Theater

The front door of the OR.

I thought I would try to give you a word picture of what the OR is like in Kapsowar. All operating rooms in Kenya are called theaters stemming from the old British use of the word when an OR had stadium seating with a central stage so that medical students could observe and learn surgery. No worries, stadium seating is no more but the term has stuck nonetheless.

The theater in Kapsowar is truly amazing. Complicated ortho, neurosugery, plastics and general surgery cases go on here with very minimal equipment and supplies. From what I could tell the infection rate after surgery here is equivalent or perhaps less than those I have seen back home. This is really remarkable considering the environment in Kenya and on the wards is less sterile in general than back home and the theater itself. It makes me wonder if all of our sterile techniques back home make that much of a difference. The scrub sink is inside the OR itself. It is a huge concrete basin than sometimes does and does not have actual running water. Everyone uses the same scrub brush for weeks until it finally falls apart. The soap we use to scrub in is just bar soap from the local shop and it too is reused until it runs out.

Inside the OR. I am having my gown tied in the background. Dr. Christina is scrubbing at the sink. We are about to do two cases side by side in the same room. The first case has already been started.

Once scrubbed we walk to the side of the OR where a sterile table is set up with gowns and gloves. The gowns are made of green cloth and are reused and sterilized in the theaters one and only autoclave. Many times surgerys have been limited in a day due to running out of gowns as the little autoclave sometimes has trouble keeping up with the pace. It is amazing that something like clean gowns can limit your ability to do surgery.

Washing the instruments in the sink before putting them in the autoclave.

The autoclave that keeps the OR going.

We always gown and glove ourselves and then help in sterilizing the field by scrubbing down the exposed area of body three times with three different solutions. This is a bigger cleaning process than we use back home and perhaps this is where the true value lies in keeping the infection rates low. With the patients that we see in Kapsowar your guess is as good as mine about the last time they bathed so this extra cleaning process really is vital.

Getting ready to do an emergency c-section. Patient has been scrubbed down and is now being draped.

The anesthesiologist, a Kenyan named Thomas, is really very excellent. I have never seen someone place a spinal faster than him. We have become good friends. Being Kenya bugs and flies are a part of life. One of the helpful tools in this Thomas' tool kit is a handy fly swater that he keeps at the head head of the patient and doesn't hesitate to use should the need arise...even during surgery. One day a fly landed on the patient while they were being preped and Thomas didn't think twice about hitting the fly and the patient. It made me laugh. Hard as I tired though, I could not get this man to pose for a picture with fly swatter in hand.

Thomas and I inside the OR.

The OR also does not have any airconditioning. Back home one of my big complaints is how cold all of the ORs seem to be. Here, however we have the opposite problem. With the African sun beating down on top of the building and us all gowned up with gloves and masks it can get really hot in a hurry. I never usually sweat during sugery, but this time I have been concious to not let the drips roll down onto the sterile field.

Suture and the availability of the right tools is hit or miss. This just forces us to all get out of our ruts and get creative. Sometimes the scissors and clamps work and sometimes not....always an adventure. We have to be careful when using suction because if we leave it on for too long it will overheat and burn out. We are constantly asking for it to be turned on and off during the cases.

Within the theater there is a little side room that dressing changes and smaller procedures can take place in. Often there are two or three patients in the room at the same time having things done.

I am continually amazed at how many people this one OR operation can serve and the complexity of the cases that can be taken care of with the limited resources. This really says a lot about the talent of the surgeon Dr. Rhodes. He is certified in general surgery and plastics, but could also be certified in ortho as well. He truly wears just about every hat and has an incredible heart to serve. What amazing talent!

Just got called to dinner...I will continue with this thought later.