Day 2: Dakar
We drove through a congested city in the early morning to get to the hospital. People sometimes dodged taxis; taxis sometimes dodged horse-drawn carts. The five large bins of medical equipment we took with us from the United States arrived in the OR. We quickly unpacked and sorted. Disposable items that don’t get used will be donated.
Guinea-Bissau, Burkina Faso, Benin, Tunisia, Chad, Mali, Democratic Republic of Congo, Cameroon, and of course Senegal. These were the countries of the urology residents, pediatric surgeons, and general adult urologists who were waiting for us in the operating room this morning. All are from French-speaking countries, and many were anxious to try out their English. I speak no French. This occasionally poses a problem because everyone wants to be helpful. You ask for a suture and someone brings you a ladder. Despite a few glitches, all went well and the first cases were completed (almost) as normally as they would be in Pittsburgh. We all breathe a sigh of relief after the first cases are in recovery.
We have two OR rooms running at the same time, so we plan to do around eight cases a day, depending on the length of the individual case. Rama Jayanthi, a pediatric urologist at Nationwide Children’s Hospital in Columbus, is the surgeon in the other room. We scrub with one of the local residents or attendings. The emphasis is on training and safety. Overall their basic technique is excellent, and they have done their homework. The Internet has provided a flattening of the medical knowledge landscape here, but surgery is a skill not learned in a book. Some pick it up very quickly. The patients come in and out of the rooms as do the doctors. Some bring cameras, most use their cell phones to take a photo if they can get close enough. It can get warm under the lights with the crowd pushing against you for a better look, especially when the air conditioner is struggling.
All but one case was completed, so that boy will need to be first tomorrow, which adds to the burden of the next day’s work. All of the children have congenital abnormalities, most not life-threatening, unless you define what threatens the happiness and well-being of life to include cultural isolation, inability to marry, chronic infections, incontinence, or pain. Urologic abnormalities in children are usually kept secret. They are never as obvious as the photos of kids with cleft lips advertised in magazines by programs that are looking for donations.
The last case done, we’re off to do rounds and head out for dinner. Afterward, we will have a team meeting to discuss the day’s events despite that we are all a bit tired. We mustn’t fool ourselves that we could not have done better, or predict how our intrusion into their daily routine can be as helpful at times as it is disruptive.
Fran Schneck, MD, 24 April, 2012