Weekend Musings: African Critters

I have always found little insects incredibly annoying. When holidaying in France, the small flying things that land on you and itch usually drive me into cover, exacerbating my pasty complexion. Even in the UK, I would find flies and insects a great way to spoil an otherwise idyllic spot. Here, whilst insects are aplenty, surprisingly I find myself far more accepting of such things, even admiring their audacity and resourcefulness.

Sometimes they indicate their

affection!

There are ‘ants’ aplenty. From the large termites building architectural wonders, the rainforest Soldiers / Fire (advise to avoid being bitten) to the tiny little critters that are everywhere. And I mean everywhere. Whilst they are ‘harmless’ they’re ability to crop up at any location is a little taxing at times. Any food source left without impenetrable covering will be found and, if exciting enough, swarmed upon. Needless to say, we live in resigned acceptance that these are our inevitable house guests. There is a longstanding conflict which neither side is ever likely to win!

Even as I am writing this, I see the occasional scout whizzing along the desk. Sometimes, they find you unawares and explore you too. They are so small and quick that when you do notice, they are very difficult to find and remove. And of course, an itch is never just an itch here. A compulsory body inspection is required to rule out / destroy personal invaders.

I am less affectionate of their utilisation of the theatre suite though. I described a few days ago how fortunately they stop moving when the hot water is added to the leaves and sugar that goes into making African tea. Extra protein?! But intraoperatively, I confess, they do cross a line that I cannot accept. Sometimes I see one running across the drapes through the ‘sterile’ field. I am pretty sure that they have come from the patient (the team does a good job of keeping their obvious presence in the operating rooms at bay). I am afraid that when they present themselves in such a fashion, they get an extra helping of surgical spirit.

This is one of the many challenges that we face with regards to maximising the sterility (or rather cleanliness) of our procedures – of paramount importance when considered in the context of the mesh surgery. Mesh is an implant which harbours potential disaster if infection should manage to find its way to it. When I compare and contrast the almost space age like approach that is now commonplace for orthopaedic theatres in the UK with what we have here, I sometimes think that we must be walking a very tight line. But what we are doing seems safe in the twenty patients who have undergone mesh surgery so far.

However, I cringe at the unmistakeable grey / brown that tinges even the third set of swabs we use to prep the patient (clean the surgical field before the ‘sterile’ drapes are lain), a clear indication of the ingrained dirt most of the population wear (3 washings with Savlon, 2 of spirit if you’re interested). My dissatisfaction regarding the flies in the operating room has become increasingly vocalised (gently and politely of course). Something we must eliminate. When they land on the instruments, your ear or the back of your neck toying with you, I can barely contain my frustration though. Equally, the staff’s efforts to swat the blighters is almost as bad, the sterile field sometimes forgotten in attempts to placate me! The canvas drapes also seem a fairly flimsy barrier (they soak up the smallest amount of liquid and I am sure that more than just a single celled organism could quickly find its way through the weave.

But for all that, we are doing well with all our operations. There are a number of steps that we have included to optimise the cleanliness of things, particularly for the mesh surgery. The hernia patients also all stay for two days postoperatively, receiving IV antibiotics for this time (first dose on induction) and then 3 days of oral to go home with. I have recounted the UK day case mesh hernia practice a number of times with one single dose of IV antibiotics on induction. But that was met with a knowing smile. It’s not quite the same when a patient returns home to a hot and dusty mud hut that they share with chicken and might not wash for…. for… a while. That said, this schedule is the same as they employed for their sutured hernia repairs before I came, and we have in fact reduced postoperative infection rates.

Perhaps, if we can get things firmly established, we can try pushing the boundaries out again in the future. But ‘polepole, polepole’, slowly, slowly.