A more organized approach was used for today. We were able to round on the entire service (120 + patients) before breakfast. A quick meal and then off to casting rounds while part of the team retrieved supplies from the depot. Cases moved smoothly, but we were realizing that every patient was infected – wounds that were closed, wounds that were open, wounds that we thought would be closed – it was all infected and this continued to be a source of frustration.
Photo by Samir Mehta
We were still waiting for radiographs from our cases from the day before. Rounds continued to produce more cases. We completed ten cases. Derek actually performed a “wet” read of a post-operative radiograph from the day before – it was hanging up wet, drying as it was developing … no PACS system here.
A Drop in the Ocean?
Wound rounds were a bit surprising – the sheer number of infected or rather “pseudo-infected” wounds … some with pseudomonas and others with some other microbe … more cases, of course, came about …
I wonder what it is that we do here – how it even makes any bit of difference when there is no follow-up really, no prosthetic care, no therapists to do crutch training, fly swatters in the corners of the operating room. Is there really any benefit to what we are doing or is it simply a drop of water in an ocean of wreckage?
And now what – it is 819 PM. I have a Prestige in front of me. It’s supposed to be the best Haitian beer but I can’t taste anything right now. I barely have the ability to write complete sentences. I need to take a shower. It’s been a few days.
Time-Out Policy for Quality
We’ve instituted a time-out policy here in Cange. The radiographs are unlabeled (no markers with D or G – left or right), difficulty with language, splints or casts on the opposite extremity or bilateral injuries, incorrect patient lists (which are essential given that these patients are constantly changing, moving, or just plain unknown), consents that are very basic (“operation” as opposed to “left lower extremity open reduction and internal fixation” with all risks and benefits explained). We are hoping that by introducing these policies that we can improve the quality of care being provided.
Photo by Michael Ashburn
Tracking the Wards
We’ve also affectionately renamed parts of the hospital complex as “SICU” (surgery floor), “MICU” (essentially has become a surgery floor), and “the Dungeon” (an extension of the surgery floor) which adds to the Peds ward and the Church (which was the Clinic). Patients are constantly being moved all over and it is hard to keep track of where and who we are taking care of … or what we are taking care of.