Big OR day tomorrow...

Today I went through more supplies trying to organize alot of the stuff we have. There's so much old stuff that has been donated that's just tucked away in these warehouses and no one has any idea what it is. Justin and I rummaged through alot of boxes and old musty closets (amidst huge spiders, lizards, and rats) trying to sort through what can be used. I broke the last gigli saw that we use for amputations on my first day Monday! (oops....). We did find two more saws that we could possibly use for some of the cases-we had the nurses autoclave and sterilize them this afternoon.

Another thing that I'm getting used to is making the OR schedule and prioritizing what cases should be done with the limited time and resources we have on a daily basis. Tomorrow we have 4 emergent amputations for infection-I'm going to do more amputations here than I've done in my whole residency! Then next week I'm going to have alot of big cases to schedule. The health care system is a bit different than back home for scheduling surgery. If a patient is brought to the ER they have to pay a registration fee before they can be seen, then they have to render cash for xray, then if they need to be admitted, payment has to be rendered before they can go upstairs to the floor. Then if surgery is scheduled, they have to pay cash before we can book them. If any of these steps are not met, then we're just in a holding pattern. It's a bit frustrating, b/c these people can't pay all this money at each step and some of them need emergent surgery. Justin and I may end up spotting some of the patients if they can't complete payment-some of them will die if we don't. Another frustrating thing is that many of the trauma patients will sign out AMA (against medical advice) b/c they want to go to "country doc" who basically is a local herbalist who just takes their money and gives them some bogus treatment. A guy today came in today with a really horrible shoulder fracture/dislocation and other injuries after being hit by a car. I saw him and then ran up to the OR to check if I had the instrumentation to fix him-by the time I had come back to the ER later on, he had signed out AMA!! Justin says I'll see alot of that-the problem is that once they realize that "country doc" treatment doesn't work, they just come back to the ER 20 times worse or infected needing an amputation.

I'm beginning to feel more and more comfortable around here. I know where things are and am becoming more efficient. Today when I went to the floor for rounds, all the nurses and patients were calling me by name-the patients appreciate the way I interact with them. Liberians have this snap that they do everytime they shake your hand-I got it down now so I'm cool!!  Some of the patients have been in the hospital for a long time just waiting for surgery or trying to fight off infection. I think malaria is getting the best of one of my guys.

Anyway, I had a fight with my stomach last nite-nothing a little Levaquin and Immodium won't ward off. I'm feeling better today...think I dodged a bullet on that one by jumping on top of it early! I just got back from dinner with 3 other doctors at this place called Rozi's. It's like a Liberian soul food spot in the middle of the hood. Really good food.  I'm going to try and get a good nite's rest b/c tomorrow is going to be a busy day! Hope everyone had a good day!

Big shout out to Elaine and my Sinai 8E crew! Thanks for the continued well-wishes and prayers. Your boy has grown up!! I appreciate your support for the past 5 years! You guys are the best!