Reduce, Reuse, Recycle

Living in Kenya doesn't make it easy to keep tabs of what is going on in the US.  I had no idea that the government was on shutdown because of budget issues until I was emailing with a very good friend back in the States who is employed by the government.  He mentioned that he was in the middle of an unpaid vacation because Congress couldn't agree on how to spend its money.  It appears that the big sticking point is paying for Obamacare.  If I remember correctly, the bill increased coverage and tightened regulations on insurance companies, but did very little to control the escalating cost of healthcare in the United States.  With increasing coverage, and continued increased costs, there is a lot of unrest about where the trillions of dollars are going to come from to fund healthcare.

Well, I have a few ideas on how we can control some costs.  It may only be a small impact, but it is a start.  I've learned these methods from working the past 6 weeks at a mission hospital in rural Kenya.

Lesson #1. Reuse everything.
In the states, everything in the OR is disposable.  Use it once and throw it away.  At Tenwek, everything is reusable. Use it once, clean it, and use it again.  Repeat until it falls apart.  Even the disposable things are reused.  It's like washing your plastic cups and using them again, instead of filling up the garbage and then going to the store to buy more plastic cups.
One example is Bovie pens and the grounding pads that accompany them.  Bovie pens are cool little instruments that use electricity to cut tissue, and seal off small blood vessels.  A grounding pad is put on the patient so that the Bovie Pen will work.  In the states, they get one use and then are thrown away.  Here at Tenwek, they get used until they no longer function...then we improvise and get them to function again.  A single bovie pad will get hundreds of uses.  When the stickiness wears off, we tie them to the patients leg.  When the electroconductive gel wears out, we squirt KY jelly on them.

What else do we reuse besides Bovie pads?  Ventilator tubing, C02 monitor tubing, SCD's, Bowel Staplers, Ligasure, all laparoscopic equipment, light handles, all drapes and gowns, pleurovac containers, suction tubing...and the list goes on.  This is just a list I made from looking around the OR.  I haven't even looked into the wards.  Some of these items are inexpensive, but others are upwards of $400-500 each. If it ain't broke, don't throw it away.
Some of you may saying to yourself, "I'd be worried about infection and cleanliness with using a bowel stapler for a second time."  Well, we soak things like bowel staplers in Cidex to re-steralize them, and studies show it is effective and safe.

Tubs of Cidex containing "reusable" instruments. 

#2. Give your post op patients Demerol and Tylenol for post op pain control.
Having surgery can be painful...especially with an incision all the way up your abdomen.  In the states, we drown our patients with pain medication after their surgery...because people expect surgery (and most of life for that matter) to be pain free, and the hospitals expect the nurses and doctors to keep their patients happy.  Vicodin, ocycodone, morphine, dilaudid, fentanyl etc.  are used quite frequently and does a great job of making patients not care about the pain.  However, one downside of narcotic pain medication is that it also numbs your bowels and slows them down, giving you an "ileus". (Ever gotten constipation after taking Vicodin?  Imagine what happens when you take something 10x more powerful than Vicodin).  Getting an ileus can prolong your hospital stay by days to weeks.  You can't go home until you are able to eat and poop.  Some estimates put the total collective cost of ileus at  around one billion dollars per year.  I'm convinced that Kenyans are tougher than us wimpy Americans.  They take barely any pain medication after surgery...sometimes only Tylenol.  And I've never heard them complain.  One benefit of no narcotics...I haven't seen a patient with a post op ileus yet.  Ironic?  I think not!

#3 Make people eat Ugali and Sukamawiki everyday (the staple foods of Western Kenyans.)
It is fun to do surgery when 95% of your patients have no other medical problems.  Perhaps this is because they don't go to the doctor much, but my guess is that it is because Kenyan's bodies are being treated how the human body was designed to be treated.  Very few Africans are overweight, almost no one smokes cigarettes, processed food means that your corn and flour are in a bag, and just about everyone works outside for a living.  I was in clinic the other day when I saw a lady in her 70s who needed thyroid surgery.  Whether I am in the US or in Kenya, I always ask a few questions to assess whether the patient is physically fit to undergo surgery. When I asked this weathered lady (who looked more like 85 than 70) if she could walk a city block without getting short of breath she responded by saying that she walked 2 km to see me today at the hospital.  Lets just say she sailed through surgery.
The latest statistics show that obesity and obesity related conditions will cost the U.S. about $190 billion dollars this year.  Type 2 diabetes will cost us $174 billion.  We could trim our waistline and tax bill by eating only Ugali (a corn meal) and Sukamawiki (collard greens/kale).

I'll leave you with a picture of me operating on a guy with anthrax in his throat.  Never a routine day here!