The crowing of the rooster roused most of the team and we stumbled into the kitchen; many ready for their morning coffee although personally I was after the my cold water I had stashed in the group fridge.
We had our plan for day one prior to arrival. The Ortho team left for their clinic in the compound seeing patients. The plastic surgeon and the general surgeons to another area seeing other patients. The number of patients and the amount of space didn’t really jive apparently and according to the surgeons paper work doesn’t really change despite the language used.
The OR & PACU nurses spent the morning making organization out of the chaotic pile and organized the 28 bags of supplies and equipment. It was a necessary job and one that we rocked despite the fact that what we really wanted was to provide patient care.
So in the afternoon we could have just relaxed but instead we farmed ourselves out to various areas to provide whatever help we could. Some went to the clinic to help with patient care which they found very rewarding. I ended up in ICU, along with the physiotherapist, to provide some patient care. Turns out we had both been out of this setting for a combined total of 58 years but it was like riding a bike, turns out we hadn’t forgotten a thing and didn’t miss a step. It was incredibly eye opening to see the close proximity of the patients and how basic it all was. So while we can provide care the hospital system has no food and no basic sanitation areas so when the patient needs a drink of water, food the family is asked to provide these. As far as bathroom facilities the ICU has none so family has to pack the patient up and take them somewhere.
We knew before we arrived, in theory, that we are very privileged to live in a country that has health care. There is a constant outcry by both providers and patients when our system develops issues but I now understand the concept of first world problems. Each and every Canadian has access to health care even if they forgot to renew their card. Here in Haiti we know, again in theory, that we will change one person’s life but we won’t change the system. As an outsider looking in it is obvious that on a local level and a national there are so many issues that it’s hard to even articulate them all. We obviously can’t change the system so we need to adjust and work within it.
Which began shortly after our team meeting but I digress. The surgeons finalized the operations for tomorrow and then we meet for a team meeting. As the nursing lead it was my job to organize all of the supplies and equipment needed (supplies are disposables and equipment is the reusable instruments). It is a bit of a challenge to think outside of our usual box where the system is so defined. There is lots of thinking on the fly and the surgeons are obviously going to be flexible in these circumstances which will help a tremendous amount. There were a few mini meetings post meeting and then I sat down to write out the slate. This meant I was going to be on the last truck going out for supper as I needed time to calm the chaos and get, on paper, things organized for everyone.
But then the plan changed and as anticipated it was as chaotic. There was a patient that required surgery this evening so the Haitian surgeon organized for the Canadian team to have operating time. No orientation manual because it was missing, no supplies planned as we were told we could use their supplies tonight, no interpreter, no friendly local nurse who was willing to help us (despite her charge nurses departing instructions) and no functioning anaesthetic machine. Fortunately the patient spoke good English, a spinal anaesthetic was appropriate and the orderly was very accommodating of our requests.
It’s rather,well, primitive is the best word I can find, as the Operating Room set up and condition predates all of the OR nurses experience and we’ve been at this for a long time. But the basics are the basics and we provided care to a patient who required our assistance. We came back, both jacked up and exhausted. Over the top because we were fulfilling our mandate of helping the patient and exhausted because it was strenuous trying to plan for all the unforeseen items and being on top of the game. The surgeon was his usual complimentary self and even noted he thought it had “gone swimmingly” and that, as usual, the nurses made his life easy. Well I’m pretty sure it wasn’t an easy case as it was an extremely bad tibia fracture but it’s great to know that we hit it out of the ball park.
As a personal aside I will note that I already have one serious regret about this trip; one that is going to have a daily impact on me. I brought my old nursing shoes, the ones that spent a few years being kind to my feet at work. They aren’t being very kind and loving to my feet so as I wrote part of this I soaked my feet in the sink and had a beer. Now it is seriously past time to get to bed tonight as we have a full day with two Operating Theatres running tomorrow; one where the slate is not set in stone and we need to be able to react and plan in a heartbeat for the unexpected.
There is nothing constant but change.