To get to ORI takes about 30-40 minutes in rush hour traffic from our hotel.Then we turn off a busy street into a dead end alley that is not wide enough for 2 cars. This gets interesting when a car is trying to leave and another comes down the alley. Vietnamese stand off! Won by the larger vehicle as the other backs up between the bicycles, scooters, stores, and pedestrians. The entrance to the hospital is gated and upon going through the gate, there is a large courtyard, half filled with scooters and a small open garage on the left for more scooters and cars. The building is 3 sided and currently 4 stories with a 5th being added. A tile saw cuts continuously during the day adding a loud whine to the honking din from the street and the cacophony of voices from the wards.The floors have an open hallway facing the courtyard. Wide enough for a stretcher, lined with chairs and filled with people.The first floor is mainly wards. We go up the stairs to the second where there is a small clinic room with a table and chairs upfront, a row of lockers and behind the lockers a sleeping bed for a doctor. There is a table against the wall for examining patients. In the morning, the chairs are filled with doctors and nurses and their table stacked with charts as they complete the paperwork that never ends in medicine. Passing by this room, there are 3 wards filled with beds.The beds are metal frames with a bamboo mat laid upon it. Families care for their children. There is a male and female bathroom at the end of the hallway with a toilet that does not flush. The floor is wet as this room also is the shower that hangs from the wall by the sink. A plastic bucket sits by the sink to fill with water and flush the toilet. Stairs go up/down at both ends of the hallway. As we turn to the right, we approach the OR. A small room “the command center” has lockers, a few scrubs, a clothing tree from which hang the clothes of the doctors and nurses, a sink, a small table and a few chairs. It has a window, a large ceiling fan that sounds like it will take off when you turn it on and an AC unit! Looking through the window it is about 3 feet to the wall and window of another building. The window lets in some light and some fresh air. The next room on the left is the OR laundry, instrument sterilization and pre op area. The children come walking or carried by their mother, they are weighed on a small scale and given an IM injection. The mother then sits holding them waiting ever so patiently. A shoe rack with mismatched rubber “OR” sandals sits in the hall across from this room. If you try to enter the OR wearing anything but these, excited Vietnamese breaks out. Even the children must leave their sandals and put on a pair of these!
Stepping through glass doors on the left is the first OR followed by a small holding room and the 2nd OR. The scrub sink is down the hall on the right and at the very end a small room with a water bath that boils instruments between cases. As surgery is completed, patients are wheeled into the holding room or the hallway and casts applied. They stay in the hallway sometimes for hours until they disappear to the ward. Occasionally a nurse is with them but often, they just lie on the stretcher until the effects of anesthesia have worn off.
Anesthesia here is primarily Ketamine. They have an anesthesia machine but it appears to be broken and the one general anesthesia case was done with manual ventilation. A piece of gauze with a few strands pulled out is taped to the nose as a visual breathing monitor.
The OR nurses are very good and anticipate well once they understand what is needed. Instrument pans sit on a counter along the wall and the tops are lifted off and selected instruments removed to the sterile OR table. After the cases, instruments that will be reused are washed and boiled for a variable amount of time.Asking for equipment is done with a combination of our poorly pronounced OR Vietnamese, English and hand gestures. Often smiles and giggles erupt when we attempt to pronounce an instrument. Then, several people will go in different directions bringing what they think we want. When there is no understanding, we get Rose to translate or today Duc who speaks English well. He is a biomechanical engineering student at the University of Iowa home for the summer who has volunteered his time to be with us in the OR (or been shanghaied by Rose!)
Coming from the OR back towards the “command center”, a wall of waiting parents and patients per intently towards the OR. Entering the command center, our room attendant studies her English use of propositions and watches over our belongings and instruments. The table has bananas, Vietnamese cookies and water on it for us. This is an oasis of calm for a few brief minutes between cases. Today, we did 10 cases all of which went well. Anesthesia was getting patients ready and turn over time was almost non existent. I saw some additional patients for clinic and we now have 7 patients selected for surgery tomorrow and 7 on the waiting list for one of the next teams or next year. As we were leaving this evening, 5 mothers came up with flowers for us to thank us for operating on their children!
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