“In Tanzania, the hospital was two hundred miles of sometimes one-lane dirt roads from Dar es Salaam, and flooding during the rainy season cut off supplies–such as medications and anesthetic gases–often for weeks at a time. There were thousands of surgery patients, but just five surgeons and four anesthesia staff. None of the anesthetists had a medical degree. The patients’ families supplied most of the blood for the blood bank, and when that wasn’t enough, staff members rolled up their sleeves. They conserved anesthetic supplies by administering mainly spinal anesthesia–injections of numbing medication directly into the spinal canal. They could do operations under spinal that I never conceived of. They saved and resterilized their surgical gloves, using them over and over until holes appeared. They even made their own surgical gauze, the nurses and anesthesia staff sitting around an old wooden table at teatime each afternoon cutting bolts of white cotton cloth to size for the next day’s cases.”
-from The Checklist Manifesto, by Atul Gawande
Ben's Notes 