April 23rd, 2019 by Galit Rudelson

This one is for my medical friends! Non medical friends, feel free to read, but be warned it might get a bit outside of your comfort or interest zone.
Today I spent the full day in the operating room. It blew my mind on how simultaneously similar and different the experience was. Like the US, there is an emphasis on sterility in the OR (called the “operating theater” here). But the emphasis is much different than the US. To get into the Theater, you must walk through a common area, where everyone eats their food and relaxes between cases. There is a door leading out of this to the operating rooms, but it usually kept open. Within the same hallway is the bathroom, whos door can often times be open, meaning there are open doors ranging from where people eat, to the bathroom, to the operating room! And the scrubbing station is the same place that people wash their hands after using the bathroom.
The room itself is fairly similar to the US’s operating rooms, so I wont bore you with the details. There is a table for the patient, anesthesia stands at the head. Theres a scrub nurse (who’s also first assist) and a circulating nurse. The doctor explained that in bigger cities there is enough staff to have a first assist, a scrub nurse, and a circulating nurse. But here, rurally, they adapt.
I was surprised to see that the patient buys all of their own sanitary plastic for the bed (what they lay on) from the market across the street, and brings it themselves. On second thought though, although we do not buy these supplies from the market across the street, we still pay for it in our final bill. So I guess its not that different.
The patient climbs onto the bed themselves, and then are given spinal anesthesia, so they are awake throughout the case! The first case went very long, so they ended up having to convert to general for pain. But the last case the patient clearly was in pain towards the end, but did not complain to the anesthesiologist, so they did not convert to general.
A couple of interesting things that happened/ I noticed during surgery. First, they do not have unlimited packs of sterile water, like our hospital. So water from the tap is put into a water boiler (exactly like the one I have in my house), boiled, and then poured onto the sterile field into a bucket. Bloody lap pads are then dipped into it to rinse off. If sterile water needs to go directly into the body, then they open up a pack of room temperature water.
Second, the operating room is very hot. I would estimate the low 80s. The doctor is sweating through the whole case (rightfully so), but dropplets of sweat are dropping onto the patient! He stopped operating several times, and asked the circulating nurse to wipe sweat off of his face.
Third: the power. Now side story for a second. I happened to be in a room today that had the news on. They were discussing the frequent power outages going on right now. Turns out, they were fairly rare for the last two years. Only in the last 2 weeks have they become so common. The news explained that the energy comes from Nigeria, and is currently barely flowing in our direction, but they are working hard to fix it. Ok so back to the operating room. When the power goes off, there is a backup generator, but it does not kick in automatically. That means that we are left standing in semidarkness (there are closed windows in the operating room, but they are tinted so nobody from the outside can see in). Somebody runs to the generator to turn it on. But in the mean time, everyone takes out their phones, turns on their lights, and crowds around the table with their lights on, so the surgeon can see. He does not keep operating, but it helps him make sure everything is safe while we wait for the generator. The power came on and off 3 times throughout the first surgery. So we stood in darkness 3 times. Mind you, the patient is awake throughout all of this! In the background you could hear a rooster. A very different OR experience from the states.
And the surgeries done there are much different. Today was a “simple myomectomy.” This was the largest uterus I have ever seen, with so many fibroids. But the doctor explained to me that women will try everything before they will consent for surgery. Natural home remedies, prayer, herbs. Meanwhile the fibroids grow and grow. If this case was in the states, I doubt anyone aside from a Gyn-oncologist would try it. But here the junior house officers (that have been operating for 4 months) feel comfortable doing the surgery (with assistance of a senior OBGYN). They said that it is just so common that people let their conditions go. In fact, our first case was so large, they had to convert to hysterectomy. They consented the patient for it right in the middle of the surgery (since she was awake). Why not consent her before? Because she would not go for it! Cut the problem out, don’t cut the uterus out! They explained to me that some women believe that terrible things happen when you lose your uterus, to the point that they might even melt! The second case we cut out so many fibroids the uterus looked like a shredded rag. But the doctor was able to stitch it back together to resemble a uterus with apparent ease. Incredible.
All in all, they are able to do all of the same surgeries we are able to do. They try to maintain the same level of sterility, but it is difficult with the resources. And they work under some difficult circumstance, that are just every day occurrences here. I was very impressed.