First week: Monday

Any first week should surely be one of easing in gently. Surveying what's going on and where I can fit in. Well, that was my plan initially! And my first week back was a full week of clinical stuff - back with a bang so to speak, but actually probably the best way to get 'up to speed' with things again.
 
My plan had been to cruise round the different theatre complexes (there are 4):

• Main - which has 8 theatres in total but not really running more than 4 a day
• Paediatrics - 3 theatres - all running daily
• Obs and Gynae - 3 Gynae theatres (but only 2 running) and 1 Obstetrics
• Emergency - 3 theatres - variable running!

  And of course I couldn't forget or leave out the Intensive Care Unit - which was somewhere I was really keen to have a look and see what had happened in my absence.

Monday:

  I decided I'd ease back into Zambian anaesthetic life gently by going to main theatre. I don't know whether if it was post election blues or not but the productivity was pretty low. In fact despite four theatres being prepared and full of anaesthetic Mmed (trainees)there was only a total of 5 operations carried out throughout the whole day. Two of which were in my theatre!

  I was starkly reminded of some of the problems here with delayed healthcare with the first case. A victim of a road traffic accident (very common due to poor infrastructure and  vehicle condition).

  He basically arrived with a broken leg. Well, ok I am slightly underplaying it. There is broken and there is properly broken beyond all belief. He clearly falls into the latter. If you look closely you can see where the skin is tented from the femur overlying the fracture.

 Of course in the UK we would be keen to fix this (in a 23 year old bloke) as soon as possible. Hmmmm.... 5 months after the initial injury he arrives in theatre to have a plate placed so that he is able to weight bear. He will never play football or run to the bus properly ever again, but at least he will manage (hopefully) to use the leg and not have it amputated.

 And credit where credit is due the surgeon did a fantastic job and managed to do this without too much blood being lost and also it was about a 2.5hour procedure which to be fair seemed fairly swift, and the spinal anaesthetic lasted all that time!

  For me the major plus point of being in theatre was being witness to the third year MMed (3rd year of 4 of training) actually teaching a first year MMed how to put in a spinal anaesthetic (an injection of local anaesthetic into the spinal fluid). A definite progression from the last time I was here as the MMeds are taking on the responsibilities of teaching their more junior trainees which can only bode incredibly well for their future as consultants. And is a huge plus in the quest for sustainable healthcare and education.

 

And above are the pictures of the antiseptic technique and then the close supervision and teaching of a first year MMed placing a successful spinal anaesthetic being supervised by a third year.  Brilliant!

  For the sharp eyes amongst you - you will notice  we did not use any drapes-correct: there are no drapes!

Positioning is not so easy when there is no ODP, a thin unmoving bed - so straight legged spinal application is a trickier affair than first appears!

 However the really good point is that the spinal packs are created by the theatre porters and these are definitely being created more often than they were when I was last here. Secondly the needles used for the procedure are purpose built spinal needles - not a 'make do' intravenous alternative. However the 22Gauge is still a rather large needle compared with the 24 or 25G we normally use in the UK - the risk of headache is definitely worse. But still - this is great progress.

  SO, Monday, the start of the week was pretty positive indeed. Onwards and upwards....