OR Shut-downs

A major problem in the hospital has been that the main operating room has been shut down for the last month due to leaks, and subsequently positive microbiological cultures from the theaters. This has obviously compromised the ability to do any surgery and is very frustrating to surgeons, hospital staff, and patients. It highlights, in general, the difficulty in maintaining theaters at minimum standards and the general neglect of support to basic health services such as surgery. The fact that the main theater has been closed in the country's main referral hospital is very distressing to all. It is currently unclear when the problem might be resolved. As a result, mostly only emergency cases are being done in the OR in the emergency room, which has extremely limited resources and poorly functioning equipment to take care of frankly the sickest patients in the hospital. There are, of course, fortunately, other private hospitals in the city that also provide surgical services, however they are more expensive.

Many of those patients who have elective surgical problems have been discharged. On the surgical oncology ward the most striking observation is that all of the patients with cancer on the ward have locally advanced or widely metastatic incurable cancers of the breast, liver, soft tissue, and esophagus--ie, none are curable and the majority of the patients are most in need of palliative care. Any operation would be palliative. A number of these patients have been or are being evaluated by hospice care which has been a critically important service.

Many other patients on the ward are still hospitalized with various stages of severe surgical infections and chronic wounds, recovering from trauma, or from operations for abdominal emergencies such as bowel obstruction and perforated ulcer. The hospital and wards are still limited by supplies, with limited consumables such as gauze and suture, as well as basic equipment such as blood pressure cuffs. All vital signs are taken manually. The last night on call there was no functioning manual blood pressure cuff for the ward holding the 40 surgical inpatients.

A hospitalization can cause financial ruin for an often already impoverished family and this, along with the actual resource limitations, really limit the studies and services that can be provided. It seems there really needs to be greater research on the economic burden and contribution to poverty of health care costs—and especially for surgical problems.