My First Day in Surgery: Part III, Scrubbing In and Screwing Up June 27, 2006
Posted by jaotte in Healthcare, Humour, Medical School, Medicine.6 comments
Not everything in the Operating Room can be sterile. Anything in contact with the patient or the discontinuous surgical field (the draping over the patient, certain trays of tools, people who are scrubbed in, and almost everything inside a package) is sterile. However, masks, caps, and scrubs – all donned outside of the OR – are not and neither is anything below the waist. It is funny to think of people as “sterile” (safe?) and “not” in this environment, but it is entirely necessary; there are usually two nurses on each case, one is the scrub nurse and the other is the circulating nurse, who is not dressed in sterile garb. If you touch the circulating nurse or anything else that is not sterile, you become unsterile.
My mistake: during the laproscopic inguinal hernia surgery, I was near the foot of the bed with the monitor and controls to my right. The circulating nurse (non-sterile) had to stand on my right hand side occasionally to manipulate the controls, and on one such occasion her shoulder brushed my upper sleeve. Solution? The scrub nurse was able to get a plasticky ’sleeve’ to slide over the affected area.
To become surgically sterile in the first place is a careful craft that can only be mastered with practice and attention to detail. The ritual of “purifying oneself” isn’t all that horrible, really. If you are past the ominous red line in the OR area, you are already wearing your scrubs, cap, and ID tags. Time to scrub in. Those who had scrubbed in earlier in the day were free to substitute a simple washing and alcohol rinse for the whole procedure, but this being my first time (ever), it was key that I practice the technique all day long.
Over at the giant stainless sink, you must first don a mask, which cannot be touched at any point after the following step. You are to grab a foil-wrapped package of scrub soap and open it up. This isn’t a bar of Ivory like your mama used to use, but rather a yellow sponge impregnated with pink suds, sporting a clear plastic bristly brush on the backside. There is also a blue nailpick included in the package, which can be used if you’ve been gardening right before, but otherwise, it goes into the trash. With a swift movement of the hips, the water can be turned on. At all times, one must keep their elbows below the hands; the idea is to rinse all the yuck down to the elbows where it can drain off. Once the arms are thoroughly dripping, you can turn off the water and lather up. Take pleasure as the pink bubbles collect across your skin, because the vigorous, ‘down to the bone’ bit comes next.
My teacher abandoned me mid-scrub, but had the courtesy to direct me to the sign on the wall with the appropriate directions. There were different procedures depending on whether this was to be a “long scrub” or a “short scrub,” the former has more strokes (a stroke being one complete back-and-forth motion). Starting with the fingernails, 20 parallel strokes. On the fingers, 15 strokes per finger times 4 planes. The back of the hand, 15 strokes times 3 planes, the same for the palm. The arm was to be completely scrubbed using small circular motions. It was hard to tell exactly how much to do (I’m sure there was a number), so I just scrubbed until my skin was turning red from the abrasion. Now comes the rinsing motion, as before [elbows down!], and a bit of shake/drip dry. If you touch any part of the sink, the corner of a paper towel, your scrubs, or whatever during this procedure, you must redo it from the start. In case you were wondering, by the end of the day, after scrubbing 4 times, my hands were not raw, they were just very clean.
There is an artful way to enter the Operating Room. With your hands in front of your chest, elbows down and to the sides, carefully use your bum to push the swing door in. Head to the far side of the room and stand around like a gimp, dripping away, until the scrub nurse has a chance to hand you a sterile towel. There is even a special way to dry your hands, as every care must be taken to dry the hands first and work downwards to the cesspools that are your elbows. Drape the towel on some piece of equipment or another, as instructed, and get ready for the dance.
Dancing is not something I’ve ever had a lesson in. I know that true dancers must execute each move with precise timing, effortless grace, and exquisite control. Those characteristics are also essential for the gowning and gloving ritual. The Scrub nurse holds up the sterile gown so that you can shove your arms in each of the sleeves, only as far as the wide, elastic fabric cuffs. Latex surgical gloves of a the appropriate size (6 1/2 [smallish] for me) are retrieved and one is held open in front of you. Reaching up with your right arm to the sky, you can get just enough tension on the gown to be able to shove most of your hand out of the sleeve, invert your hand into something resembling a diving airplane, and shove it downwards into the glove. The same basic procedure is repeated with the second glove. Some people wear vinyl liners for their gloves if they are allergic to latex or afraid of becoming so.
My mistake: While I assisted her on the cyst-removal surgery, the Resident noticed my gloves were a bit large. I thought they were fine, as they felt good, but she did have 7 more years of schooling than I, so I trusted that. As I scrubbed for the next surgery, I asked for size 6 gloves. I could not get my hands all the way in, and when trying to force it, I put my right hand straight through the glove! They managed to remove the gloves and get me a good ‘ole set of 6 1/2s. I felt stupid for making the nurses do the extra work, but now I really know my size!
Now for the ties on the gown. The circulating (non-sterile nurse) has probably already done up a little snap at the top of the back and a small inner tie at the right hip. With your hands, encapsulated in a sterile field created by the gloves such as they are, the remaining tie at the front must be undone, handed to the nurse, and then your arms are kept elevated while you spin counter-clockwise. She hands you back the tie and you do it up at your left hip. I didn’t really get the importance of this at first, but my mistake explains it.
My mistake: As I undid the tie at the front, one of the ties fell near the floor. It became non-sterile in doing so, and the circulating nurse had to use a clamp to pinch it shut at my hip (as I would not be allowed to touch the ties anymore). Everything below the waist is considered non-sterile scum.
A little bit more practice will smooth out the kinks in my technique I reckon. I was just so excited to be in the OR that whatever stupidity I got up to could not bring my mood down.
My First Day in Surgery: Part II, All the Operations June 24, 2006
Posted by jaotte in Healthcare, Medical School, Medicine.add a comment
So Dr. Blair arrived just before his first case, around 8:15. He gave me a quick intro, and we wandered around the hallway a bit, finishing conversations with his colleagues and reminding others of new policy. Children's Hospital recently got some new funding for the "Scrambler Room," an OR theatre dedicated to extra cases, emergencies, and other unexpected procedures. It is a wonderful idea, as it allows for all the regular/elective surgeries to go ahead as planned, but it is difficult to show the provincial government that it is useful, given that it does not reduce the wait-lists. So the advice to a colleague was "yes, yes, please make use of the room."
We started with an Examination Under Anesthetic (EUA) in the Dentistry Suite. The patient had trisomy-21 (Down Syndrome) and had a few congenital abnormalities, one of which contributed to his developing gangrene of the anus. All of the necrotic tissue had been removed and his perineum reconstructed beautifully, but we needed to see if there was a fistula (aberrant connection) between his rectum and anything else. The nurse had to remove his diaper and clean him up, and I helped just by holding the legs up. On went the glove and lubrication, and Dr. Blair had the pleasure of feeling for any such fistula. There was nothing there, so we cleaned up and left the room to the ophthalmologist and dentist who were to do EUAs of their own on the same patient.
I did not scrub in for the first operation, which was a re-anchoring of a child's Venous Access Device (VAD). He had a lot of abnormalities of the tracheobronchiole tree (the conducting airways) and it was imperative that his health care providers be able to stick drugs in his veins if ever he arrested, hence, having the VAD as an easy access point. His VAD was shifting around in his chest a lot, so the Fellow went in, stitched it to his pectoralis major [I'm guessing] and that was about it. What surprised me was that in most of the surgeries, they did not use a scalpel for the incisions, but rather a cauterizing-blade. The way Dr. Blair described it, “the patient has to be grounded so that the current can go through them; the cauterizer superheats all the water in the tissues around the blade and literally explodes the tissues apart.” Okay! I know that they often separate tissues by spreading them apart rather than cutting them, because they tend to tear along natural borders and heal faster. Perhaps the use of the cauterizer involves this logic?
Anyhow, with that case done, I was able to scrub in on the three or four cases. I’ll describe the scrub procedure and all my faux-pas in a later post.
I am told that “inguinal hernias are the bread-and-butter” of pediatric surgery and true to this, three of the remaining six cases were of that sort. Repairing an inguinal hernia in a male is basically the same procedure every time, so I won’t keep repeating it. Once the patient is well under anesthetic, the navel to groin area is prepped with something akin to iodine. Drapes are put on so that only the important part is showing. An incision is made with the cauterizer and the spermatic cord and testicular arteries/nerves are isolated. If you think of the pelvic region as a cavity, like the main (palm) part of a latex glove, a hernia is just an out-pouching of that membrane, such that you get a structure like a finger on a glove. So our job was to go in and cut off that finger! If there is any bowel or omentum, we had to push that back into the main cavity first. Then we would sew at the base of the finger, and cut just above to remove the out-pouching. Stuff it all back in, stitch the inner layer, stitch the skin shut, put some steri-strips on, and voila!
My favourite case was removing a sebaceous cyst, because I got to get my hands in there and do a fair bit. A little girl had a noticible lump, growing in size over the past year, on her left shin. The Resident made an incision, and I held the retractors as she probed around. The cyst was well-defined, and we were able to remove it without damaging the capsule. It was about 2 x 2 x 1 cm and a squidgy white. I swabbed away any blood through the procedure and cut the sutures as the Resident sewed. It was an easy, clean case, but I was really glad to be assisting.
We did another inguinal hernia repair, this time on an infant. The only differences as compared to the first similar operation were 1) the anesthetist was a lot more nervous 2) to keep the baby warm, we put them on a sort of inflatable bed that was hooked-up to a heat pump 3) we used the ‘hernia spoon,’ a cafeteria spoon that has been modified with a little slot cut into it, in order to hold up the hernia tissue whilst it is sewed – I’m not really sure why it was necessary, but it was funny to see anyway.
I didn’t scrub in for the affectionately named “autistic toenail” case, because it was a very minor procedure. Normally, they would just give a local anaesthetic for the operation, but the patient required a general because he would not be persuaded to cooperate whilst conscious. It was a simple ingrown toenail, but I was warned that this is one of the more “hard to tolerate because it looks so gross” cases. I was okay with it; my only problem was that my legs were starting to get sore from standing around all day, something I’m not used to after 10 months of sitting in the classroom for 8 hours a day. Anyway, the Resident handled this one. In these cases, the body reacts to the toenail as a foreign object, so the scene was pretty messy to start. The Resident made a nice clean cut, did some curettage (scraping) of the nail bed, and packed it with a strange grid-like gauze, impregnated with something (perhaps an antibiotic? I forgot to ask). She bandaged up the toe and it was all set!
The reason that boys often get inguinal hernias is that their testes descend through the abdominal wall and create a weakened area in the wall as a result. Inguinal hernias in females are not very common, but we had a 14 year old female with a recurrent one on the left side. We wanted to be sure there wasn’t also one on the right, so we did a laproscopic exploration to find out. Under anesthetic, she was prepared and draped in the usual sterile fashion. The Fellow first made an incision above the obvious hernia and began to repair that. He also made an incision near her navel. The nurses dimmed the houselights and we filled her abdomen with gas to inflate it. He put the laproscopic camera in and we all had a look on the monitors at the right side. No hernia was obvious, but the surgeons decided to tie it off just in case. The Fellow was only allowed to had the two incisions – one for the camera, and the other (over the real hernia) where he eventually put the needle pusher in. To tie off the possible hernia, he only really had one hand. He had to stitch against a lot of tension which was really tricky, pull the suture thread out of her body, tie a knot, push it back inside her, and so on. He was frustrated at having such a hard time with it, but I was totally fascinated and told him that it was like he had just landed on the moon – one handed.
He was nearly done but it was time for the nurses to change shift. Everything was on pause while they did their count of sponges, rubber stoppers, and sutures, and got their gowns and other sterile stuff on. After the surgery, there was a discrepancy in the count. It said 9 lengths of suture (+ needle) had been dispensed, but there were only 8 packages around. Because of the really minimal incisions and the fact that six people were watching, we knew there was nothing left inside of the patient. Hospital protocol demanded an x-ray of her abdomen. Irradiating a girl’s ovaries is not something anyone wanted to do, especially because we knew it had just been a mistake due to the mid-operation shift change, but we had to. Of course, the x-ray showed that nothing had been left inside.
Things were running late and Dr. Blair was stressed about the waiting around, having to do the x-ray, and the change in shift. I decided not to stick around for the last case, a bilateral inguinal hernia, because I’d only slow down the OR, I’d seen the procedure a few times before, and frankly, the day was a lot to take in already.
It was a great experience to see how things go in the OR. It was a bit slower paced than I had imagined, but that was partly the nature of the day. The night before someone had died on the table, and before that, they had been operating on the kid with Hanta virus which made a big splash in the newspapers. I now have a good idea of what a day-in-the-life of a Chief of Surgery is like. Lots of meetings, red tape, and so on; many smiles but also some angry parents.
I think I have to spend more time with surgeons to know the job is right for me, or if I’m right for the job.
My First Day in Surgery: Part I, Introduction June 24, 2006
Posted by jaotte in Healthcare, Medicine.add a comment
On Wednesday, I was lucky enough to be able to shadow the Chief of Surgery at Children's Hospital here in
Vancouver. He had been my small group's tutor in January for a unit on "Host Defenses and Infection," and had invited us to spend 1/2 day with him in the OR at that time. I didn't think I could spare a morning off, so I decided to wait until the summer.
Up at 6:30, toast with peanut butter and fruit salad in my belly, and out the door to catch the two busses that would take me there. I arrived at quarter to eight and was able to find the OR desk with a bit of help. It was hard to feel comfortable going through the heavy double doors (opened only by pressing a giant red button) and through to the hub, but I was nudged in there. I checked in an was given the code to the women's change room (and proceeded to forget this 4 digit pin code at a few points throughout the day). On the door were the instructions: ID Badges must be worn at all times. Tuck the scrub shirt into the pants; cover street shoes with booties; don a cap; no food or drink past the line; remove all jewelry or cover it up, etc.
There was a pediatrics resident getting dressed at the same time, so she helped me select a set of the size small scrubs, the pants of which were quite large but could be gathered elegantly in lumps around my waist by the actions of the drawstring cord. I didn't want to catch any flak, so after removing my wristwatch, I took out my eyebrow piercing. I later noticed the head anesthetist’s dangly earrings, but I thought as the lowest person on the totem pole, I was 'better safe that sorry.'
Once dressed, I sat in the little orange room with phones for the surgeons and residents to dictate their reports. Well, it wasn't an orange room so much as the orange sectional couches from the 70s really dominated the small space. I waited. I looked at the massive wall clock every 2 minutes, for I'd left my watch in the change room. Minutes passed, and nothing happened. A few elderly surgeons and their strapping young residents filtered in. A nurse or two with colourful caps made their way in. And then they came.
There were about 15 of them. I couldn't see at first past the cart of linens that was rolling down the hallway. I could hear them cheerily chattering, patting each other on the back, squeaking their shoes down the corridor. A hoard of OR Nurses entered the clean zone. This was the metro blur I had been waiting for. Congratulatory giggles drifted towards me as the women teased the surgeons. I thought of my dad, an OR nurse, and wondered if there were any male nurses here. I wondered if his OR was as friendly as this, and if every morning, someone sitting in the little orange room could feel the calm before the storm.
Learning About the Himalayas June 21, 2006
Posted by jaotte in Culture, Himalayas, Humour, India, Medicine, Nepal, Tibet, Travel.add a comment
Today I went to my doctor to get a "needle-stick kit"; basically, this consists of a short-term regime of anti-retrovirals in case I happen to poke myself with a needle (that may have come in to contact with an HIV/AIDS patient). He really had no idea what to give me, so he called his friend in the ER, who directed us to St. Paul's Hospital (which offers top-notch HIV care).
Later, I watched a BBC documentary series about the Himalayas. My grandfather made me a VHS tape from the TVOntario broadcast and mailed it to me. From Pakistan to Mt. Everest to Bangladesh, Michael Palin leads you through the wonderful cultures and scenery of the Himalaya. I especially enjoyed when a head cold, compounded with altitude sickness, had Palin collapse in a heap at the base of the Annapurna peaks. Definitely a worthwhile couch-potato experience – but don't forget the snacks. I must admit that my VCR is broken, so I headed to school and used the one in the Medical Student Lounge. A classmate joined me for a bit (only to have a nap on the sofa, really) and by the time the custodian entered the room and started washing the doorknobs, I figured I had better go home. So truthfully, I didn't get through all 352 minutes. I turned it off at the Everest base camp portion, as I know my journey will not take me that far . . . this time.
Afterwards, I ventured to the library and got a large pile of language and travel books. I want to write down a few basic phrases in Ladakhi and Nepali before I go. Here's what I picked up:
- A Course in Nepali (David Matthews)
- Conversational English-Nepali Dictionary (Gupta)
- Modern Literary Nepali: An Introductory Reader (Hutt)
[this one was a mistake; I don't think I can learn the script that easily. oops!] - Nepal: The Rough Guide (David Reed)
- Conversational Ladakhi (Sanyukta Koshai) [this is a thick book!]
- Lonely Planet: India
Tomorrow is my first experience in the Operating Room. I'll let you know how that goes. I need to pack my lunch and get to bed early for my 8AM debut.
A Bit of Tourism by Train in India June 19, 2006
Posted by jaotte in Culture, India, Travel.1 comment so far
I have two days between arriving back in Delhi (from Ladakh) and setting off for Kathmandu. Delhi is very close to the city of Agra, where the Taj Mahal stands majestically. I would be remiss not to visit this wonder of the world, since I’ll be in the neighbourhood anyway. One thing that I didn’t realize is that the Taj Mahal is closed on Fridays! This will make my plans a little cramped, since it is a Thursday afternoon and all of Friday that I have free, but I can use the second day to visit the lesser known and appreciated Agra (Red) Fort.
I’ve been trying to figure out how to get there in the most inexpensive way, and the trains are apparently the way to go (as the buses would take up most of one’s free time). The trick is that there isn’t much space reserved in “tourist class” so you have to buy tickets well in advance. There is a sort of e-ticket option that can be used. Booking is a little scary considering Delhi has many stations, and I’ll have to figure out a way to get to them from the airport (and make sure I allow enough time for all the transfers). Likewise in Agra, there are a number of possible arrival points and I’m not sure which will be best. I will use the Indian Railways site to find the correct trains, and then book them at the Indian Railway Catering and Tourism Corporation site. I found a great beginner’s guide to train travel in India online, which has been the source for most of my information so far.
Cheap hotels can be found through Expedia. All I really need is a bed, a lock on the door, and access to a bathroom. And $17/night can buy that, plus a smile (according to some hotel reviews published on the site). I’ll let you know.
Testing 1-2-3: Post-Dated Blog Entries? June 18, 2006
Posted by jaotte in Medicine.add a comment
I am trying to figure out: If I post-date a blog entry, will it appear at that date/time or will it just appear right away (with the later date included in its properties)?
This could be a great tool to keep this blog rolling whilst I'm away for 51 days. I can pre-create entries that explain where I am and what I am doing.
WordPress is seven hours ahead of my time zone; it is currently 19:09 according to it. If all goes according to plan, this post will not appear until 19:30, WordPress time.
EDIT: Yes! It works!
Volunteering in Nepal; Citamol June 17, 2006
Posted by jaotte in Culture, Medicine, Nepal, News.2 comments
If you are going to volunteer in Nepal, there is a lot to learn before you go. Please see my previous posts for lists of organizations you can volunteer with there.
A coalition government involving the Maoists has been formed. Elections for the constituent assembly will soon follow and it is expected that Maoists will disarm under UN supervision. Not being an expert on the situation, I can't predict what the political climate will be like in two months (when I am to be there) or in two years. Most news services are declaring this move an end to the internal conflict, but there are forces outside of Nepal - like the Indian Government – which may oppose the change. At any rate, I am very excited to be visiting this nation in their time of, for lack of better word, revolution. The situation has been drastically altered in the past few months and it must be an incredible time for the Nepali people.
There is a comprehensive site for volunteers headed to Nepal that gives some idea about Health, Money, Security, Culture, and some examples of experiences there. It looks like I've got a lot more reading to do!
The arrangements for my volunteer post have been finalized. When I arrive at the Kathmandu airport, someone will be holding a sign with my name on it to greet me and bring me to the organization's office. Before we head there, I'll purchase my Nepal Tourist Visa at the airport. Once at the office in Kathmandu, I will fill out some paperwork and pay my fee which is a very small amount considering transportation, orientation, accommodations and meals with a local family, and supervision. My contact has mentioned something about an "icebreaker" exercise involving local cuisine during the orientation. Yum!
I will probably stay the night at a hostel in Katmandu, and get transported to Lubhu or Chapagoun. I am not sure if I will be stationed at the same clinic for the full two weeks or if they will swap me between the two. Although I have malarial prophylaxis medications, I will probably not take them as my posts will be in a low-risk area. Here is a map of the Kathmandu valley area that shows their location:
In these places, the health clinics are run jointly by community and government, and about 35 to 40 patients come each day. I asked about bringing medical supplies (to donate) and the response was "We would be more than happy to receive medical supplies as health posts do not get enough medical supplies from government and how much government supplies its finished within a week. Almost always most of the poor patient cannot afford even single tablets of citamol."
In my limited readings, Citamol [an analgesic and anti-pyretic - I think a derivative of acetaminophen/paracetamol] is the 'magic pill' of this region. In some cases, it is the only medication available, but they cost 40-50 Nepalese Rupees each ($0.76 Canadian, using this currency converter). That is actually a hefty sum when you consider a full dosing regime (multiple pills for multiple days) and the average annual income in Nepal (about $200).
I think some of the money you have donated should definitely go towards a whole bunch of Tylenol (or generic equivalent).
According to one article, religious mission groups have been known to give out tablets of Citamol as "gifts from God" in order to convert Chepangs to Christians. Belief in the power of Citamol has (anecdotally) caused some to abandon their use of traditional medicines, which may not be the best result. I think I will be learning a little bit about Ayurveda and other traditional medicine systems with The Himalayan Health Exchange in Northern India, so I hope I can transfer some of that knowledge to practice in Nepal. It would be fantastic to learn a basic list of which non-Western medications are indicated for what, and when they should be given. I will not have a lot of exposure to these ideas this trip, but some fellow medical students will be studying traditional and natural medicines in Northern India. I can ask them to share their experiences with me once we are back in school.
Short Update: Med Surplus Ain’t Glamorous June 16, 2006
Posted by jaotte in Medicine.1 comment so far
I got a large duffel bag from MEC and proceeded to "Logistics" at Children's and Women's hospital. The director there was really helpful; she pointed to a shelf and said "help yourself." There was a lot of stuff that I couldn't identify, a lot of bits and bobs that would only be useful if you had the other bits, and tonnes of expired surgery supplies.
I grabbed some catheters, syringes, gloves, and so on but I'll have to sort through it and see what is really going to be useful and worth carrying. Perhaps I'll send pictures later. This stuff is not light! When I got home, I realized that my hiking shoes gave me no trouble. I wore them around the city and walked up a lot of hills, and my feet have not yet complained. Hooray! I think I made the right selection.
Now, I'm going to go rollerblade around Stanley Park with a friend and try and get my lungs into shape for the high-altitude assault that is quickly approaching. My hope is that if I work my lungs out enough in the next few weeks, stomping around in the Himalayas will be marginally less difficult.
Fundraising Decisions June 15, 2006
Posted by jaotte in Ethics, Fundraising, Medicine, Travel, Volunteering.2 comments
Originally, I set up a DropCash donation site to raise an arbitrary amount of money for my upcoming medical trek to Northern India and Nepal. My brother (Christian) recommended the site to me, as I my previous intention was only to approach local businesses and not family, friends, and blog readers. Well, Chris, it turned out to be a very good idea. At first, I sort of hid the link. I advertised the blog to my family and friends but not the fact that I was collecting money, but my aunt found it and started the ball rolling. I made the 'donation' link that much more visible. As the expenses started to add up and people simultaneously showed their incredible support, I worked harder on the blog to make it a resource for people with common interests. Absolute transparency and no administration fees in my operation! I'd tell you the brand of underwear I'll be bringing along if I thought it might be important or helpful to you. (Incidentally, I don't believe this trip requires any special underwear.)
Yesterday, with your generosity, I was able to reach $500 collected via the donation site, which was incredible and overwhelming for me. I don't think I ever expected to reach that amount, which is why it was set fairly low compared to the overall cost of the trip. Realistically, the trip will cost a lot more than $500, as you can see in my Expenses section.
I would be remiss not to attempt to fund more of the journey from a source other than my own student loans, so I have created another donation campaign. The last thing I want is to appear greedy or ungrateful. I sincerely hope that I am not offending anyone with this move. If you think it is a terrible idea to continue, please let me know.
If no one else contributes financially, I will still be incredibly happy for making it this far and pleasantly surprised by all of you. Insights, tips, well-wishes, and encouragement are also a valuable currency; without those, I never would have imagined this trip, created this blog, decided Nepal was safe, solicited donations, bought tonnes of alcohol hand sanitizer, asked the hospitals for surplus supplies, thought critically about cross-cultural care, or even believed that I could do this.
Gearing Up! June 15, 2006
Posted by jaotte in Medicine, Travel.1 comment so far
I picked up some excellent gear yesterday; here’s the list:
- iodine water purification tablets and neutralizer (for my time in Nepal)
- Kleenex wipes and some bottles of alcohol hand sanitizer
- a tube of Polysporin (probably for my patients and not me)
- D batteries for my flashlight
- a North Face mummy sleeping bag rated to -7C for ~$90 at Valhalla Pure [the salesclerk there was fantastic; when I told her my needs, she had no trouble encouraging me to go for an inexpensive model; I could afford to have the extra weight because this isn't a traditional "hiking" trip]
- Garmont hiking shoes for $125 at MEC [A guy at MEC who had been to the region and heard that I would be standing around treating patients all day recommended against a hot, less-comfortable boot; the shoes we chose are pretty stiff and have a good tread for the snow, if I encounter any]. I am normally the person to focus a lot on getting something for the lowest price, but these fit like a dream and I really think it is important for my feet to be happy.
- a large pack rain cover for, well, rain. Also, this should help protect the beast as it will go through an airport 14 times in my journey.
I need to go back to MEC and get some compression straps because my sleeping bag will never roll up as tight as it’s stuff-sack without them, and also a medium duffle bag for the medical supplies. There is no way I can fit my hiking gear [sleeping bag, ThermaRest], clothing [cold weather for the Himalayas and warm weather for Delhi and elsewhere], personal supplies [medical, toiletries], medical equipment, and a pile of medical supplies into a ~60-65L bag. Nico lent it to me yesterday and it is roomy, but I’m going to be away for a long time and I don’t think I can pack in all the medical extras in there. If I were just going on a hike or traveling, it wouldn’t be so difficult. There is no way I want to lose the ability to bring medical supplies, and the airlines do allow two checked bags, so I’m going for it!
Children’s and Women’s Hospital have offered some supplies to me and I will go an peruse them tomorrow, probably after buying the duffle bag.
