Reality Bites

So the reality is sometimes sobering. We are having a great adventure here in Mongolia; mostly because of the fantastic team of people I came here with and the beautiful, generous, and ambitious people we are teaching. But there are harsh realities. There are no chest tubes.

We have seen two significant chest trauma patients within two days here in Mongolia. One had a flail segment with four broken ribs after a car accident, and one had a 75% hemothorax after a drunken brawl. Two major chest traumas, zero chest tubes.  Each of these patients had a 12Fr suction catheter, placed about 3 inches deep in their pleural space, and that catheter was clamped. Intermittently, someone would take a syringe and manually evacuate what they could before re-clamping the tube. There are no chest tubes, and there are no pleura-vacs. We replaced one of these suction catheters with a nasal airway (larger bore catheter, more integrity to the plastic) and then we had nothing to attach it to. The doctors were able to find a pleura-vac at another hospital – but here, there are no pleura-vacs. Once the borrowed equipment arrived, and the nasal airway had been inserted, we had to find a suction device to attach to the apparatus – there are some of those around, but they are scarce and in demand – we used one anyway.

We have brought a dream package of things to this place. Generously donated fancy things like endoscopic staplers, and skin glue, disposable trocars, and endo-catch bags. We have brought all this with our fancy education and a team full of heart, but there is simply not a chest tube to be found. Not a pleuro-vac, not a Jackson Pratt drain, not even a sharp knife blade - the reality is sometimes sobering.