On Thursday I went to the recovery room, where patients wake up after their surgeries. The first one this morning was Daniel, a 22 year-old who experienced a laryngospasm, where the vocal cords seize up and block the airway. This phenomenon is uncommon, but when it occurs is typically more severe in young, strong patients. In the worst cases it can pull fluid into the lungs as the patient struggles to breathe with an obstructed airway. However, after a bevy of responders surrounded and worked on him, he was able to breathe normally, and he should be fine going forward. Daniel had a foot surgery to straighten a hammer toe. This correction of a relatively small problem now will prevent more serious issues down the line, since foot deformities that affect the gait can produce knee problems later in life. Since so many of the cases we’ve been dealing with involve remediation of chronic conditions, it’s encouraging to be able to catch one early on and prevent a degenerative sequence.
Meanwhile, a 33 year-old who was having a hip replacement came into the recovery room. Dr. Tony Kim did an ultrasound-guided nerve block for her that will give her 16 to 20 hours of pain relief. 79 out of the 85 patients this week got one of these procedures for post-op pain control. If they still have pain, or if it’s not possible to block the site, they’ll get a dose of fentanyl. The protocol for tracking narcotics at the Obras requires keeping all used syringes, ampules and all the other drug delivery components, so that they can be accounted for at the end of the day, and then again at the end of the week. In the U.S., controlled substances are tracked electronically with passwords and fingerprints. Here, because of scarcity, ampules of controlled substances are not wasted, and the process of tracking them is very labor-intensive. The team badly needs a dedicated pharmacist who could take on this task.
After the recovery room, patients will go to the men’s or women’s ward of the Obras hospital. Unless they have an infection that requires them to be isolated, all the patients are housed in big, open rooms with several beds each, and they have to get themselves with walkers to the communal bathrooms, carrying their own toilet paper as they go. Once they’re discharged, they can go back to Casa de Fe if they need a place to stay before setting off on long bus rides home. There again they will stay in beds in the men’s or women’s room, and meals are provided. An average stay at Casa de Fe including days before and after surgery is about ten days. Infected patients remain in the hospital until their cultures come back, so that they can be given the right antibiotic to combat the specific bacteria they are fighting.
This week we had 11 patients with infections, whereas usually there are three or four. One of the greatest needs is for more resources to combat these debilitating conditions, which undermine the effectiveness of surgery. To start with, there’s a need for culture swabs to have on hand in the operating rooms. Then, after surgery, high risk patients need a dose of intravenous antibiotics. This is the standard of care in the U.S., but here there’s not enough of a supply to maintain that standard. And then, infected patients really need a minimum of six weeks of additional sensitivity-specific oral antibiotics, but here there’s such a mentality of scarcity that each case requires a separate request and sourcing of the medication. If Faith In Practice had the resources to provide more antibiotics, we might be able to ensure long-term success of the interventions we’re providing. Of course, the entire Obras facility has areas of need for remodeling to bring it up to US standards, but in the short term, simply administering the necessary quantity of antibiotics would be an inexpensive improvement.
Courtney Kim, Team Blogger
