Lessons from Chaos #5: A ‘dirty African hospital’

Operating room in the DRC

I once worked in a hospital in the Democratic Republic of Congo. I was on a mission with an international NGO. We had a 100% post-operative wound infection rate.

I went to the Field Coordinator and told her of the problem.

She said, “It’s a dirty African hospital.”

“F-U,” I said. “I’ve worked in forty 'dirty African hospitals' and never had this problem. Patients are safer at home, waiting for laudable pus. When did this start and what happened then?”

Turns out it was the new 90,000 Euro autoclave.

We went back to sterilizing equipment with an old autoclave heated over charcoal and the infections ceases.

Unfortunately, I was labeled a troublemaker by the international staff, but I didn’t care. The patients got better care, and the local staff appreciated me standing up to management.

It’s a lesson I’d learn again and again.

Many international staff believe in the mission or organization more than the local staff.

Lesson from Chaos #6: Doctor we have none

It was my first case in Malawi. I don’t even remember what it was, but I knew there was an HIV rate of 30% among surgical patients. After scrubbing I looked at Sister Lewende, at my assistant and one of the local nurses.

With horror and disdain, I asked, “Sister, where is your eye protection?”

She looked at me calmly and addressed me like I was a child. “Doctor, we have none,” she said.

Embarrassed, I realized I was an asshole.

It was a lesson I’d learn again and again.

Low resource settings lack many of the supplies and equipment we take for granted in the US and Europe. It is the local staff who are the real heroes.