Friday, June 29, 2012

Mongolian Queen

I was given this very special gift from the Choibalsan team as I left Mongolia this year. Mongolian women have a respected place in this strong culture and I was incredibly honored to receive this doll. I recommend Jack Weatherford's book "The Secret History of the Mongol Queens" for additional reading on how women helped save Genghis Khan's empire. 

Clapping in the O.R.?

Returning to Choibalsan to work with this team again was truly a joy and a privilege. It was encouraging to see how much the team had learned – in technical skill and in surgical judgment. It was a pleasure to return to a somewhat familiar environment in such a far away land. It was a privilege to work with our friends and colleagues from our last visit.

I took a special pleasure in learning that one silly little thing I had done last time I was in Choibalsan, has become routine here in the operating room. The first time we were teaching here, I used to clap and cheer whenever the gallbladder was finally freed from the gallbladder fossa. I think surgery is fun and I think finding those moments of small victory are worth celebrating. Okay, it’s silly, but somehow, it has stuck. The first day of our trip this year, the operating team cheered raucously after the first gallbladder was released from the gallbladder fossa – and I laughed in shock. They then informed me that they do that for every cholecystectomy … every one.

If the legacy I have left in Choibalsan is the ability to celebrate the small victories – well I am more than fine with that. Cheers to my friends in Mongolia who do their job well and do their job with joy. 

Like a Prayer

The last time we were in Choibalsan, as part of our training program, we introduced the WHO surgical checklist and emphasized the importance of the “surgical timeout.” This short verbalization of the operative game plan introduces the patient, the procedure, and any known issues or potential areas of concern. The “timeout” serves to put the whole operating team on the same page. It is a moment of pause before you carry on with serious business, and sometimes, can be almost, like a prayer.

During this trip, we were happy to learn that the Choibalsan team had adopted the “time out” for all of their procedures. We brought additional translated copies of the WHO surgical checklist for the new operating rooms and started to teach the concept of the “debrief.” I am sure our star students will adopt this practice as well as they have the timeout.

(I encourage anyone who is interested in global health to read Atwul Gawande’s book The Checklist Manifesto)