In the Theatre

I’ve discovered that a moving way to observe the conditions of a nation is in its operating theatre.

on the path to the surgical building

The day started at 7 am again, catching a taxi to go to Zomba Central. You never think about it, but it is such a comfort to know where you are going. I marched proudly through the hospital almost completely knowing the way to the surgical conference room this time. I got much fewer stares. I was there first and all the doctors and techs came trickling in just before “half seven” in Dr. France’s words.

He got down to business, asking about the on-call shift, asking the group quiz questions about it, and then asking about “The List” referring to the order of cases I watched Wilson draw up yesterday. After the meeting a bunch of us followed Dr. France to pediatrics to check on a patient mentioned in the on-call report. It is really nice to watch adults interact with infants, it just makes you believe in everyone to watch them melt at the slight of a tiny baby. Next we went to the theatre. Yes, the way we refer to it as the OR, they call it the Theatre. I think I like their way.

Wilson sent me in via the girls’ locker room and met me on the other side. He asked a scrub nurse coming off duty if I could use her kit, so she gave me her scrub dress, cap, and some gumshoes to wear. I had never seen a scrub dress before, and it was really, really weird to have my shins bare in the theatre. Had it been as air conditioned as all the ORs I’ve been in at home, I would have gotten hypothermia myself.

There was a bit of waiting around as everyone got ready and set up. Like other parts of Malawi, the theatre isn’t quite as organized as in the states, but it still definitely gets the job done. Some general observations

-       It was really well equipped. All 4 of the functional theatres really just looked like outdated theatres in the states, with older equipment.

-       Patients walk themselves into the theatre, usually naked beneath a sheet tied around their necks like a toga, sometimes holding a catheter or IV bag. I have one slightly sweet and slightly dark image of Dr. France holding a small boy’s hand as he walked him into theatre 2.

-       Anesthesia is mostly administered through spinal injections. This is painful and difficult to do, but all the patients I saw endured without complaint

o   That means they are awake, talking, looking, sometimes laughing as they are being operated on. I felt so, so bewildered watching a man converse jovially with the anesthesiologist while Wilson had his entire hand inside the man’s abdomen.

-       The theatre is a happy place. The most laughter I’ve heard in the whole of Malawi was walking around the surgical facility. People know what they have to do, they’re performing immediately effective medicine, and they (for the most part) have the tools to do it, so I understand the lightheartedness. Also it was echo-ey, that could have been why too.

So what I mean about seeing Malawi though its operating room- there were distinct trends that set Malawi and its problems apart. Again for hippa purposes I’ll just discuss these themes:

1.     Hernia- intense physical labor is frequent in the work available here

2.     Burns- (many, very terrible burns, even warranting a tool called “bone nippers” to amputate unusable fingers) because people use open fires in the villages, especially now that winter is approaching; unattended children wander into them, epileptics seize and fall into them, cooking accidents occur

3.     Genital infection- this is only a guess, but I would say poor overall hygiene for the impoverished and unclean water to bathe in

4.     Orthopaedics- I figured it out- road collisions cause many fractures, whether car on car or bicycle or pedestrian; also the physical labor positions can cause work accidents; theatre 3 was just ortho

Despite seeing more blood than I’ve ever seen, I had a fantastic day in the theatre. The medicine was engaging and inspiring, but the people were also so much fun.

-       Wilson offered me some of the lunch that had been brought in to share. He offered me some chicken from a pot, and for politeness I used a spoon to get a bit out- a nice drumstick looking piece. He just said “wow, so you like the head.” I raised it to eye level and saw a beak. And a comb. All I could say was “I DON’T WANT THE HEAD” and he let me put it back

-       Also getting lunch, Wilson I couldn’t figure out how to open one of the steam cookers. I asked Wilson for help and after struggling for a moment he said as he attempted the use of force “Don’t you cook for yourself? Shouldn’t you be teaching me how to do this?” I explained students just eat in the dining halls and he said he’d teach me to cook in the form of assembling that lunch. From struggling to hear him the previous morning to joking with him about steam cookers, I felt extremely encouraged.

-       I made friends with lots of scrub nurses and nursing students as Wilson was occasionally distracted rummaging around inside of patients. They included Modestar, who translated lots of things for me, and Ester, who called me her sister after inviting me to stand next to her, and Aciatu, who goes by Acia. She was my favorite friend because after a nice discussion during one of the procedures, she came and sat next to me later while I was taking notes. She waited until I was done and then asked me lots about where I’ve traveled to and snow. I learned she has never left Malawi, not even to Mozambique, but that she’d like to see Dubai and the UK. It was a really significant discussion for me because rarely do Malawians approach me, probably because they have to speak a second language before I can understand anything. But Acia was just curiosity and friendship incarnate, and I’m really grateful for her.

unrelated: every morning starts with tea

It was weirdly a great day and I learned a lot from Wilson and Dr. France and another surgeon whose name I never learned and all the techs and scrub nurses. When the T&L bus came for me at 3:30 I was so amped, I just wanted to talk about surgery with everyone. Once I mentioned the finger amputating most people were done though. On the way home we stopped by the Wall, where I shopped a bit before Sammy (have I mentioned Sammy? He’s a Malawian with a lot of know how who always sort of acts as a guardian/guide when T&L comes to Malawi each year) took me to a fabric store that I had missed visiting with everyone the day before. I picked out some fabrics and then we all headed home. From Annie’s lodge you can walk just one driveway down the mountain to the home of a really talented tailor. You can request anything you want and just give her the fabric and she’ll whip it up pronto. Her yard is also so so beautiful.

All that was left was dinner with the whole squad, fun roommate times (Ashley surprised me with chocolate because she is 5’6” of kindness), and then bed to prep for our journey to Mulanje the next day…

With love and an iron stomach,

Lauren

I am grateful for…

1. Being somewhere where all I have to do is try my best- my whole job is love

2. Bread and marmalade

3. chocolate

What will I do to make today great?

1.     Get to know Wilson better

2.     Breathe deeply

3.     Write in my journal

Daily affirmations. I am…

Reverent (when required)

3 Amazing things that happened today…

1.     Wilson made fun of me for being unable to cook

2.     I watched very graphic surgery

3.     Errands in town with Sammy and going to the tailor

How could I have made today even better?

Talk to more scrub nurses