This morning, a small group went to the screening area where the patients had gathered to find out if they would be having surgery. I had left the scheduling meeting after the charts had been reviewed, but the team leaders, Michael, surgery, Mercedes, anesthesia and the Clinical Coordinator, Yazan stayed to do the boards, the large tagboards, one for each day that have slips of paper for each patients taped up into time slots for the six operating room tables. Apparently, new disagreements arose, likely in part due to the fatigue of the hour, and in the end, Yazan decided to limit the number of palates per table per day and to have no palates on Thursday. This drastically reduced the number of cases, making the Honduran representatives very unhappy. This morning, the "for sure" patients were told "yes," a small group was told, "no," but another large group was told, "maybe." The decision was made to do the OR setup, have lunch and then tackle the scheduling again.
I was blissfully unaware of this controversy as we drove to the hospital after breakfast. Although it's old, it was built in that beautiful style I've seen before in Latin America, all open courtyards and wide walkways and lush plantings. Sally, who's been here before had a warning: be careful on those beautiful black and white tiled walkways after mopping or rain. Apparently they becme like black ice. Before we could go to the ward, everyone was needed to unload crates and boxes of equipment and medications for setting up the OR's. three nurses and I took on the task of reviewing the three "crash boxes." These are very similar to fishing tackle boxes and house the emergency drugs. There's a very long list of what should be in them in terms of medication and equipment, so we spent about an hour and a half making sure each box had what it needed, weeding out the expired medications and replacing them with new vials.
Finally we got the go ahead to explore the wards. Post op is the women's ward and there were still two patients there. We were able to walk around a bit, but got no response from the three nurses at the nursing station to our very cheery greetings. We did get what I think might be called the "stink eye," from at least one nurse - a first for me. Tomorrow, on team day, I'll be searching for an extra big box of candy to give to the nurses on Monday. This will start my Dr. Bartlett's tried and true method for overcoming hostility of and encouraging cooperation by the ward nurses.
#1. Bring a large box of candy and present it to the head nurse with introductions of myself and the OpSmile nursing team and effusive expressions of gratitude for allowing us to share their ward.
#2. Be pro active in stripping the sheets and putting on clean ones after patients are discharged.
#3. Find out where the brooms are kept and help sweep the ward between surgery days. Empty the trash cans when needed.
#4. Pick up or clean up bodily waste if you see it on the floor.
Initially, steps 2-4 might be seen as demeaning and lower your status - doctors should not stoop to doing menial tasks. However, if you persist in working side-by-side at these shared chores, you will end up being seen as a "regular person" as well as a respected doctor. As a final gesture, I always ask the PC to order a cake for the last day. The next team that comes to the hospital will find the nurses much more receptive.
We continued our explorations, but the pre-op ward, which is actually a little closer to the OR, had just been mopped so we were not able to see it at all. Tomorrow, after our team day, we have a 5:00pm pre-surgical meeting at the hotel. When that's done, Sally, Maria, Monika and I (pre/post nurses) will go over and check the kids who will be having surgery on Monday and do some set-up of the wards.
When we were done at the hospital, Kara, the program director, asked me to come to the Op Smile Clinic to see a couple of kids who were scheduled for Monday and whose parents were worried about coughs. I hadn't been to the clinic before and hadn't realized what an amazing place it is. It was built with money from some companies in Japan in 2006 and provides first class cleft lip and palate care for kids in Honduras. They have two operating rooms where they do cleft lip surgery, a recovery room and other rooms for dentistry, speech and audiology, nutrition and psychology. After I examined the kids, who were fine, I noticed that Kara was on the phone with Glenn, the pediatric intensivist who is still in Denver and will be arriving tomorrow. She was explaining about the conflict about palates and trying to get his opinion. I asked if I could speak with him and explained the dilemma as diplomatically as I could. He asked my opinion, and I told him that solely from a pediatrician's point of view, and after listening to Michael, I felt that the team could handle more palates and that certainly the nurses could handle more. He and I turned out to be on the same page in that we both are used to coming in early and leaving after the last patient is stable, letting the nurses go back to the hotel rather than asking them to stay. He talked to Yazan and Michael, and suddenly, everyone relaxed and the disagreements disappeared. They put back in all the palates and started calling parents who had been sent home. They called Mercedes at the hotel as she needs to sign off on this as well, and she just said she was fine with whatever they wanted to do. So now we will have very long days but we will get the surgery done on all these kids, including the 22 year old, and it will be worth having come on this mission.
Tomorrow is team day and we are going to Valle de Angeles, a small tourist town about half an hour from here. There's a volunteer with a house with a pool who has invited the team to lunch. More about the day tomorrow.
I've posted some photos of the hospital and clinic.
I was blissfully unaware of this controversy as we drove to the hospital after breakfast. Although it's old, it was built in that beautiful style I've seen before in Latin America, all open courtyards and wide walkways and lush plantings. Sally, who's been here before had a warning: be careful on those beautiful black and white tiled walkways after mopping or rain. Apparently they becme like black ice. Before we could go to the ward, everyone was needed to unload crates and boxes of equipment and medications for setting up the OR's. three nurses and I took on the task of reviewing the three "crash boxes." These are very similar to fishing tackle boxes and house the emergency drugs. There's a very long list of what should be in them in terms of medication and equipment, so we spent about an hour and a half making sure each box had what it needed, weeding out the expired medications and replacing them with new vials.
Finally we got the go ahead to explore the wards. Post op is the women's ward and there were still two patients there. We were able to walk around a bit, but got no response from the three nurses at the nursing station to our very cheery greetings. We did get what I think might be called the "stink eye," from at least one nurse - a first for me. Tomorrow, on team day, I'll be searching for an extra big box of candy to give to the nurses on Monday. This will start my Dr. Bartlett's tried and true method for overcoming hostility of and encouraging cooperation by the ward nurses.
#1. Bring a large box of candy and present it to the head nurse with introductions of myself and the OpSmile nursing team and effusive expressions of gratitude for allowing us to share their ward.
#2. Be pro active in stripping the sheets and putting on clean ones after patients are discharged.
#3. Find out where the brooms are kept and help sweep the ward between surgery days. Empty the trash cans when needed.
#4. Pick up or clean up bodily waste if you see it on the floor.
Initially, steps 2-4 might be seen as demeaning and lower your status - doctors should not stoop to doing menial tasks. However, if you persist in working side-by-side at these shared chores, you will end up being seen as a "regular person" as well as a respected doctor. As a final gesture, I always ask the PC to order a cake for the last day. The next team that comes to the hospital will find the nurses much more receptive.
We continued our explorations, but the pre-op ward, which is actually a little closer to the OR, had just been mopped so we were not able to see it at all. Tomorrow, after our team day, we have a 5:00pm pre-surgical meeting at the hotel. When that's done, Sally, Maria, Monika and I (pre/post nurses) will go over and check the kids who will be having surgery on Monday and do some set-up of the wards.
When we were done at the hospital, Kara, the program director, asked me to come to the Op Smile Clinic to see a couple of kids who were scheduled for Monday and whose parents were worried about coughs. I hadn't been to the clinic before and hadn't realized what an amazing place it is. It was built with money from some companies in Japan in 2006 and provides first class cleft lip and palate care for kids in Honduras. They have two operating rooms where they do cleft lip surgery, a recovery room and other rooms for dentistry, speech and audiology, nutrition and psychology. After I examined the kids, who were fine, I noticed that Kara was on the phone with Glenn, the pediatric intensivist who is still in Denver and will be arriving tomorrow. She was explaining about the conflict about palates and trying to get his opinion. I asked if I could speak with him and explained the dilemma as diplomatically as I could. He asked my opinion, and I told him that solely from a pediatrician's point of view, and after listening to Michael, I felt that the team could handle more palates and that certainly the nurses could handle more. He and I turned out to be on the same page in that we both are used to coming in early and leaving after the last patient is stable, letting the nurses go back to the hotel rather than asking them to stay. He talked to Yazan and Michael, and suddenly, everyone relaxed and the disagreements disappeared. They put back in all the palates and started calling parents who had been sent home. They called Mercedes at the hotel as she needs to sign off on this as well, and she just said she was fine with whatever they wanted to do. So now we will have very long days but we will get the surgery done on all these kids, including the 22 year old, and it will be worth having come on this mission.
Tomorrow is team day and we are going to Valle de Angeles, a small tourist town about half an hour from here. There's a volunteer with a house with a pool who has invited the team to lunch. More about the day tomorrow.
I've posted some photos of the hospital and clinic.
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