N’DJAMENA, Chad – Previous humanitarian work in Honduras, El Salvador and Ecuador as a civilian has equipped her well for this line of work and expertise. She knows what it’s like to have to perform her duties in an underdeveloped facility with limited resources. To complement her civilian experience, her 12 years in the military between the National Guard and Reserves as a nurse has taught her to adapt and overcome things as they come her way. On paper, she may very well be the most ideal candidate to be a part of Medical Readiness Exercise 19-1 at the Military Teaching Hospital.
“With the experience I have, I thought I had one of the bigger advantages coming into this exercise as I have administered anesthesia in several developing countries during civilian medical missions,” said Maj. Jennifer Hall. “Although eager to travel to a new country, I felt as though I may not gain additional anesthesia training as I have encountered many situations similar in the past. The mission in Chad would prove to be more challenging than I had anticipated.”
As a nurse anesthetist with the 378th Medical Detachment, 3rd Medical Command Deployment Support, Chadian anesthetists welcomed her into their anesthesia world of improvising with minimal supplies and resources. Taking away some of her normal anesthesia equipment and medications that she has in the United States caused initial stress, as she was forced to adapt to an unfamiliar environment. Her stress hit a peak early in the mission as she was called into an ongoing surgical case in another room to assist with an anesthesia emergency.
“The patient was vomiting under sedation and at extreme high risk for aspiration of gastric contents into his lungs,” said Hall. “The room was not equipped with any emergency airway equipment, as there was only enough equipment to supply one room.”
In collaboration with Chadian and French nurse anesthetists, they had to quickly gather multiple supplies and secure his airway as well as stabilize his hemodynamics. They only had one ventilator in the hospital and several surgeries left to do. Even with an additional ventilator, there were no critical care nurses to manage a ventilator in the recovery room for prolonged periods.
“We had to make the decision to remove the breathing tube after surgery and hope that his lungs would recover. I was never happier to see the patient sitting up in bed the next day in recovery.”
As soon as she started to feel more comfortable in her environment, they ran out of the normal size spinal needles and there she was, nervously administering spinal anesthesia with a much larger needle than she has ever used, placing her out of her comfort zone yet again. Just when she thought she was great at what she does, it didn’t take but a change or lack of familiar equipment to humble her.
“I would say that the biggest thing that I came away with from this exercise was improvement on my overall readiness,” said Hall. “We all know how to perform our duties with everything we need, but it’s in the moments of figuring out how to do your job with little to nothing that we really grow and adapt.”
Hall went on to say that it was an eye opening and emotional experience to witness adults and children with serious medical and surgical ailments waiting patiently without complaint in the 100-degree heat to be seen by the medical team, or sitting for days or weeks in medical tents with nurses treating their infected wounds.
“I appreciated the patience of the Chadian and French nurse anesthetists as they watched me initially struggle but adapt and become very efficient at delivering anesthesia with whatever supplies I was handed for the day,” said Hall. “As I prepared to leave Chad, I couldn’t help but to be thankful for the cultural and learning experiences and appreciate that I may have taken away more than what I gave in return.”