Wahala

Let me introduce you to a wonderful Hausa word: Wahala  (pronounced wuh- hall- uh). Wahala can be loosely translated as “trouble” or “problem.”  The light fuses were just the beginning of the wahala last week.

Monday afternoon at 2:30 the chef (who is the manager of the OR) informed me that the big washing machine was broken and we only had three packs (sets of sterile gowns/towels/drapes) left.  Consequently we had to cancel all of the non-emergent operations for the rest of the day. Apparently the washing machine had broken that morning, but they had not informed the OR or started washing  by hand. So, we discussed that they should tell us earlier next time and start washing by hand if the machine breaks again. Ok, fine, no big deal.  By Tuesday the washing machine was up and running again.  

Thursday I spent the day in clinic. One of the nice things about clinic is the mid-afternoon break. Clinic closes from about 1pm-3pm. At 2 pm I was pretty exhausted and looking forward to a quick nap. I had been asleep for about fifteen minutes when the phone rang. It was the chef. “Doctor T, we have a wahala in the bloc, the washing machine broke again and we only have three packs left. Can you come?”  I woke up and walked back up to the hospital. First, I talked to the chef…in a combination of broken English and Hausa I figured out that at 2:30 he was told that the washing machine was broken and they didn’t have any more gowns or drapes they could sterilize. Only 3 packs were left. We had 2 emergency laparotomies scheduled already, and a couple more elective cases planned. And, who knows what emergencies could come in? So, we moved the elective cases to the next day and decided to go ahead with a laparotomy.

Then I found M in the pharmacy to ask for her advice. We walked together over to housekeeping with see what was happening with the broken washing machine. There we saw a huge washing machine propped up on its side next to a large pile of dirty OR gowns and drapes. Thee laundry men were sitting staring at them both. It was obvious that the washer hadn’t been working all day. 

the big washers (one has been broken for a while, the other works...sometimes)

Why didn’t they tell us in the morning instead of waiting until there was a crisis? Just two days ago, the laundry supervisor, N, had promised M that he would call immediately if the washing machine broke again. But, he hadn’t. So, she told him that she was very unhappy, even angry, that he hadn’t kept his word.  And that they shouldn’t wait to let the OR know when the washing machine was broken. Also, they should start immediately to wash by hand. Well, he didn’t take that too well. In fact he said he wasn’t going to talk to her for a month because she had gotten angry with him. Anger is taken very seriously in this culture.

He then disappeared for a while and we again talked to some of the other laundry personnel to figure out why the OR wasn’t informed and why we weren’t washing the clothes by hand (that is how most people wash their clothes here). Soon, N returned and shortly thereafter about eight guys from the shop were there working on the washing machine. I think after about 20 minutes of explaining and listening, they finally understood that if we don’t have sterile gowns or drapes, we can’t operate. And if we can’t operate and an emergency comes in…someone could die.

M and I went back to the sterilization room at the hospital to try to figure out why we only had a one-day (or less) supply of gowns and drapes. Seems like we should have some reserve, right?!  Turns out we had been running low on gowns and when they ripped/worn out they weren’t being replaced. Also turns out that we had a whole box of new gowns down in the pharmacy ready to be used!  The pharmacy staff just didn’t know that the OR needed them.  M brought them up from pharmacy and the immediate crisis was resolved.  I got to clinic an hour late. 

The next morning, I stopped by the sterilization room where the man who folds and sterilizes the equipment proudly showed me a huge stack of sets, all ready for the OR!

One more wahala solved...for now