Several people have asked me about the specifics of the hospital setup, and I keep finding myself comparing and contrasting the system with the hospitals back home in San Diego. ECWA Evangel Hospital is relatively small but still sees the same diversity and severity of illness and injury that UCSD or the VA gets, albeit with several twists.
The first thing I was exposed to was the ICU, which is a 3-4 bed room with a greater nursing:patient ratio than the ward and the capability to suction, give oxygen and monitor blood oxygen level (pulse oximetry). Other than that, it’s really no different than the ward: it is not setup to ventilate patients or to monitor vital signs continuously. I have been told that the frequency of power outages in the hospital (at least several per day) would make it very difficult even if the equipment were available. On occasion they have left people intubated if a family member is willing to stand and bag-ventilate.
Down the hall from the ICU is the “private ward,” which consists of private rooms that cost approximately twice as much as a bed on the ward. To me this seems like a deal for those who can afford it, as the “wards” are truly that: old-school style long rooms with beds lined up on both sides. The “Male Ward” and “Female Ward” each have 20 beds in the room with an overflow off to the side. Each patient is provided with a bed with an old mattress and old, though clean, sheets. Meals are not provided—family must bring in any food for the patients. For our patients with severe malnutrition, this is a little tricky. We can order a mixture called “kwash pap” from the pharmacy for those who need liquid nutrition. Originally developed for those with kwashiorkor, it is a mix of peanut oil and some carbohydrate source that I can’t remember right now. Apparently it tastes horrible but it’s done wonders for some of my patients.
The pediatric ward is my favorite place, despite the fact that when I walk into any given room I am greeted by at least 10 mothers/family members starting at the “bature” (white person) like I came from Mars. There is a peds ICU which is roughly equivalent in ability to provide acute care as the adult ICU. There are also a couple UV beds for phototherapy as needed. The “ward” rooms have 8 children/babies in each.
There is no running water anywhere in the hospital except in the operating rooms, which makes everything more difficult. And as for supplies…. It’s so difficult to get anything that I don’t think I’m ever going to complain about trying to find things on the VA floor ever again.
There is a maternity ward and labor and delivery area in a separate building that I rarely go into. I think they deliver babies over there.
The operating “theater” (per the British term) is where I spend the bulk of my time. There are two operating rooms that differ in many ways from those back home, the most notable being the absence of disposables. We resterilize and reuse EVERYTHING, with the only exception being gauze and gloves. No throw-away gowns or hats-even the face masks are fabric.
The OR staff are great-we have a good group of scrub and circulating nurses, though the lack of supplies keeps the circulator less busy than in the US! Many have been working for a long time and thus seem to know more than the residents about the cases we do—just like at home.
We have no anesthesiologists at the hospital-anesthesia is provided by one of the 3 nurse anesthetists-the OR nurse in charge, Simon, is a CRNA and the others are designated on the paperwork as “RNA.” I have no idea what the technical difference that makes Simon “certified” in Nigeria is. They are all very capable of general anesthesia for the adults as well as the newborns. Their job is made more difficult (or maybe just simpler? I don’t know) by the fact that we have no narcotics at Evangel, in the OR or otherwise. General anesthesia is with gas and paralytics as needed. Unlike the situation in the ICU, we have a backup power supply for the ventilators in the OR. We end up doing a lot of cases under spinal anesthesia as well. Major dressing changes/debridement that would likely be done under general anesthesia in the US are done with ketamine for sedation. The area that is the equivalent of a US “Post Anesthesia Care Unit” needs some improvement, but hey, at least I don’t have anyone calling me to give anyone more Dilaudid.
All areas of the hospital are staffed by Nigeria family practice residents in cooperation with their “consultants”=attending/staff physician. Though other teaching hospitals in the area have surgery/internal medicine/ob-gyn residencies as well, there is only a family medicine one here and thus the residents are trained to do everything. In the surgery department, the senior residents are more than capable of doing many of the general surgery procedures. Dr. Ardill and the other staff physician mainly step in on more complicated or specialized cases, which is why I have gotten to do so much pediatrics, urology, and neurosurgery.
Now that I’ve given you a little tiny piece of the picture of Evangel Hospital, I’ll end this very long blog entry with a little bit about my day. Yesterday I spent 2 hours in the internet café attempting to upload photos—and failed. I’m sorry but you all will just have to wait. This morning I went with a couple Nigeria friends to the church across the street. Worship time was great, despite my relative claustrophobia—the Nigerians don’t see personal space as an issue at all! In the afternoon I went hiking with the Mitchells around the Jos Wildlife Park, which is a big area that has some beautiful trails and the most pitiful little zoo I have every seen. The lion and lioness were in a cage that was way too small. A far cry from the zoo I am used to. I did, however, get a great picture of me and a cow. Very exciting.
I only have a little over a week left in Nigeria. Please pray that I would use this time wisely and as God would want me to. I feel like I have so much to learn and so little time in which to do it!
Also, I want to say good job to Regan, who is much smarter than her mother. While I am running around the world making a mess, she decided to be efficient and stay at home to make a difference. Yesterday her Girl Scout troop did a beach cleanup, then she volunteered at the San Diego Rescue Mission with church! I guess I’ll accept that as her excuse for not writing.
The first thing I was exposed to was the ICU, which is a 3-4 bed room with a greater nursing:patient ratio than the ward and the capability to suction, give oxygen and monitor blood oxygen level (pulse oximetry). Other than that, it’s really no different than the ward: it is not setup to ventilate patients or to monitor vital signs continuously. I have been told that the frequency of power outages in the hospital (at least several per day) would make it very difficult even if the equipment were available. On occasion they have left people intubated if a family member is willing to stand and bag-ventilate.
Down the hall from the ICU is the “private ward,” which consists of private rooms that cost approximately twice as much as a bed on the ward. To me this seems like a deal for those who can afford it, as the “wards” are truly that: old-school style long rooms with beds lined up on both sides. The “Male Ward” and “Female Ward” each have 20 beds in the room with an overflow off to the side. Each patient is provided with a bed with an old mattress and old, though clean, sheets. Meals are not provided—family must bring in any food for the patients. For our patients with severe malnutrition, this is a little tricky. We can order a mixture called “kwash pap” from the pharmacy for those who need liquid nutrition. Originally developed for those with kwashiorkor, it is a mix of peanut oil and some carbohydrate source that I can’t remember right now. Apparently it tastes horrible but it’s done wonders for some of my patients.
The pediatric ward is my favorite place, despite the fact that when I walk into any given room I am greeted by at least 10 mothers/family members starting at the “bature” (white person) like I came from Mars. There is a peds ICU which is roughly equivalent in ability to provide acute care as the adult ICU. There are also a couple UV beds for phototherapy as needed. The “ward” rooms have 8 children/babies in each.
There is no running water anywhere in the hospital except in the operating rooms, which makes everything more difficult. And as for supplies…. It’s so difficult to get anything that I don’t think I’m ever going to complain about trying to find things on the VA floor ever again.
There is a maternity ward and labor and delivery area in a separate building that I rarely go into. I think they deliver babies over there.
The operating “theater” (per the British term) is where I spend the bulk of my time. There are two operating rooms that differ in many ways from those back home, the most notable being the absence of disposables. We resterilize and reuse EVERYTHING, with the only exception being gauze and gloves. No throw-away gowns or hats-even the face masks are fabric.
The OR staff are great-we have a good group of scrub and circulating nurses, though the lack of supplies keeps the circulator less busy than in the US! Many have been working for a long time and thus seem to know more than the residents about the cases we do—just like at home.
We have no anesthesiologists at the hospital-anesthesia is provided by one of the 3 nurse anesthetists-the OR nurse in charge, Simon, is a CRNA and the others are designated on the paperwork as “RNA.” I have no idea what the technical difference that makes Simon “certified” in Nigeria is. They are all very capable of general anesthesia for the adults as well as the newborns. Their job is made more difficult (or maybe just simpler? I don’t know) by the fact that we have no narcotics at Evangel, in the OR or otherwise. General anesthesia is with gas and paralytics as needed. Unlike the situation in the ICU, we have a backup power supply for the ventilators in the OR. We end up doing a lot of cases under spinal anesthesia as well. Major dressing changes/debridement that would likely be done under general anesthesia in the US are done with ketamine for sedation. The area that is the equivalent of a US “Post Anesthesia Care Unit” needs some improvement, but hey, at least I don’t have anyone calling me to give anyone more Dilaudid.
All areas of the hospital are staffed by Nigeria family practice residents in cooperation with their “consultants”=attending/staff physician. Though other teaching hospitals in the area have surgery/internal medicine/ob-gyn residencies as well, there is only a family medicine one here and thus the residents are trained to do everything. In the surgery department, the senior residents are more than capable of doing many of the general surgery procedures. Dr. Ardill and the other staff physician mainly step in on more complicated or specialized cases, which is why I have gotten to do so much pediatrics, urology, and neurosurgery.
Now that I’ve given you a little tiny piece of the picture of Evangel Hospital, I’ll end this very long blog entry with a little bit about my day. Yesterday I spent 2 hours in the internet café attempting to upload photos—and failed. I’m sorry but you all will just have to wait. This morning I went with a couple Nigeria friends to the church across the street. Worship time was great, despite my relative claustrophobia—the Nigerians don’t see personal space as an issue at all! In the afternoon I went hiking with the Mitchells around the Jos Wildlife Park, which is a big area that has some beautiful trails and the most pitiful little zoo I have every seen. The lion and lioness were in a cage that was way too small. A far cry from the zoo I am used to. I did, however, get a great picture of me and a cow. Very exciting.
I only have a little over a week left in Nigeria. Please pray that I would use this time wisely and as God would want me to. I feel like I have so much to learn and so little time in which to do it!
Also, I want to say good job to Regan, who is much smarter than her mother. While I am running around the world making a mess, she decided to be efficient and stay at home to make a difference. Yesterday her Girl Scout troop did a beach cleanup, then she volunteered at the San Diego Rescue Mission with church! I guess I’ll accept that as her excuse for not writing.
1 comment:
I'm going to remind you of this blog when I hear you complain of the VA. I love the pic, by the way...at least you downloaded one!
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