The Improvisational Surgeon: Cardboard Casts, No Power, Patients Galore | KERA News

The Improvisational Surgeon: Cardboard Casts, No Power, Patients Galore

Apr 26, 2016
Originally published on April 26, 2016 7:08 pm

At the Koforidua Regional Hospital in Ghana, Dr. Forster Amponsah is about to start an appendectomy in one of the hospital's four operating theaters. A half-dozen other patients who have been prepped for surgery lie on gurneys in the surgical ward's foyer. Amponsah is planning to do all the surgeries in quick succession — but then the entire wing of the hospital goes dark.

"The general electricity is out and our generator is broken down," Amponsah says.

Ghana has been experiencing rolling power outages for months. As Amponsah waits for the light to come back on, orderlies wheel two more surgical patients into the foyer and park them in the queue that's quickly turning into a backlog.

The loss of electricity is just the latest stumbling block to getting surgery done.

A new report in BMJ Global Health says essentially that surgery has become the overlooked stepchild of global health. The authors say that 5 billion people lack access to proper surgical care and they argue the world needs to rethink the importance of surgery.

Ghana is actually doing better than many African countries when it comes to surgery. The West African nation is trying to make it universally available. But the Koforidua Regional Hospital illustrates some the challenges. The facility has four operating theaters and two surgeons but there's only one anesthetist, so both surgeons can't operate at the same time. Amponsah says they often run out of medical supplies. He explains how he can make a chest tube drain from a plastic water bottle. On the morning that I visited the hospital, which has 400 beds to serve the eastern region of Ghana, the chief surgical nurse got called off the ward to cover at maternity.

After a half an hour, the power flickers back on. Amponsah starts an appendectomy while at the same time triaging his waiting room. He orders two patients he deems "not emergencies" to be sent home and rescheduled for another day.

Soon after Amponsah cuts open the abdomen of the first patient, it's clear that the suction machine is on the fritz again.

An intern fetches another suction machine from one of the other operating theaters.

Before Amponsah is even finished with this operation, a nurse comes to his side to tell him there's been a car crash. An open top Jeep has somersaulted off the highway. One of the passengers is in extremely bad shape.

The Cuban-trained doctor will spend much of the rest of the afternoon stabilizing and patching up these car crash victims. Then he'll return to the patients waiting on their gurneys back in the surgical ward.

"There are times that we stay here until 3 a.m. We stay here until the next day and we have to come back the next day," he says.

Around the world this experience for surgeons is not uncommon. Dr. Josh Ng-Kamstra, one of the authors of the new report on global surgery, says in much of the developing world surgery gets far less funding, attention and resources than treatment for, say, infectious diseases.

"This is a problem that's been really developing over the last number of decades as surgery hasn't had the kind of media attention as other global health problems have had," Ng-Kamstra says.

He says international donors have been interested in programs that show results. It's easy to quantify the impact of a vaccination campaign or the distribution of bed nets to block malaria or the provision of anti-AIDS drugs. Funders can say, "X number of people were served." Providing surgical care, however, is more complex. Not only do surgeons have to be trained, but health care systems have to be strong enough to support to support them. Electricity, anesthetists and functioning suction machines are all needed.

Ng-Kamstra says surgery has been so ignored in the overall global health landscape because it's difficult and complex. He says billions of people now don't have access to it.

"We are not calling for access to the most expensive, highest-tech procedures," he says. "We are talking about basic surgeries that we want everyone in the world to have access to."

Surgeries like the hernia repairs and appendectomies that Amponsah at the Koforidua Regional Hospital in Ghana had been trying to get finished all day.

Amponsah says he and his colleagues often have to improvise to get surgeries done, borrowing suction machines from other wards or making casts out of cardboard.

"This is what I have and I have to make do with what I have," he says cheerfully.

And even though he often ends up working long days, he says he loves his job.

"I'm needed here!" he says. "And I'm satisfied when I see people get better."

Copyright 2018 NPR. To see more, visit http://www.npr.org/.

KELLY MCEVERS, HOST:

Here in the United States, doctors perform millions of surgeries a year in hospitals, clinics, even in their offices. But in many parts of the world, surgery is not so easy to come by. A new report says billions of people around the globe lack access to even basic surgical care. To get a better sense of the challenges of performing surgery in the developing world, NPR's Jason Beaubien went to Ghana where he observed one surgeon on just one afternoon.

UNIDENTIFIED MAN: (Foreign language spoken).

JASON BEAUBIEN, BYLINE: It's a bit after midday at the Koforidua Regional Hospital in Ghana. This place is about an hour and a half north of the capital, Accra. Six patients are waiting for surgery on metal gurneys. Dr. Forster Amponsah is about to start an appendix operation when the electricity shuts off.

UNIDENTIFIED CHILD: (Crying, foreign language spoken).

BEAUBIEN: One of the young patients is spooked by the darkness. This surgical ward has a dedicated generator, but it also is dead.

FORSTER AMPONSAH: The general electricity is out, and our generator is broken down.

BEAUBIEN: Still in his scrubs and a hairnet, Dr. Amponsah switches from surgeon to electricity repairman. The doctor and one of his nurses start making phone calls. They think they might be able to borrow a generator from another part of the hospital.

AMPONSAH: (Foreign language spoken).

UNIDENTIFIED WOMAN #1: (Foreign language spoken).

BEAUBIEN: As Dr. Amponsah tries to line up power, orderlies wheel two more patients into the waiting area. What's happening here illustrates some of the huge challenges of providing surgical care in poorer parts of the world. A report in BMJ Global Health says about 5 billion people lack access to proper surgical care globally.

Ghana is actually doing better than many African countries when it comes to surgery. For instance, this hospital has four operating theaters and two surgeons. But there's only one anesthetist, so both surgeons can't operate at the same time. Dr. Amponsah says they often run out of medical supplies, and just this morning the chief surgical nurse got called off the ward to cover at maternity.

Finally after a half an hour, the main power supply flickers back on. Amponsah whirls into action.

AMPONSAH: Sena...

SENA: (Inaudible).

AMPONSAH: Can we go in with the chest tubes?

BEAUBIEN: He swings his arms as he herds his staff back into the operating theater.

AMPONSAH: Appendix one - chest tube - OK. OK, so let's do one appendix, then we'll do a chest tube.

BEAUBIEN: Amponsah preps the appendectomy patient while, at the same time, triaging the growing crowd in the waiting room. He orders two men that he deems not emergencies to be sent home and rescheduled for another day.

He cuts open the abdomen of his first patient of the day and discovers that the suction machine is on the fritz again.

AMPONSAH: Suction is not working. (Inaudible).

BEAUBIEN: A intern rushes to get one from one of the other operating theaters. Then with the patient still open in front of him, a nurse comes in to tell him there's been a car crash. An open-top Jeep has somersaulted off the highway. One of the passengers is in extremely bad shape. The nurse puts Amponsah on speakerphone with the triage staff at the emergency room.

AMPONSAH: He's what - breathing from the nose.

UNIDENTIFIED WOMAN #2: He's bleeding from the nose.

AMPONSAH: I'm coming to see. I'm coming to see.

BEAUBIEN: Dr. Amponsah finishes the appendix operation, strips off his surgical gloves and rushes out of the ward. The emergency room is up a hill across the hospital grounds.

AMPONSAH: (Foreign language spoken).

BEAUBIEN: Amponsah barks orders at the orderlies and then whisks the most severely injured of the patients, a teenager with a fractured skull, onto a gurney.

AMPONSAH: Get a bed sheet to cover him until...

BEAUBIEN: The doctor spent much of the rest of the afternoon patching up these car crash victims. Then he'll return to the patients who've been waiting all day for him.

AMPONSAH: There are times that we stay here till around 3 a.m., and we have to come back the next day.

BEAUBIEN: One of the reasons people aren't able to get surgery in many parts of the world is because surgery is so complex, and it requires highly trained surgeons, support staff, drugs, equipment, nurses. It's expensive. Dr. Josh Ng-Kamstra, one of the authors of the new report on global surgery, says putting together and maintaining these complex systems isn't easy, and it's something that international donors have often shied away from funding.

JOSH NG-KAMSTRA: This is a problem that's been really developing over the last number of decades as surgery hasn't had the kind of media attention as other global health problems have had.

BEAUBIEN: International donors have been interested in programs that show quick, tangible results, he says. It's easy to quantify the impact of a vaccination campaign or the distribution of bed nets to block malaria or the provision even of anti-AIDS drugs. Funders can say, X number of people were served.

Funders are less interested in tackling thornier issues like medical education and the country's faulty electrical infrastructure. Ng-Kamstra says even a basic surgical program can dramatically improve patients' quality of life and even save lives.

NG-KAMSTRA: We're not calling for access to the most expensive, highest technology-based surgical procedures. We're talking about basic surgeries that we want everyone in the world to have access to.

BEAUBIEN: Surgeries like a hernia repair and draining fluid from around someone's lung, surgeries that Dr. Amponsah at the Koforidua Regional Hospital in Ghana had been trying to get to all day. Amponsah and the other surgeon finally make it through the backlog. When they leave for the evening, the waiting room's empty, but the nurses have already lined up a full schedule of surgeries for the morning. Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.