American medicine is a little obsessive about infection control.
I will probably never get used to the casual attitude that medical practitioners in the rest of the world have toward touching other people’s blood. Perhaps we are more obsessive than we need to be? But in a place where the HIV rate is approaching 20%, I’m not sure there’s room to debate the practice of wearing gloves. And whether the obsession is necessary or not, my instincts fight me every time I enter a hospital here. I wonder if this is how parents once felt about making their children use seatbelts.
I’m always a little inspired when I find that after years of working in medicine, I’ve actually acquired some wisdom, but today I had the opportunity to re-assess what I think I know, when I was invited to watch a surgery. The hospital was a missionary effort typical of African hospitals. A series of low, stucco buildings strung together, with wide open doors and windows, each bearing the hand-painted name of its purpose. Office. Outpatient. Theatre. (“Theatre” is what the English and South Africans call an Operating Room). The private patient room where we were waiting had purple wallpaper and a flat screen TV on the wall, but no soap in the bathroom. The orderlies who started up the IV didn’t wear gloves, and when there was a problem and I helped to disconnect and restart the line, we got a few drops of blood on our ungloved hands. My instinct told me I needed soap. In its absence I just rubbed my hands with water really hard, and dried them on my skirt because there were no towels. It is always this way and yet I’m still surprised, unable to unlearn what I’ve been taught. I still keep expecting soap. Does the bathroom in this room serve any purpose, or is it just hear because they think that’s what “private patients” expect?
The surgical prep progressed and the infection control was “fine,” but still not obsessive enough for me. I guess the upside is that there weren’t a bunch of mean surgeons barking at everyone the way they do in America. And as soon as the OR door closed, I forgot I was in Africa. Bright lights with shining equipment given by donors, a highly skilled nurse, anesthesiologist, and a surgeon who all clearly knew what they were doing. The instruments and cotton balls were all counted, all hands stayed above the operating table, and the surgical draping and technique were just like what I’ve watched a hundred times back home. The surgeons even bantered about their weekend plans and told stories about their training. Just like home! At one point, the rain started and the thundering on the tin roof reminded me I was in Africa. It was strangely normal to still feel connected to the world outside, rather than cut off in sterile isolation the way American hospitals feel. The surgeon’s cell phone rang a few times, and we were treated to a ring tone chorus of “He is the Alpha and the Omega, the Beginning and the End, God of all Creation, Our Savior and Our Friend!” Before the surgery started, everyone in the OR bowed their heads together to say a prayer. Obsessive for them? Maybe.
When the surgery ended we all breathed in relief, or I did anyway. It was a little 2 yr old having a hernia repair and I remembered going with my own little boy when he was 6 weeks old to get his hernia fixed. They took him away from me to the OR in his little gown. This time, I was that person taking the baby away from his Mom and Dad. It was a little emotional. But as the anesthesiologist leaned over to tell me halfway through, “I am good. We are very good here. But in the end it is up to God.”
I suppose all the obsessiveness over hygiene and controlling microbes has gotten us somewhere. In fact, I’m sure that it has. But is there also another way? One that is less about control and more about doing what makes sense for where you are, and maybe listening to the rain. How I ended up here and not there, an American and not an African, one way and not the other, remains the mystery of my life.
It’s hard to think there is any other way than believing it is up to something bigger than Me.