Pharrell is Happy

I actually cannot believe I have been here six weeks already – the time is literally flying by!

I have spent the last few weeks in theatre doing anaesthesia. What an experience! Although the principles are the same, it is really different to home. There are relatively few drugs, limited equipment, minimal monitoring and there seems to be a lot of emergency / near-fatal incidents that we narrowly and sketchily navigate. No complete disasters yet thankfully (*touch wood*). I’ll say one thing for this place though; it certainly brings out ones creativity and resourcefulness. Today for example I fashioned a sharps-box out of an IV fluid bottle, and the other day I made a suction catheter using an IV line set and a surgical blade. Sure who knows what’s next? I’m thinking about creating a heart-lung bypass machine from empty Nile Special and wine bottles before I leave: watch this space. 

Highly organised anaesthesia workbench: pre/intraoperative

I have a great laugh in theatre with the staff. To say this place is chilled out is a major understatement. Some days we end up starting the first case at 10.30AM. (Scheduled for 8.30). The nurses are regularly either missing in action or are having a snooze on a trolley in theatre. We are forever running out of sterile linen (sheets, gowns etc), to the point where some days we finish early – not for lack of doctors or nurses or patients: purely no clean sheets. It’s the simple things really!

I am no longer much of a novelty in theatre and everyone is pretty much used to my big white mzungu face by now. Of course my name is still a bit of a challenge – but we’ve resolved that now as most people have taken to calling me Farrell, pronounced Pharrell. This is not a joke. Neither is the sporadic serenading of ‘my song’ Happy, often preceded by ‘Pharrell why are you not smiling today?? You should be more like your song! Because I’m HAPPYYYYYYYYYY...’. For anyone who doesn't understand this reference, please click here: https://www.youtube.com/watch?v=y6Sxv-sUYtMI 

I mean I hate to be a Debbie-Downer, but recent situations where it might have been inappropriate to be humming my theme song:

1.       When that woman’s spinal anaesthetic wore off in the middle of her hysterectomy surgery. [Painful for everyone]
2.       When the laryngoscope batteries ran out during a difficult intubation.
3.       When the ‘emergency C-Section’ patient unexpectedly pushed the baby out on the floor of the operating theatre (this happened twice).
4.       Blood pressure of 54/32mmHg.

I will admit on these occasions I have struggled to remain calm, mainly because of the slow reactions of others and their seemingly nonchalant attitudes facing really urgent situations. I am definitely underestimating my colleagues though, because despite the turtle-style pace, situations are remedied, rectified and resolved with or without my hysterics every day. The answer to every stressful situation here is laughter – whether this is a defense mechanism, a relief release after-the-fact or genuine sadism, it seems to keep everyone in good spirits and relationships on good terms behind those operating doors! 

Even the patients laugh. One day we had a full and frank discussion with a woman who was having her womb removed (under spinal anaesthetic so she was awake for the procedure), about her daughter’s eligibility. The intern, Felix, had spotted her in the family waiting area (ie. the corridor outside theatre) and she had piqued his interest. We discussed her cooking skills at length, as well as the dowry and her likelihood of fertility. By the time we had her womb out he had a date with the daughter, never a missed opportunity!

Old EMO ventilator with manual bellows: uses ether

Glostavent Ventilator: uses halothane and runs on an oxygen concentrator.

I am really enjoying myself here. I'm getting great exposure to medicine and surgery in a developing country which is really something you cannot learn in a book. I've also encountered some incredible doctors who are really well capable, and I have been really impressed by the medical students' knowledge and skillset which is very promising for the future. I think this has been a really important realisation for me: to appreciate that the majority of doctors I've met in Africa are fully capable of treating patients to an acceptable standard without any help from a mzungu. It is not the lack of homegrown skill or knowledge that limits care here, but rather the lack of resources. Granted, Lacor is considered one of the best hospitals in Uganda. What sets it apart from other hospitals in the region is the funding from Italian and Canadian (and now a small part Irish!) organisations, charities and individuals. This not only keeps the hospital afloat, but invests in technologies and equipment to progress the standard of care, striving toward European and US standards. For example, each of the ventilators cost £20,000, funded by African Mission a few years ago. These machines are what we consider life-support machines at home: breathing for the patient when they cannot manage themselves. No other hospital in the region can afford even one of these. I spoke to doctors working in Gulu Referral Hospital five miles down the road who have several patients who would benefit from this simple machine and may well die without it. It doesn't matter how many doctors see those patients - be they Irish, Canadian, Chinese or Ugandan - it won't change the simple fact that it is the equipment and drugs that matter most of all. I haven't made any specific requests regarding how our donation to Lacor should be spent - I have heard many stories about donors insisting on spending money on specific areas that do not benefit the greatest number of patients (like expensive equipment that may fall into disrepair). Instead it will go toward the general running costs of the hospital: funding essential drugs, powering the generator when the electricity goes out, laundry, hospital maintenance etc. The simple stuff we really can't survive without! 

And as for me being here, I am definitely gaining at least as much from the experience as I am giving back to the community. I am benefiting so much I sometimes feel guilty. So all I can say at the moment with certainty is that I'm providing an extra pair of hands, sometimes another perspective or idea on a clinical problem and an enthusiasm for work (which sometimes wanes in the evening after inhaling a lot of halothane, but an enthusiasm nonetheless!). I consider this stint volunteering as reconnaissance for future work volunteering - finding out what works, what is useful for hospitals with limited resources and what is really needed in developing countries so when I have more skilled training I can really put it to good use. Even though I've had some tough days (I will admit to at least one occasion of homesickness, a serious craving for a Shell's goats cheese sandwich and cup of Barry's tea), this is the single best decision I've ever made - and the best thing is I have many many more weeks to go!