road before. I was just curious to see how badly the driver would lie, or how badly he would estimate the travel time. “20 minutes.” Hmph. Just what I suspected. Off by 100%.
We got to Mwami 45 minutes later.
Once we arrived I checked in on how the new machine was doing. The anesthetist told me it was doing just fine, even the halothane leak had stopped. I suspect that the thymol preservative had plugged the hole as small amounts of halothane leaked out over the past 2 weeks. However, a huge leak had developed in the old Drager 2A. I took a look, confirmed what I had been told, and quickly realized that there were no tools to disassemble the thing and try to repair it. They’d have to use the 50 year old Boyle’s machine as their back up, like they did before the glostavent arrived.
I went to bed, again, face down. It was hard to sleep without the fan I had become accustomed to during my time in both Lusaka and Yuka. I couldn’t tell if it was me I smelled, or just memories of the people I’d spent the past 2 days with on the bus.
The next morning, the Ang and Peduche families (Philipinos, both) and I loaded into the Toyota 4 wheelers to drive to lake Malawi (WE left on time, and bought fuel legally! Where’s the fun in that?
It took about 25 minutes to enter/exit Malawi/Zambia. The guy on the Malawi side recognized me and said, “Hello Mr. Cobos!” I hadn’t even given him my passport yet. (It pays to have friends in high places!)
After getting to Lilongwe, we stopped at 4 or 5 stores to buy stuff for the weekend. Most of the businesses are owned by Indians or Mid-easterners. A large procession was passing through the main street, mostly in purple. I had forgotten it was Good Friday (purple being the symbolic color of repentance, used generously in Catholic festivals).
We arrived at an estate on the shore of lake Malawi, near the city of Salima. Our hosts are a wealthy Muslim family who happen to live back in Chipata, Zambia and have been patients of Mwami. They invited the doctors to join them for the long holiday weekend at this retreat, which they themselves hadn’t stayed at for over a year. We stayed in 2 guest duplexes (3 other Philipino families joined us), next to their own main, large, house. Local workers cleaned for us, and it reminded me of Africa’s old slave age.
The first thing you notice about ANY building that Islam has anything to do with in all of Africa is... it’s clean. And in Africa, that stands out like a sore thumb. A beautiful, magnetic, sanitary sore thumb. I love it. Ah, to be clean :)
Iqbal’s family came to Zambia nearly 100 years ago, as negotiators between the Zambians and the English. Now, they’re traders, and run a farm with 500+ employees. They dismiss dishonest workers on the first offence (stealing is a major problem, and they claim they could write a book over 1000 pages long describing all the methods the Zambians have stolen from them).
The electricity went out, as usual. It was hot, and I couldn’t sleep in the heat. Eating a big Philipino dinner hadn’t helped either. I woke up in a sweat about 2 AM.
8 hours later we arrived at Chipata. The Mwami hospital mini-van that was SUPPOSED to meet us was no where to be seen. Was I surprised? Nooooooooooooo! Jim called on the cell phone. No answer (no surprise). He sent a text, no reply (no surprise). 1 hour later we hired a taxi to drive us there. How long will this take,” I asked. Of course, I already knew how long. I had ridden the road before. I was just curious to see how badly the driver would lie, or how badly he would estimate the travel time. “20 minutes.” Hmph. Just what I suspected. Off by 100%.
We got to Mwami 45 minutes later.
Once we arrived I checked in on how the new machine was doing. The anesthetist told me it was doing just fine, even the halothane leak had stopped. I suspect that the thymol preservative had plugged the hole as small amounts of halothane leaked out over the past 2 weeks. However, a huge leak had developed in the old Drager 2A. I took a look, confirmed what I had been told, and quickly realized that there were no tools to disassemble the thing and try to repair it. They’d have to use the 50 year old Boyle’s machine as their back up, like they did before the glostavent arrived.
I went to bed, again, face down. It was hard to sleep without the fan I had become accustomed to during my time in both Lusaka and Yuka. I couldn’t tell if it was me I smelled, or just memories of the people I’d spent the past 2 days with on the bus.
The next morning, the Ang and Peduche families (Philipinos, both) and I loaded into the Toyota 4 wheelers to drive to lake Malawi (WE left on time, and bought fuel legally! Where’s the fun in that?
It took about 25 minutes to enter/exit Malawi/Zambia. The guy on the Malawi side recognized me and said, “Hello Mr. Cobos!” I hadn’t even given him my passport yet. (It pays to have friends in high places!)
After getting to Lilongwe, we stopped at 4 or 5 stores to buy stuff for the weekend. Most of the businesses are owned by Indians or Mid-easterners. A large procession was passing through the main street, mostly in purple. I had forgotten it was Good Friday (purple being the symbolic color of repentance, used generously in Catholic festivals).
We arrived at an estate on the shore of lake Malawi, near the city of Salima. Our hosts are a wealthy Muslim family who happen to live back in Chipata, Zambia and have been patients of Mwami. They invited the doctors to join them for the long holiday weekend at this retreat, which they themselves hadn’t stayed at for over a year. We stayed in 2 guest duplexes (3 other Philipino families joined us), next to their own main, large, house. Local workers cleaned for us, and it reminded me of Africa’s old slave age.
The first thing you notice about ANY building that Islam has anything to do with in all of Africa is... it’s clean. And in Africa, that stands out like a sore thumb. A beautiful, magnetic, sanitary sore thumb. I love it. Ah, to be clean :)
Iqbal’s family came to Zambia nearly 100 years ago, as negotiators between the Zambians and the English. Now, they’re traders, and run a farm with 500+ employees. They dismiss dishonest workers on the first offence (stealing is a major problem, and they claim they could write a book over 1000 pages long describing all the methods the Zambians have stolen from them).
The electricity went out, as usual. It was hot, and I couldn’t sleep in the heat. Eating a big Philipino dinner hadn’t helped either. I woke up in a sweat about 2 AM.
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