It is really hard to run a hospital without reliable electricity. It’s possible, of course, and there are medical personnel around the world that do without reliable electricity—but it is really, really hard. So when reliable electricity exists, it opens up a whole new level of possibility to medical care. Equipment becomes dependable. The X-ray machine functions. The lab centrifuge functions. The fluorescent lights in our clinics and operating rooms function.
Reliable electricity at Bongolo means that we can do things many surrounding hospitals cannot. For instance, we can operate on polytrauma victims — like this man who, one Wednesday morning, had two teams working on him: one fixing a femur fracture, the other a forearm fracture.
It was a bloody, crowded affair. And then the electricity went out.
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Just so we're clear, there are zero formally trained orthopaedic surgeons currently scrubbed in on this operation.
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Bongolo is fortunate to be located next to a large waterfall, which has been harnessed for decades to give hydroelectric power. But the nationalised hydroelectric grid often fails for a few hours at time, several times a week. It’s prudent therefore to be prepared with a back-up system, which the hospital has: a 400 kVA diesel generator with an automatic switch that senses and activates whenever the national grid is out. Consequently, we hardly go more than 10 seconds without electricity.
And so we counted to 10, expecting the lights to flicker back on and the suction machines to start slurping again.
Except this time the electricity didn’t come back on.
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It gets even more chaotic in the dark.
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Down the hill and across the road from the hospital is the generator complex. There is a small electrical panel and a few buttons on one end of the generator (which is the size of a trailer truck cab). Flipping through the buttons revealed a number of faults: under-voltage, fuel leak, and several other indecipherable acronyms.
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The generator complex and general storage building
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It’s rare, but even the back-up generator can fail. It’s prudent therefore to be prepared with a back-up-back-up system, which the hospital has: a smaller, older, but otherwise functional 200 kVA generator that can power all the essential areas of the hospital. All that was required was the flip of a switch, and the back-up-back-up generator would start roaring to life.
Except this time the electricity didn’t come back on.
Unfortunately, surrounding the second generator were a series of small ditches with random large-bore aluminum electrical cables sticking out of them. The project to replace the external wiring connecting the generator to the hospital grid hadn’t yet finished. The generator, though functional, was useless.
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At this point the situation in the operating room was getting desperate. No power meant operating in the dark. The surgical team stood by the patient with various metal instruments sticking out of the forearm and thigh, holding pressure on the oozing incisions with large, sterile gauze. Even with flashlights and headlamps, the orthopaedic drills wouldn’t spin without electricity. And, to make things worse, the anesthesia machine’s backup battery was about to run out.
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Not pictured: the anesthetist prepping the patient in case of ventilator failure from prolonged power outage.
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It’s unprecedented, but even the back-up-back-up generator can fail. It’s prudent therefore to be prepared with a back-up-back-up-back-up system, which the hospital, as it turned out, has: a small generator (but still big enough to require a backhoe forklift to move it), the sort used for industrial welding projects, tucked behind several large steel drums of fuel and covered in cobwebs. It wouldn’t cover the whole hospital; but it could power a single operating room...maybe.
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The cobweb-infested generator is taken from storage and hauled up to the hospital
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Placed outside the operating room building, long extensions cords snaked from the generator inside into le bloc opératoire 3. The anesthesia machine, the drill’s power source, and one portable exam light were plugged in. The operation continued.
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The generator is left outside of the operating room building and hooked up to a few, precious machines inside.
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Three electrical systems failed that day. Thankfully, the patient survived and—after a blood transfusion—recovered uneventfully, blissfully unaware of how close to death he brushed. It took several more hours before the electrical woes were finally solved.
What did we learn? We learned that it is impossible to be too prepared. We learned that maintenance personnel are worth their weight in gold.
And we learned that it is really hard to run a hospital without reliable electricity. It’s possible, of course, and there are medical personnel around the world that do without reliable electricity—but it is really, really hard.
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And now...for some family pictures!
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The kids were thrilled to welcome Nathan, our first personal visitor to Bongolo and a medical school classmate of Kim's from Brisbane.
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Along with several dozen other hospital workers, we participated in the annual independence day parade (in which we were supposed to dress up "in uniform").
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Solène defends her buttered baguette from her intruding father.
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