June 28 - What patient privacy?

In this post: Day one Muhimbili, patient presentation, cardiac surgery

We started in the hospital today, which is associated with the
Muhimbili University of Health and Allied Sciences. It is pretty
central to Dar and a warm 25 minute walk from our hotel in the morning
(warm even at 07:00). There is something nice about stepping into a
university campus from the streets of Dar. It almost feels like an
oasis amongst the chaos of the city, with students working on laptops,
professors strolling the grounds and the feeling of higher learning in
the air. It is Academia I guess, and I think I feel so comfortable
because I've spent all of my adult life in it (having passed my final
med 2 exam, I am now officially in Grade Twenty-two!).
Jeff and I are both doing a surgical elective while at Muhimbili and
we heard that they had a lecture/ teaching session at 7:30 on Mondays,
so we got there bright and early to sit in. We were both pretty
shocked when, in front of 30 doctors and med students, they wheeled in
a patient and laid him out on a gurney that was set up in the corner.
A nervous resident then proceeded to present the patient (in English,
so we had no trouble following along, but the patient probably had no
clue what they were talking about). It then seemed that whenever the
docs in the audience felt like it, they got up to examine the
patient's findings (in this case, jaundice) with a curtain half-drawn
so that we could still see the patient's head. It just felt like a
bizarre show-and-tell at school. The resident then had to field a
number of questions from the docs in the audience in what seemed to be
a formative evaluation. Jeff and I, having just completed that unit in
school, did pretty well. Unfortunately he was having a harder go of
it. Apparently he was an upper year resident, so it was a striking
difference for us about the level of schooling in Canada compared to
here. While I hope that this is only one case in an otherwise
wonderful school, I unfortunately have the feeling that this may
develop into a theme in the days to come.
After the teaching session, I met up with the cardiac surgeon that I
would be spending the next three days with and he took me over to the
operating theatre for the day's case: open ligation of a patent ductus
arteriosus in a 9 year old girl. (For those of you less medically
inclined, the ductus arteriosis is a structure in your heart that is
vital for proper oxygenation of blood in the fetus during pregnancy.
Once the baby starts using its lungs, it doesn't need this structure
and it normally closes off in the first few hours. In this case, the
little girl's ductus arteriosus didn't close, which actually makes
things pretty bad. She was 9, but because her body was never getting
the oxygen it needed and was working so hard to pump blood around her
body, she was the size of someone years younger than she and was
effectively skin and bones.)
The operating room was surprisingly modern (see pictures),
with most of the standard bells and whistles one would find in Canada.
In fact, the whole process seemed very familiar and I immediately felt
at home in their OR and during the procedure. The cardiac surgery
program is a new one at Muhimbili, run by three cardiac/vascular
surgeons who are amazing and very welcoming. The nurses and
perfusionists in the room were also very welcoming and I had much of
the same banter with the nurses here as I normally do in Canada. It
usually starts with one nurse coming up and standing next to me,
marking their height on my arm and then laughing. I usually indulge
and walk around for a little while at their height… it usually gets me
in pretty good with the nurses, which I guess is as important here as
it is in Canada.
There were a few hiccups during the induction procedure
(putting the patient to sleep)(medical note for Patty's interest:
Ketamine to induce, halothane was the gas of choice, although they
also have isoflurane on the cart; no art line; morphine post op with
local costal block before closure), but the rest of the surgery went
amazingly well without complication. It wasn't a 'crack the sternum'
type operation, but a smaller incision with access to the heart
through the left ribs. It was pretty neat to see and a nice feeling to
know that this child will probably start feeling much better almost
immediately. I'm looking forward to tomorrow's procedure, a mitral
valve repair that will need cardiac bypass.