In Kenya, operating in our comfort zone

“Traveling makes one modest – you see what a tiny place you occupy in the world. ”
-Gustave Flaubert

We have come to Kenya, expecting to work outside of our “comfort zones.”

Our patient has arrived from miles away, riding on the back of her husband’s bicycle. She has an enlarging, bleeding mass growing off of the side of her neck. There are no pathologists available, so we are uncertain what kind of tumor it is, although it appears to be a cancer. She has been wearing a scarf to hide the mass for the past year; her head covering is speckled with blood.

We are anxious. Unexpected things can happen in an operating room this far from home. We expect the local power will fail several times each day. The OR team members come from different hospitals and we barely know each other. The operating room will be sticky and warm despite the air conditioner. None of us has ever worked in an OR that has two operating tables in the same room. Some of our favorite technologies are missing. And like many Kenyans, the patient has had no access to regular medical care, and there are things we do not know about her medical history.

Surgery is a complicated, dynamic, choreographed variety of chaos, and this unfamiliar environment magnifies the potential for catastrophe. The circumstances here are starkly unfamiliar. Back home, it takes months for team members to learn each other’s routines. We do not have the luxury of time. We introduce ourselves.

The patient is moved to the operating bed and is soon asleep. Our surgical team starts slowly but picks up steam. We build up confidence and the case develops a flow. When things become difficult or unfamiliar, our routines are cast aside and we work around the obstacles. The lights flicker off, but the battery powered headlights work just fine, and the anesthetist squeezes the bag until the ventilator again has power. Before long, things feel familiar and safe. The tumor is removed, the stitches are placed, and the patient moves to the recovery room.

Like all of the Kenyans we encountered, she is grateful and gracious. I, too, am grateful for the team that is here. Our surgeons, anesthetists, and nurses perform 25 operations and see 1000 clinic patients over three days. This place has turned out to be a comfort zone after all.

Bruce Campbell is an otolaryngologist who blogs at Reflections in a Head Mirror.

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  • http://pulse.yahoo.com/_JYZSGDUXTNSTJUV5WJB3ZIY23M terminator

    i can relate to this. my situation occured in haiti where a 4yr. old slipped and fractured her tempero-parietal leftside. the parietal was cracked and the pia mader mininges was visible. i had no operating room. i had my bag of goodies and ether—yes, ether!!!
    i had 1 trauma nurse with me.the pt. was placed on raised plywood inside a straw covered school classroom.
    she pulled through. this was back in july 2011.
    it was a frustrating experience but, my comfort zone set in after we had this under control…..lot of praying went on.
         -            ——— a one time dr. without borders and still doing mission medicine today————-