Do you ever feel like you are so stuck in your little bubble of a life that you don’t even consider anyone else outside of it? Like no one even exists outside of your bubble and everyone that does lives exactly like you do – because, honestly, what other way is there?? It is so easy to get consumed when you are in CRNA school, as it sucks up every second of your time. Sometimes I forget to come up for air every now and then, and make sure the people outside of my bubble are ok.
Keeping that in mind, I tend to think that every hospital in every state in every country functions the same way. Everyone uses the same medications and the same equipment. Everyone practices anesthesia the exact same way. Because, again, what other way is there?
Going to a third world country was eye opening, earth shattering, and humbling. I can now confidently tell you that there are very few things that are, in fact, the same with the practice of anesthesia. Our group brought a lot of our own tools and equipment so it would be familiar to us. But watching our native anesthesiologist perform anesthesia was very different. Not that he isn’t providing just as good of care, just that it is different.
Developing Country Operating Room
vs. American Operating Room
For instance, they do a lot more spinal anesthesia there because they do not have a reliable anesthesia machine to use for general anesthesia. Our group brought a very basic anesthesia machine from America to use, so we were able to provide general anesthesia as well. The machine itself is completely non-electric because the electricity is known to cut out (and did). Luckily, my friend and I divided and conquered. One of us would be hand ventilating the patient while the other would push IV medications and chart. It would have been much more difficult had we been on our own.
It is also very common to have two surgeries going on in the same room at the same time. As in … side by side – with no walls or dividers. Irrigation is accomplished with a squirt bottle, as opposed to our fancy machinery. The gowns and drapes are fabric, and washed in between cases. The only way to scrub in for surgery is regular soap and water. Prepping the patient is done with gauze and iodine.
Another thing that took some getting used to is that they reuse just about everything. In America, we use 1 anesthesia circuit per patient. Here, we used 1 anesthesia circuit for the entire week (29 procedures). In America, oral airways and ETTs (for intubating) are 1 time use only. Here, we used them repeatedly. They are cleaned in between, but sometimes that means just wiping it with an alcohol swab.
Does privilege = advantage?
It makes me wonder though, who is doing it better? In some ways, they are doing it better. People are not as sick there because they are not diagnosed with a million and one mild insignificant disorders. They are not on any home medications (which can be both good and bad). They do not take any pain medications at home. This is actually a good thing for anesthesia because it means they have not built up a tolerance yet. We can use fewer medications in surgery because they are naïve to them. This means less narcotics and faster recovery and discharge times. Also, most of the things that they reuse are not sterile. An oral airway or ETT is never sterile. Clean technique is used in both countries.
Coming from a land of too little back to our home of too much definitely makes me think that we are over treating in America. We complain about limited healthcare access but in comparison, we have too much healthcare access. People get unnecessary medications, unnecessary treatments, unnecessary surgeries which often make their health worse instead of better. We prolong life so much that it is more about quantity instead of quality.
America has long-term care facilities where we keep people “alive” for years and years. It may sound harsh, but we honestly waste so much money and supplies and resources fighting losing battles. The people that we served rarely live past 60s, and yet here we fight to keep people alive well in to their 80s or 90s whether they like it or not. We keep people alive who will never enjoy another second of the “life” we are forcing them to have.
But unfortunately that is the American way. It is how we have all been brought up and programmed.
So we continue on fighting, but for what?