It has been a long day #1 - which is typically not how it goes??? Hoping it will be earlier tomorrow night because while I thoroughly enjoyed my peanut butter sandwich for lunch, I just ate peanut butter & crackers for dinner & at this rate may not want peanut butter when I get home - which I rarely eat anyway...For those of you concerned I slept well last night with no leg cramps - Hooray!!! I felt rested & it was great that I had packed everything in my bag ahead of time. I went to breakfast & they have a buffet - none of which I partake of, but I noticed a tag for Gari - a food we will get for the families and it is definitely not a "crackers or a chip"-I am told it is another carbohydrate - so something got lost in translation. My standard breakfast is a 2 egg "omelet" (I use that word loosely) as all they add in are onions & peppers & I have a piece of white or wheat bread & whatever the fruit of the day is - if they have it as they put out 1 tray & then it is gone. Also, pretty sure I will not eat eggs for a few weeks after eating them for 13 mornings in a row...but it does give me a good start for the day and I am not daring enough to et what is in the "buffet" although one of the students said the bean & rice mixture is pretty good so maybe I will try that??? I will again divide this up into sections.... Mission, Humanitarian and Misc for anything else that comes to mind :)
MISSION: Monday starts surgery days and I know the first morning is slow as we have to first go through the mock code emergency drills and they start each operating table one at a time. We have 2 operating rooms here each with 2 tables, so it is a "4 Table Teaching Mission" which also means the cases will take longer as they teach and new physicians are in all the roles - Anesthesia, Surgery etc. I told the PACU team I did not think we would get our first patient until 11 am. I knew that I needed to focus on some teaching & education for the PACU trainees as the "educator & PACU team leader" because nursing in 3rd world countries is very different that in the US and scopes are different and I do want to contribute to their knowledge while we are togetehr for 5 days. Unfortunately, I had not a moment to think about that yesterday & honestly didn't start looking at the Op Smile Academy resources until I was on the bus today but I went thru it and think we can do a lot of baseline education today.
Back in the PACU we have 4 beds - all have dilapidated mattresses with cracks in them & one bed is so low to the ground it would be hard to manage a patient in it, 2 beds don't have side rails which is a definite patient safety risk (someone literally need to be on or next to the bed at all times & one nice bed. However, they did bring us Op Smile Ghana red & white striped sheets & that made them look nice :) plus some blankets for the patients & the "chux" we need to put under their heads for drooling/bleeding so we keep the sheets clean & trash bags -so Overall I felt better about our supplies as we finished setting up!
I totally had to pull out & dust off that box in my brain with "mission knowledge & experience" and reactivate it today since it had been in sleeping mode for a couple of years but it all came right back and I also jumped into "full educator mode" did lots of teaching & felt like I co-signed 75% of all the charts today. Della the Pediatric Intensivist is from the PICU at the largest hospital in Accra & he is AMAZING!!! While we waited for patients this morning he & I decided to open up the emergency drug box and review with the other 6 nurses each medication - the type of drug, action, indication etc. We spent 90 minutes tag teamed in discussion& examples & it was great so that was today's education in addition to working 1:1 with the trainees & patients. Tomorrow I am going to review Malignant Hyperthermia - a rare but life-threatening complication especially in African Americans - it has only happened on one mission I have been on and was a mild case but it is a big focus and always important to review the high risk-low volume situations.
I was off by 45 min the 1st patient got to the PACU at 11:45 and the first wound we all cleft lips (my favorite "easy fix-big impact". Our first round of palates were in there by 3 pm -some of them very unhappy. It was a normal PACU day -slow then 3 patients come all at once & there's a lot of chaos. A few today did get the "extended stay package" if they got extra sedation at the end of the case and it took them longer to wake up as they need to be somewhat "awake" to go to the post op ward. The table #1 team of anesthesia & surgeon was my favorite - they were super-efficient and ahead of all the other tables cases and their patients all came in calm & has easy PACU courses. In fact, when they were finished, I said "could your team just take the last patient from Table 3 because they are way behind & at this rate we will be here late & they just smirked. 30 min later the surgeon was in the hallway & said to me "your wish was granted" :) they took that case but unfortunately it was still a later night. By 6 pm we only had 2 patients left & a bus was returning to the hotel. I offered that 3 of the PACU nurses could go back & 4 of us would stay for the last 2 patients. Abigail immediately volunteered (she is a single mom & brought her baby & her niece watches him at the hotel while we are at the hospital). After that NO-ONE wanted to go - I gave them my best speech about pacing ourselves through the week& still no takers. I think they all feel like they need to stay so they get "good marks" on their training evaluations & I told them that was irrelevant> Then I got frustrated because they stayed but were on their phones & I had to "assign them" in teams of 2 to specific patients. I must be doing something wrong? and of course it is ALWAYS the last patient that misbehaves. Tonight it was a 12 year old boy with a fistula repair (had a prior palate repair that opened up = fistula) and cutting thru old scar tissue = more bleeding. So we watched him closely & didn't send him to post op until 8:30 which led to the hotel arrival at 9. Fingers crossed tomorrow is an earlier return! The power at the hospital went off a few times between 7:30-8:30 & then we heard the thunder & it was storming outside so that was the cause.
HUMANITARIAN: There was not a lot of time to think about this today - which was okay because yesterday the sheer volume of needs overwhelmed me & still does a little too. Salam came into the PACU in the morning & we chatted & then she came back about 5:30 when she was off work thinking that perhaps I could leave but that was not the case -we said "maybe tomorrow & I definitely need to make that work. I am hoping she comes again in the morning & we can better detail out the "financial calculations" we did re. the needs of the 43 people, and the other things that were mentioned that I my brain turned off as I was in survival mode.
I did review the plan with Abigail asking her about getting things a "Malcom's" the store vs the Open Market & she & Beatrice looked up costs on their phones & to me it doesn't look like it would be horribly more expensive for the 25kg of rice - but I understand for people here why spend 60 Cedi more ($5 US) if you can get it for less. To that I say because I can use my credit card :) A lil tender mercy as I arrived back at the hotel & went to the desk to get my room key back. There was just me & 2 other Op Smile folks & I asked the person at the desk if they knew where I could get Cedis for my US dollars & she gave me two bank options that were not close to the hospital BUT the girl standing there said - I can help you exchange money!!!! I asked "are you a "money changer" since that is what they are called & she said no I am the mission social worker, but I am local and have a bank in the area. I was shocked & also not at all surprised. While it seems wildly improbable that of the 80 team members there was one in the lobby with me that could help me with exactly what I needed - I absolutely do know I am "on the Lord's errand" and He knows I need some help!!! So hopefully that will happen tomorrow morning. When I got back to my room, I texted Salam with the good news, but the text would not go thru (she has an android) and that has happened before so I can't wait to talk to her in the morning.
It's 11:30 & I need to go to bed!!! but if I don't blog every night, I will never blog so I am skipping the Misc category & going to sleep. I am not even going to check for typos or edits - sorry!!!
LOTS OF LOVE TO ALL who have text or reached out - I am so grateful for your support, prayers, positive thoughts and encouragement as I am on this Op Smile Mission and also equally if not MORE important here to help humanity in Ghana XOXO Nurse nancy
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