Fieldset
Haiti: Day 5

Wendy leaps logistic hurdles to get a patient the surgery she needs in Haiti

We did our first surgery today, at about 2pm, right around when we were wondering if we should just go ahead with moving the second operating room (OR) without having test-driven the first. The case was a transverse presentation, in labour, uterus fibromatous. The baby was small and had some mild respiratory distress. Hopefully transient. Apparently the fibroma made things a little tricky, but the surgeon tells me that blood loss was minimal. Logistically, all we needed were new batteries for the oximeter. (The new rechargeable set are still at Jude Anne.)

This evening, though, Jude Anne called me with news. They had received a patient with a ruptured ectopic pregnancy, tachycardic and not exactly stable. Definitely someone to rush to surgery. Except that, they had no scrubs. The gynecologist on call had the right instinct and was preparing to transfer her urgently to Solidarité. I told him to send the anaesthetist with her, and two brancardiers also, so that they can go straight up to the OR. He had already called ahead to prepare them on the other side.

Then I called logistics. The laundry moved yesterday, and while it is functional and clothes are clean, there is a problem of drying. The weather has turned, the wind picked up two days ago, and so there is dust everywhere. We have to rely on the electric dryer.

He passed the cell phone to the anaesthetist at Solidarité. She knew the case was coming. She said, we have no sterile sets for spinal anaesthesia. We've had none since the afternoon. Can you send some from Jude Anne?

This astounds me, since we've only done one surgery at Solidarité. How is it that all the spinal kits are at Jude Anne? But this question I will try to sort out tomorrow. The ectopic pregnancy would be done under general anaesthesia anyway. I called Jude Anne back. They said they would bring some.

In the meantime, logistics managed to find some scrubs that were ready and was sending them to Jude Anne in the car. Right now. So I called Jude Anne again, to say, since scrubs are coming, better to operate on the patient there. It's better for her. I really would like to minimize having to transport patients who aren't exactly stable.

Then, logistics called back. We thought they were sending the spinal kits, but the driver received nothing in return for the scrubs. Argh! Another phone call to Jude Anne, the receptionist brought the phone up to the OR where the surgeon had just scrubbed. The anaesthetist assured me she had given the kits to the guard, who was to give them to the driver. And yes, when I called back to logistics, he had heard on the radio that the driver had arrived with them.

I said, let me make absolutely sure that they arrive to their destination. I called Solidarité, and that receptionist went up to the OR to find the anaesthetist there. I told her that the patient would be operated on at Jude Anne. She said, yes, the driver has just come upstairs with the spinal sets.

Tomorrow, though, we will be packing and moving the second OR, so we will have to transfer surgical patients to Solidarité, so the system (anaesthetist, brancardiers, car, call ahead) must be efficient. I worry about this.