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Operating Theater Fills Critical Surgery Gap in Post-Dorian Bahamas

Direct Relief
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By Noah Smith

As an orthopedic surgeon and medical chief of staff at Rand Memorial Hospital, the main hospital in Grand Bahama, Dr. Freeman Lockhart did not expect to be working in a war zone-like field tent for the better part of a year.

But after Hurricane Dorian took all of the island’s hospitals offline, a tent seemed like a great option next to the alternative, which was having no operating theatre available to the island’s more than 55,000 residents and thousands of residents on smaller, neighboring islands.

The field tents, while providing a critical service in late fall of last year when they arrived, are tough to keep sterile – an even more pressing issue during the pandemic – and are unsuitable for winds exceeding 40 miles per hour, much less hurricane season.

“If faced with a Covid patient, we didn’t have much ability to clean and sterilize the tent,” Lockhart told Direct Relief. They did not have to face such a situation, though still had to deal with the standard cleanliness issues.

“There was always the question of sterility. That’s a huge issue in any operating room. In a field hospital, we had challenges in trying to establish some level of keeping everything clean: leakages, water collects inside the tent, and there’s always the concern of mosquitos finding their way inside the tent. There’s only so much you can do to secure a tent,” he said, noting that the just about all cases he worked on there involved traumatic injuries such as motor vehicle crashes, gunshot wounds, stabbing wounds, and long bone fractures.

As hurricane season got underway earlier this year, Rand Hospital remained unusable due to extensive repairs after being flooded by Hurricane Dorian.

But a solution emerged in the form of a modular operating room, which is housed in a shipping container attached to the main building.

The OR, which was made by Build Health International and funded by Direct Relief, opened at the start of last month. It has been open to patients just about every day since then.

“The facility has been a godsend for us. It’s the only OR [in Grand Bahama], outside of private facilities,” Lockhart said. “The facility itself at least takes the weather element out of the picture from operating out of a field hospital,” Lockhart said, and added that beyond just structural integrity, the modular OR and its placement allows patients to be transported, in spite of any inclement weather—reflecting the fundamental challenges that he and his team have been dealing with since Hurricane Dorian.

“It’s a testament to the skill, professionalism, and dedication of these surgeons who have succeeded in maintaining continuity of care despite having to operate, for over a year, in a tent and now in this modular operating room. Conditions aren’t what they’re used to and it was an honor to play a role in enabling care for patients until the hospital is back up and running at full capacity,” said Andrew MacCalla, VP of Emergency Response and New Initiatives for Direct Relief.

The modular OR is split into various surgical and preparation sections, each of which has a range of essential equipment such as as different sections is outfitted with a range of essential equipment, such as a procedural stretcher, surgical table, tabletop aspirator, electrosurgical unit, patient monitors, and diagnostic board as well as oxygen outlets, LED lighting, and foot pedal soap dispensers.

Still, the modular OR is not quite home for Lockhart.

The space is smaller than Rand’s OR, making movement inside the theatre more difficult, and also preventing the use of specialized equipment such as C-arm and endoscopy machines. This prevents some procedures, which require use of such equipment, from being performed on the island.

Despite this, Lockhart feels confident about his ability maintain care in Grand Bahama this Hurricane season, the pandemic’s second wave, and beyond.

“We flattened the curve for the second wave here, though in the capital [Nassau] they are having challenges trying to get control of it. If we will have a Covid patient, we are comfortable that we can clean the OR throughout and sanitize and then re-use it,” he said.

“With this module coming online when it did, it was a huge relief for all staff concerned.”

Direct Relief has supported Rand Memorial Hospital with $1 million in grant funding for a range of projects identified as top priories by the nation’s Ministry of Health, including the refurbishment of nearly 150 pieces of essential medical equipment that were damaged by Hurricane Dorian. Direct Relief is also supporting the creation of two new health care facilities in the Bahamas, helping repair four existing facilities, and has donated more than 98 tons of medical aid worth nearly $8 million (wholesale).

Additional reporting contributed by Chris Alleway.