Lima First Surgical Day

Our first surgical day in Lima started bright and early at 6am. We got up and got dressed and had a quick breakfast of tamales and yogurt while listing to Incan pan flute christmas music. Our bus arrived and we loaded up all of our equipment and set off for the hospital. In Peru there are two tyoes of hospitals, private and public. Private hospitals are for the wealthy or for the few who have insurance. Public hospitals are discounted and partly paid for with governmental funding but they are less clean, less private, pretty much less every thing. The hospital we were working out of was of the latter variety. There were armed gaurds at the front gates and we had to move through huge crouds of people in various states of distress and discomfort. You would see gaping wounds and festering infections all waiting outside for their turn to be seen. Each different specialty had its own set of buildings. We were working out of the gynecologic building. So we arived and were issued into a small "office" to change out of our street clothes and into our scrubs. We were told that we were not allowed to arrive already dressing in hospital attire but that we needed to dress once we arrived. After dressing we got all of the equipment that we had brought and went to the operating room. To get there we had to walk through the gynecologic inpatient unit where all kinds of women were crammed into one bed right after the other with no attempt at privacy. There was a shared bathroom if you were in a position to get up yourself, but the hospital provides no essential hygiene items, your family is responsible for bringing you everything, including toilet paper. Apparently our walking through the unit caused quite a stir because they never let us do that again after the first day. The OR was located right outside the bathroom and had a very strict dress code, you could not enter without the customary mask, booties and head cover if you ever tried to enter without any one of those items you were quickly and severely chastized. Dress code aside, the ORs were pretty creepy at first with the white tiled walls and really old beds and cracked tile floors. We were offered the largest of the ORs but had been given very strict rules as to when we could use it and how we could use it. Time restrictions really put a damper on the number of patients that we would be able to see. Anyway, we prepared for the first patient and if you think about it having to bring everything you could possibly need for a surgery is pretty tough and keeping track of it all is even harder. We were allowed to use the anesthesia machine and the bed with its various attachments and some tables but we had to buy anything else that we wanted to use or ran out of or discovered that we had forgotten. It was kind of crazy when you would be in a case and need a drug that you had not brought with you and you look over at the anesthesiologist, in this case Doctora Reyes or her resident Carlos, and ask if they had it and they would say, well did you buy it? And of course we had not so either we did without our sent a runner to the pharmacy to pick it up. Some of the drugs needed to be refrigerated and so they would come in a plastic sandwich bag accompanied by an ice cube, made with contaminated tape water I am sure. At first the nurse anesthetist and I were bugged that they kept an anesthesiologist with us at all times but we soon created a symbiotic relationship in which we learned from eachother. I will go into more detail about the procedures we did in a surgical blog entry when I can upload my pictures but for now let me tell you that I have never seen this kind of surgery in any of my training so far and to me it was facinating. Some of our pictures are quite graphic but I think that you will enjoy seeing them. After a full 11 hour day we packed all of our stuff back into bags and walked them to our office and locked them up. We were all dead tierd but soon were wide awake as we cluched on to our seats for a wild bus ride back to the hotel in Lima rush hour traffic. We went to a restraunt in a strip mall on the cliffs overlooking the ocean and then headed back to the hotel for some much needed rest.