Wednesday, February 16, 2011


It is so easy to get confused about where and when you are on these trips…I think it is Thursday?  Our third operative day in Nasiriyah and I get to sleep today and switch to nightshift after my first two days here working during daylight hours.  Not that I really ever see daylight while at the hospital anyway. 

We drove from Baghdad Monday in a large convoy…five identical Toyota Land Cruisers, limited to three passengers each.  Our lead car announced our importance with flashing blue and red lights the entirety of the four hour trip and close on his heels was an imposing 4x4 pickup with a very large and imposing piece of artillery mounted on the roof of the cab, complete with it’s very own gunner for the ride.  I think we even traveled with a fuel truck and of course a tail car following us the entire way.  Four hours weaving in and out of traffic and approaching uncomfortable speeds.  All the drivers were armed and carried assault rifles in their vehicles. 

Still rolling with that surreal theme…but I honestly felt very safe the entire time. 

The security guys are pretty funny. It is abundantly clear that everyone is VERY invested in our safety.  There are guards in the hospital, sitting outside the ICU and every time someone walks out of the room they jump to their feet so that they can escort us, literally around the corner (!) into the break room where there are always between one and three additional guards/security personnel.  The guards at the guesthouse are slightly more relaxed but not much.  This morning I had two escorts for my sunrise walk around the closed and guarded compound…because the one that I had yesterday evidently was not adequate. 

Okay, so I think that should be enough about security to put everyone’s mind at ease.  Yes, I feel very safe and well looked after.  In fact, aside from the prominently visable automatic handguns on the hips of our security guys and all the rifles being carried around in hospital, everything seems pretty normal.

The ICU has eight bed spaces and currently six beds.  We have done four cases so far and I believe that three are slated for today.

ICU equipment and supplies in these developing programs seems to be the biggest issue.  Part of that challenge comes from not knowing what we have available and not knowing where to find what we do have.  This inconvenience does not lend itself to smooth execution of care inside the ICU and winds up being the biggest source of frustration.   (Well, actually no, the biggest source of frustration and possibly the most important challenge is the communication piece…but more on that later.)  But this is by no means an insurmountable problem. 

There are also odd issues that are really just functions of how medicine works in places outside of developed countries.  When we obtain a CBC here for example (which is an acronym for lab work meaning complete blood count), we send the sample to another hospital and then the family has to go to that other hospital, pay for the test, and return with the results.  And hopefully, while they are there they remember to pick up the Tylenol and ibuprofen that we will need to provide their child with pain control.  I had to wait for four hours the other night to give our first patient Tylenol because I didn’t have another patient to “steel” it from.  Had I known this was going to be an issue I would have brought a gallon of liquid Tylenol from home. 

So that is hard. 

It’s funny…we have all this technology…cardiac bypass and open heart surgery going on in the surgical theaters, a handful of ventilators, a few syringe pumps, the essentials for ICU care (syringes, saline, IV catheters and such) but then getting my hands on Tylenol or clean diapers can become such a challenge.  Weird, right?

It just makes me appreciate how much I take for granted being back home. 

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