#12 Monday, 8/26: Toe amputation, AED machine

Good evening/morning everyone. Hope you all had a great day or nights sleep. A lot happened today at Helena Goldie Hospital and there are lots of updates as well as lots of pictures of course. Today we went back to the hospital at 9 am because nobody gets there sooner. We learned that the hard way the first day we were here. They call it island time. We know it as Mormon standard time. Same thing. They're always late. Anyway today we had our surgery scheduled to remove the toe on that diabetic who had a large foot ulcer that wasn't healing. I had taught the class on doing nerve blocks.  We have the equipment however the logistics for making this all happen was a little challenging. Let me explain. The radiology room with the new ultrasound is in the original hospital area and the patient as well as the makeshift OR/ER room (I sent you a picture of that the first day we were here) is on the other side of the hospital complex. So we decided to transport the patient via truck to the radiology room and then do the block there. After that we would haul him back out to the truck and over to the other patient ward and OR. Crazy. No gurney and no wheel chair. Perfect!  What could go wrong? Well, after tracking down some needles (sort of. We had to use spinal needles for the blocks because they don't have block needles. Not ideal) we put the patient on the table and I had Dr Ray do one block and Willie the intern do the other block. Dr Ray did the adductor canal block and Willie the popliteal block (for the anesthesia people who might one day read all this and say to yourself, "you don't need to do both of these blocks for an ray amputation of the big toe" my answer is. I know. I just wanted them both to do a block so they could do one.) We made the blocks work and actually they did an amazing job with the blocks and the patient couldn't feel his foot or lower leg. Perfect. Now off to the OR. So when we said that the patient got up and started walking to the front. Again we had just blocked him. That doesn't happen in the USA because... well it just never happened okay but this guy just hobbled to the truck, climbed UP into the back all on his own with a blocked leg like no big deal. Insane. Literally insane. All my block friends will get a huge kick out of this. Next we went to the ward and OR building and again he plopped along to the bed where he lay down and we began prepping him for surgery. So by this time Dr Ray wanted to do more scanning on the OB population because their OB just came back from Gizo and he wanted her to learn the new ultrasound machine. So he asked a nurse to go throughout the village finding random pregnant women to come to the hospital so we could scan them. For practice!!! 🤣🤣🤣 Unbelievable and sure enough 3 women showed up for no reason other then because a nurse said, "Hey, you look big ole pregnant why don't you come here with me back to the hospital so some American people can look at your belly with a magic wand that I know nothing about but could be good for you and your baby. How does that sound to you? And a bunch of random pregnant women came. So, Dr Ray said he would scan these women while Willie, the intern, and I went to go chop off a toe. Jill the OB stayed behind with Dr Ray and the random pregnant humans to scan with the new ultrasound. Perfect. Well that worked OK. Willie and I chopped off the toe and the block they did worked perfectly. This guy felt nothing and received zero sedation or pain meds. What was hilarious was they taped this pillowcase sheet-looking thing up so he couldn't look down. That's nice. Considerate of them so he doesn't have to watch his toe getting whacked off. While I was helping Willie with the toe there was a fly that kept buzzing us so the nurse grabs a can of Bop (for those who don't know, Bop is a pesticide that is aerosolized so it can kill flying bugs instantly. Yeah it is highly illegal in the states :) so she's spraying it all over and and through us while this guy's toe is hanging off trying to kill this fly. At one point she is in-between Willie and me spraying down by the garbage can that is there to catch all the drippings and toe. Crazy! We get the toe off and dress it. This was the most unsterile surgery I had ever seen in my life. I mentioned something to Willie about it and he just shrugged and said "yeah. Jungle medicine." Jungle medicine indeed. Oh, and before the procedure even started the nurse set up a fan to blow from the head of the patient down to the toe. The part we were operating on. So they are blowing air from the dirty to the clean... I don't know why I bothered even wearing a mask. Surgery was a success and I went back to the radiology room to help out with the scanning of the pregnant women. They had only been scanning one and they were struggling to figure out the right buttons to push to get the measurements for the baby etc.  Remember OB-GYNs send women to an ultrasound tech to get all their scanning. They don't do a lot of it themselves so it was a bit of a struggle there and I helped show them the buttons and menus to push. In ultrasound parlance we call it nob-ology. After that and turning the 2 other hopeful pregnant women away we went to lunch. 

When we came back Dr Ray wanted me to teach the staff on how to use their brand new AED and defibrillator machine. So we gathered everyone first in the chapel outside but it was too noisy with the construction happening right by there so we moved to a room adjacent to the dental clinic and I taught then the fundamentals of the AED and how and when to defibrillate a patient. Lots of blank looks. One language gap was we use EKG and they use ECG so they didn't know what I was talking about for half the time which was odd until I explained they are the same thing. Interestingly the EKG machine leads you put on the patients are all color coded weird here. Not the same as in the US. The color coordination is all off so I had to relearn then on the new one. You know, one of the problems here is countries will donate stuff but then not leave anyone behind to assemble and teach about the equipment they donated. This was a reoccurring theme with all 4 of us.  

Oh, I almost forgot. So there was a 75 year old guy who hadn't been able to pee for 4 days and had a huge distended belly because his bladder was the size of a watermelon. A rather large watermelon actually. So I gave Dr Ray some tips on putting in a Foley catheter, but he was unable to do it so while we were waiting for more nurses to show up Dr Ray wanted me to try putting one in. Because the reality here is if we can't drain the bladder they will decompress it by putting a needle in there and draining it and then shipping him off to Gizo or Honiara to place a suprapubic permanent catheter in there. None of this is ideal nor is it the best practice. So I went I'm there and was able to squeeze a catheter past his super enlarged prostate, but hey.... I'm only an anesthesiologist! Saved him from having a super dangerous procedure to emergently drain his bladder. He felt instantly better. I think they drained over 2 gallons of pee. Yup. 2 gallons. Lots of peepee. 

So I'd say it was a very successful and productive day at the hospital. We expanded their capabilities and gave them some new tools, but man- do they need a lot more. This is just a drop in the bucket. But it's one step at a time. Hopefully my AAR (that army for after action report) can help move the needle some on the US side of things to help these people out even more. 

So tomorrow will be our last working day at the hospital. It went by very fast and was very short. Then we fly back to Honiara on Wednesday and then hopefully fly home Thursday and Friday. Crazy crazy experience. Jungle medicine to the max... or the minimum depending on how you look at it. 

Last story is one that is actually an ongoing story. So I mentioned about island time and yes that is a real thing but it can get frustrating at meal times. Every night at dinner it has taken longer and longer to get our food from the time we ordered it. A lot of it is because the Australian military is here as well and they are just busier but it been quite hilarious trying to predict when we think our food will be out. Longest so far is 2 and a half hours. No joke. So we finally wised up and said okay let's go to the restaurant right when we get back to the hotel and order our food and then we can go run our errands and come back and hopefully our food would be close to being ready. So I ordered. Went to the store walking there and back (about 15 minutes) came back and decided to take a shower and change and then go buy a drink then I came back and I waited another hour and a half for my dinner. Hilarious. Didn't work but the thought was good. Alright kids.  Hope you enjoyed this episode of adventures with LTC Teames. Enjoy the pictures. Be warned viewer discretion is advised. Til next time!

These are some photos I got from the group form yesterday I can share with you. This is going to Skull Island.

Dinner last night after waiting 2 hours for food but that soup was amazing. Coconut and sweet potato. I think I mentioned it before.

So this was after waiting an hour and a half and so I was dared by the group to go see if I could speed things up. We'll my plan was to bribe them so I gave the waitress a piece of gum. Didn't work. Still took another 30 minutes. They didn't think I would do it so they took a photo here.

Visited the pediatric ward again today and delivered some cheer. I was spreading sunshine as the song goes. Good news though, they discharged 3 of their patients so the ward was a little empty.

Arriving at the hospital and still waiting for people to show up. That's the medicine ward and OR/ER in the background and where I did the toe amputation.

This is me helping Dr Ray do an adductor canal in the rudimentary way possible.

This is Willie doing a popliteal block and doing actually a really good job with it.

This is their OB learning how to scan. This pregnant women is 18 and having her first baby. She looked very nervous but again, stoic. They are all so stoic.

Here's our block patient just walking to the truck with no shoes (a lot of people never wear shoes) and after a block with a weak leg. This is the craziest thing ever.

Him climbing into the truck with a little help.

Prepping the OR. Check out the sheet!

Taking the toe. We hit an artery at one point and blood almost got all over me, but hit the wall instead.

Almost off.

That's our scrub tech/nurse just living her best life.

And it's off!

I showed Willie how we would dress this in the US. He liked it because usually they only go around the lower foot and not the ankle. This gives the dressing more stability and won't slide off.

Willie and me, and foot- minus one little piggie.

There's our patient. He was super happy. At one point I was trying to explain to him what was going to happen with the block and the surgery and everything. He stopped me and just said "I trust you. I trust you." Meaning you don't need to explain it to me just do what you need to do. Very neat.

Jill scanning with the OB

So this was funny. Dr Ray wanted to do the EKG presentation in the chapel. Problem is there is not a plug and electricity. He said no problem we have a long cable. He wasn't joking. They stretched it across the road and then hoisted it in the air so cars could still pass, then plugged it into the second story of the building across the street. Well ok then. Too bad we didn't use the space. All that for nothing. We had to move because of the construction noise.

I told Dr Ray I wanted a picture of him with the boat. I meant like by the boat as in next to.the boat, but he thought I meant IN the boat so before I knew it, he was in the boat. Okay. This is the boat that would save lives. It can get to Gizo in 40 minutes. The banana boats an hour and a half, but they can't launch the boat because they don't have a launch ramp so there it sits collecting dust. So unfortunate.

This is me teaching the class on how to use the AED and the defibrillator machines. This guy was funny. He was the only other guy other than Dr Ray and me there so naturally he was selected to have the EKG put on him and demo the defibrillator.

He about came off the table when I did this. He thought I was going to shock him. To be fair, I did say that I would in a joking and sarcastic way but I guess the joking and sarcasm was lost on him.

We are having a good laugh as I get a volunteer to demonstrate what I'd just taught.

At the end of the lecture I told them I was going to find them all tomorrow and ask them questions about what they learned. The young nurse in the back kind of slunk down trying to hide. They all said they would hide from me and here I am pointing to her saying I'll come find you anyway. They all thought that was so funny. Their humor is in itself hilarious.

Well there you have it. Hope you enjoyed this one. And don't say I didn't warn you about the pics because I did. You know you looked at them. Even the gross ones. I know you did 🫣😜

Til next time!  Have a great day y'all!