When the power momentarily goes out in Operating Room 4, it seems like no big deal. The room goes a bit dark, though the windows provide some light. The suction and electrocautery machines go quiet. But we keep operating, mostly because: What other option is there? And the power typically comes back on in a few seconds. We make it work.
But that flicker of power has greater ramifications, because OR 4 is on the same breaker as the autoclaves - the enormous, modern machines that sterilize our surgical tools and equipment. And when the autoclaves go down, they require a much longer process to restart. And without those autoclaves, we are quite simply dead in the water.
We had an autoclave-related delay yesterday, and there was concern that today’s schedule might be truncated - or even cancelled - because the autoclaves would be down.
But it didn’t happen. The staff at St. Joseph Hospital in Koforidua, Ghana, pulled their boots up and kept the machines running. And today, our third of four operative days, working out of four ORs, we replaced 24 joints in 22 patients - 18 hips, including two sets of bilaterals, and 6 knees.
The experience of performing joint replacement here in Ghana is very different than at home. The patients are much younger, with an average age of around 30, and their deformities are profound - typically much, much worse than we see at home. And they come from much farther away. They get subcutaneous absorbable sutures for wound closure, as there would be no reliable way to have surgical staples removed at 10-14 days post-op, because their rural home is a 12-hour drive from Koforidua.
Then there is the issue of resources. Simply put, the most remote community hospital in the US gleams with technology in comparison to our St. Joseph’s Hospital in Koforidua. Every item in the hospital (like... EVERY item) bears a handwritten code which delineates what it is, where it belongs, and the year it was acquired. And those codes suggest that many of the items we use have been there a long, long time. It’s actually a pretty interesting sociological observation to wonder who else has sat in this chair, which is marked “SJH/THE/CHA 1987.”
But they make it work. A brief review of the surgical logbook here at SJH in Koforidua shows that they routinely perform orthopedic trauma cases - fixing broken bones which are shipped in from hours away. And hidden behind the well-used doors and windows here are serviceable surgical technology - autoclaves, lights, anesthesia machines - and a dedicated staff of medical professionals who reliably provide surgical orthopedic trauma care.
We have noticed this week that the hospital here seems to have improved notably since we first came in 2016. It’s been painted. The Snack Bar is open. It’s noticeably cleaner. And the surgical assistants who help us are capable and clearly experienced.
And if there is anything more charming and inspiring than happening upon a group of uniform-clad Ghanaian nursing student on the floors of the hospital, then I have not seen it. With their green uniforms and their broad and infectious smiles, they clearly tell a wonderful story about the future of medical care in Ghana. They’re making it work.
There has clearly been a flicker of power, and of light, here in Koforidua, and the health care machine seems to be up and running. Like so many regions of the world, Ghana has challenges. And we can’t change the world. But maybe we can help change some lives.
Thanks so much for your interest and your help. We are cranking as hard as we can to replace as many joints as possible during our brief stay.
Operation Walk happens because of you and your support. And we are immeasurably appreciative - as are our patients.