Good morning Monday!
It’s officially my first day at work. I dutifully arrived at 7.20am in good time for flag break. Flag break is something we had in the Boy Scouts usually when under canvas at Whit or during the summer holiday. We would stand to attention, sing the National Anthem and salute the flag. A nice way to start the day. Imagine the NHS starting at 7.30am every day outside the hospital, lined up in order of seniority, gender and department to watch the flag rise to the top of the pole and to stand to attention and sing a patriotic song. I didn’t join in this time but if my new-found friends are half as zealous as the Welsh at teaching me their National Anthem, I’ll be singing it by the end of the week!
The hospital meeting of heads of departments starts immediately afterwards. The Director returned today so the meeting lasted a little longer but attendance was rather thin. Two obstetricians sat me down at the end and wanted to know what I was going to do here. I’ve no idea really. I need to observe what you do and listen and try to understand how things work here. I can’t speak the language yet. Nevermind, we have a case of third degree uterine prolapse for surgery today, will you come and do it please?
Please come and show us how you do it. That seems to be what my translator is saying. Unfortunately the translator who eats baby chickens in their eggs with impunity finds his stomach turns at the sight of blood, so he’s not coming into the operating theatre and that’s a fact. Returning to my very convenient house I collected my scrubs (blue theatre clothes – they wear green), my clogs and my size 7.5 gloves (everyone is much smaller than I am so I brought my own) and dutifully report to the operating theatre. The equipment, instruments, sutures and methods are a curious mixture of ultra-modern and ancient, strange and familiar. An infra-red sensor turns the water for hand washing on and off and a sensor operated dryer finishes the job. Liberal alcohol ensures my hands are really clean before I don gown and gloves – it’s not the kind you would drink of course.
The spinal anaesthetic is expertly established and the operation to remove the uterus and repair the prolapse is executed as well as may be expected by a surgeon who hasn’t had the chance to do this procedure in the last 7 years. That’s a surgeon who doesn’t know the names of half the instruments, when he does they are pronounced completely differently from what’s expected, the cautery seems a novelty to the onlookers and I wonder if they use it themselves, there is no loose eyed-needle for me to suspend the vault from the pedicles so I wonder how effective the repair will be, and I am told at the age of 60 this lady still has a husband so I am to take care not to make the repair too tight.
Which reminds me, I haven’t told you about the weavers in Phnom Sarok and ladies who cultivate silk worm who I saw on Saturday. There wasn’t much activity when we showed up because it’s market day in Siam Reap. Most of the workers had gone there with their week’s worth of produce. The shops there sell to tourists but it’s getting past the season and the weavers who make cotton scarves and other materials won’t sell very much. The kramar scarf is worn by so many and seems to have several functions including keeping dust out of the mouth and nose, sling, bandage or compress for severe bleeding! I saw the collective house from which the raw materials are distributed to the weavers and where the finished products are stored ready for market. Under the house one weaver was busy at her work and allowed me to watch for a while. Everyone joined in the laughter when she threw her shuttle through the wrong weft because I was a distraction to her concentration. Easily undone. She too had to make sure her work was just the right tension, not too slack, not too tight.
We both survive the ordeal, she and I (I’m speaking of the patient now), and later in the day I returned to the ward to check on her condition. She’s in intensive care. Nurse Alison reassured me and explained that all post-operative patients go there on the first day. We duly visit her and check her pulse, blood pressure and oxygen saturation. The anaesthetist advocated measuring these vital signs every 15 minutes for 6 hours but nothing has been recorded anywhere. It’s rather over the top to do every 15 minutes but it’s rather under done not to record it at all. So I kneel on the floor (yes, the patient is lying on her own split cane mat roll on the hard tiled floor – several others are on the floor, while some occupy beds in the corridor, in addition to all those in legitimate beds) and I make the measurements myself. These are fine and we write in the notes after washing hands in the ward sink. It dawns on me what this exercise is all about. It’s not ‘Can the Barang operate?’ but it’s modelling – demonstrating – good practice, good record keeping and caring whether the patient is OK or not. “We are too busy” – to measure vital signs, write analgesia, record urine output and document prophylactic antibiotics being given – doesn’t really match with the large number of staff on the nurses station, all of whom gather round to watch me count a pulse and measure a blood pressure. The nursing is actually done by relatives who are fanning and turning her and providing food and drink.
So I swam. I didn’t sink, not this time. And the things we can teach and demonstrate turn out to be the little things that make for good practice and quality care. It’s not about the major surgery although that’s certainly ‘in at the deep end’ on my first official day, but it’s what happens at the shallow end afterwards that makes all the difference …