We start rounds in Urgance. Urgance is the Emergency Room. It consists of 6 "Boxes" (rooms), which are literally boxes with a curtain hanging in front. The rooms are generally single rooms, although I have seen up to three people in a room at a time. Urgance has access to oxygen and wall suction, and has its own supply of dressings, gloves, etc. When patients present to Urgance they are seen on one of the two beds that are not inside a room, but out in the open. If they are to stay, they will then be moved to a room. Urgance also serves as a place to put post-operative patients, since there is a smaller nurse to patient ratio and the supplies listed above. If patients remain unstable for a while, they may remain in urgance for a very long time. For example, there is a girl we are treating in Urgance currently who presented one week ago suffering major injuries from a moto accident, including an open femur fracture and an open humerus fracture. She was taken to the OR immediately and stabalized, and has remained in Urgance ever since while she recovers.
Our next stop in rounds is to pick up our "dressing cart" (simply a cart with a lot of dressings, tape, gloves, betadine, saline solution, etc.). We usually have to restock the cart before we pick it up because the nurses here don't feel it is their responsibility. Then we make our way over to the private rooms. There are about 6 private rooms offered to patients. They cost 5,000 CFAs a night (about $10) vs the 3,000 CFAs ($6) it would cost otherwise for the entire hospital stay in a non-private room. The rooms are very nice and are usually decorated with rugs, sheets, etc from the family. There is also an extra bed in the rooms for family members.
Next up: Reanimacion (aka Reanimation), which is the ICU. The only reason this area is considered the ICU is because it has access to oxygen, up to 6L at a time (which is not much), and wall suction. It is also more expensive, but often we will have to place patients there even when they do not need to be there due to lack of space in the hospital. The area was originally built to be a burn center, with a donation made from St. Mary's in Duluth. However, the infrastructure was never maintained to continue a burn unit, and it became the "ICU."
Finally we get to the surgical ward. There are about 6 rooms we see patients in on the surgical ward. Each room holds about 5-6 patients. They are stacked up against the walls (which usually have an array of bugs and cockroaches crawling on them) with their dishes, clothes, family members, etc. struggling to find space aroud them. My favorite of all the rooms is the second room. In that room are "Les trois Muskateers," three young boys who suffered horrendous injuries at different times and who have been in the hospital for months, becoming very good friends and motivating each other to get better. They all get really excited when we come see them, giving us high fives and teasing us about our French. They are inspirational in the amount of dedication they have towards their own recovery. Even though they have been here for several months (some since January), they are still happy and never cease to have fun or laugh. Rounds on the floor consist of a ton of dressing changes (apparently this is not something nurses do), and a lot of sifting through the charts to try to decipher whether or not a treatment has been given. Have they gotten their antibiotics? Do they have a fever? Has their Foley catheter bag been changed? Rarely are these important facts documented in the charts, leaving a lot of unanswered questions. We also have several (about 4 right now) patients who are still on the floor even though they have been discharged home, just because they have not paid. The head nurse (the "Majore") will not let the patient leave if they have paid, so they just sit around until they can come up with money.
Our last stop on rounds is Maternatie. We follow up on any C-Sections that we may have had. Finally, once rounds are done, we will make our way to the Bloc (short for Bloc du Operacion, or the OR). There are 2 major operating rooms, each with two tables, and yes, sometimes they have two tables operating at one time in one room. There is also a side room for minor operations and a pre-op/post-op room for patients to wait. There are two sinks to scrub (aka steralize) for the operations with soap and unfiltered water. About 80% of the time, the water is not working in the OR, so there is a bucket filled with water that we use to scrub when that is the case. There is supposed to be one oxygen machine in the OR, but that has not been seen for a while. There is a back storage room, which seconds as a call room/cafeteria, and contains cabinets full of unorganized supplies, both donated from outside donors and bought by the hospital. There are a few sterile instrument trays. There are two bovie (cautery) machines which work about 50% of the time. There is a pulse oximetry for the anesthesiologists, which usually is inaccurate, and a blood pressure machine in each room. And there is suction in at least one of the rooms at all times. (Sorry non-medical readers, that paragraph probably didn't mean that much to you).
Finally, once all of the operations are finished and there are no more emergancy operations that need to be done, we are finished and can go home to enjoy some dinner...most of the time!
--Courtney Steller
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