Sunday, July 27, 2008

Soap gets in my eyes...

I know, I know... it's been forever since I updated the blog. So, your patience pays off today! Hurah! On with our story:

The next day was spent doing some research on the internet and crunching numbers for financial decision making. What we needed was a reliable supply of anesthetic gases, vaporizers to administer them, oxygen concentrators to suppliment the air people would breath through the vaporizers, as well as replacement parts for the whole breathing system. After all, this is Africa... things break routinely. The connection to the net was so slow though, that it was hard to learn or accomplish much of anything.

I met with the accountant and business manager to discuss oxygen, halothane and concentrator costs. To sum it all up, an oxygen concentrator costs about 700 US$ and can provide 5 liters per minute of oxygen continuously. That same supply of oxygen would cost about 2 US$ per hour. Thus, one concentrator would pay for itself after 350 hours of use (excluding the cost of electricity, which in Zambia, at least, was about 2 cents per hour). in 2007, the hospital's O2 usage cost 19,333 US$, and much of this was probably wasted when staff failed to turn off the tank after the oxygen supply was no longer needed for a particular patient. That annual dollar amount would buy 27 oxygen concentrators, each of which would last 5-10 years if properly maintained.

Now, assuming that electricity is about the same cost here as in Zambia, you could purchase 3 concentrators for 2,100 US$ and run them for 12 hours per day, 365 days per year for 263 US$ worth of electricity, do it for 5 years, and the total cost would still only be 3,414 US$. Therefore, 5 years of oxygen at a cost of 3,414 US$ versus 5 years of cylinder oxygen at last years actual cost of 19,333 US$, would amount to a savings of about 96,000 US$. In others terms, in order to turn an investment of 3,414 US$ into 93,251 US$ (for a total of 96,000 US$), one would have to find an investment that gave a return of 2,700%. I am unaware of ANY opportunity that would yield such returns consistently. Other than changing practice from purchasing compressed, tank oxygen to oxygen concentrators.

Further, a savings of some 93,000 US$ would pay the present day salary of 2 anesthetists for 27.5 years, along with an extra month's salary as a yearly bonus (ignoring yearly inflation).

That weekend at church I met Ted Powers, a 4th year medical student from Loma Linda. He matched there to do anesthesia, though he had interviewed in Nebraska while I was on staff there last year. I never met him when he came to Nebraska, so it is as improbably as it is amazing that we should end up sitting next to each other on the other side of the world.

That night, along with Dr. Mataya, Ted and I went for supper to Dr. Terrie Taylor's house. She's a friend of Mataya's and just happens to be one of the world's leading experts on malaria. She comes from Michigan to Blantyre, Malawi every January through June. She has medical students and research assistants join her regularly, of which 3 were with her this evening. We had a wonderful time eating and talking together all evening. And of course, in keeping with the British tradition, there was even time for tea afterwards.

The next day I tested 3 oxygen concentrators that I found locked in a storage closet. Guess what? They all worked! Well, at least they all put out some gas from the machine that I assume is oxygen. I suppose I could've tried to burn it, or set up some explosive experiment. But I settled on just breathing the stuff and seeing if it raised my O2 saturation measured by the one functioning pusle oximeter in the OR. Maybe I'll try to blow up something next time. I'll check my chemistry books back in the states after I get back, then be prepared for more "kitchen chemistry" type fun when I return to the 3rd world. Now, I should tell you that one of the grounding pins on the power cord is broken, and another missing the air filters, but they do WORK. This was after I'd already asked if the hospital had any concentrators and was told, "We only have two, and one of them is broken." It was also after I had asked to be SHOWN the concentrators... and was taken down a side hall and pointed to an empty oxygen tank. Definitely NOT helpful. In fact, it was somewhere around this time that I had decided that I had been "helped" enough, and that I was going to do whatever needed to be done without asking for prior permission or opinions, as well as believe whatever I thought was likely true about a situation because asking for clarification would only bring a fresh supply of lies, or at the very least obvuscate the truth I was trying so hard to elucidate.

My next trip into the shower was less than amusing. To me, that is. You'll probably get a kick out of it, though. And, I'm not posting any pictures, so if you're a woman, or if there are small children around, please, feel free to continue reading my blog posts. It'll be OK. Really.

As you know, losing water here is pretty routine. In fact, I can't remember a day during my whole trip where I didn't lose either the power or water supply, or both at the same time. However, this time there was a bit of a caveat to the whole ordeal. This time, I was all soaped up, in a shower with no curtain, when only the cold water ran out (I presume I was still getting hot water out of the small reserve tank). The scalding I received was enough to test my Christianity. I rinsed my hands and eyes the best I could, then carefully made the dripping wet and naked trek to the kitchen. This is where I found the 25 liter reserve water jug and a cereal bowl to finish what is locally referred to as a "bucket bath." These 2 fixtures remained in my bathroom until the day I left the country, once again illustrating that one can never have enough backups in place.

After finishing most of the final rinse cycle, I tried to mix in a little of the hot water, which promptly also ran out. So, I toweled off and got dressed as I heard the sound of rushing water filling the pipes again (which is easy if you just leave the spigots open). So, I figured, "Might as well at least get my face washed with hot water." I splashed it on, soaped up... and of course heard the pipes run dry once again. "I just can't win here!," I thought. "About how far away is that bowel and bucket, and can I get to it without opening my eyes?"

And as for washing my clothes, well... I got back a load from the hospital cleaning department and was shocked to see that nothing was missing. What good fortune! It was only the second proper laundering my clothes had gotten in over a month. The rest of the time they had been washed by hand with a bar of soap, in the shower, sometimes on me, and then rinsed and dripped dry on a line.

So cleaning yourself and your clothes... hard. Getting said self and clothes dirty? Easy. Take for instance the storage garage, where the hospital had well over 150 cardboard boxes of varying sized and shapes dumped in a pile and containing "donations" of medical supplies/equipment from the merciful, kind and thoughtful US of A. (Don't even get me started on the utterly useless JUNK that is dumped on Africa in the name of good will! I mean, how many cardiopulmonary bypasses do you think we do here anyway?! Hint: NONE!!) So, I get in there and try to sort it all out... for 3 days. I was covered with dirt, dust and God only knows which microbes, hoping all the while I wasn't breathing hanta virus through the mask I was trying to wear while trapsing around areas that were obvious living quarters for cockroaches, bats and various other non-flying rodents. But hey, I wanted an adventure, right? At least at the end of it all we had a list of 60 numbered boxes arranged in order that had descriptions listed in an excel spreadsheet that could be searched and sorted according to contents. Christmas all over again. :)

After cleaning up I checked my email. I got a response from UNICEF regarding my inquiry into a supply of affordable O2 concentrators they claimed to supply the poor and needy of the world. It was surprisingly unhelpful. I'll never ask them for help again. I might not even offer any to THEM, actually. Sheeeez.

That night I got ready for bed without water, and wrote in my travel log by right hand, while holding a flashlight in the left.