I could write volumes about how well team members worked. While I spent most of my time in the operating room – with some time in the recovery room and on ward rounds, I’d have to say that this was one of the best groups with whom I’ve ever worked. It’s the kind of situation where everything is working so well (of course with the occasional tweaks needed to improve efficiency) that don’t know just how well it’s working. It amazes me how, never having worked with my scrub nurse Sue, she was able to learn not only the sequence of a cleft lip and palate operation, but also all my idiosyncrasies. Together we kept refining our “game plan”, with Sue half joking, “there’s still room for improvement” so that even on the last two days of the mission, we improved the efficiency of our work – things as seemingly insignificant as the room set up (i.e. OR instrument stand table relationship, etc.). I’m lucky to have worked with her – she’s one of those persons that as a surgeon you can always rely upon to make any given operation run smoothly.

For the first few days in the OR, things are a bit disorganized – all to be expected after making such a long trip and setting up in a room where you often wonder if there will be a regular source of electricity. Everyone takes responsibility for their own role and takes the initiative to “cover the gaps” in service. I’ve thought long about how it is that such a disparate group of people, some never having worked together, are able with a minimum of time be able to coordinate such a complex set of events. Justin (surgeon from Australia) and I agreed that by definition, all team members want to be there and will do the best “to make it work” and that there’s really no consciousness of “it’s not my job” or failure to take initiative, learn new skills, etc. I often think of how the same sentiment could be instilled in my co-workers back home. I guess as much as any one person can create a supportive work environment, it’s really up to the individual to make it happen and no amount of incentive/coercion can ultimately drive this to effectively happen.

Missions like this run on so much “behind the scenes activity”, that it’s often easy to overlook and give credit where it’s due. Sure, it’s easy to see the tangible results of great surgery and superlative patient outcomes as a result of quality nursing, but less obvious and underestimated are the important contributions by support staff. Every time I went to the ward to check on patients, I was greatly impressed with the work done by Elaine, Val, Heather, Rosie, Ann – Elaine who I first met in the Hong Kong airport even before the mission began as she was busily working on the patient database, and preoperative screening forms. Quietly working on the ward, Elaine orchestrated tracking vital patient information. Many others like her, especially our nursing staff in all sectors of the mission, created the safe, efficient working environment that’s remains our primary goal. The same goes for all the administrative staff and their assistants. Somehow they appeared out of nowhere whenever we needed supplies or had some vital question that needed to be answered. I could go on and on mentioning names, and I know I’m forgetting to mention a few (sorry !), but I would like to say a very special thanks to Walter, Washington (thanks for the diagrams !), Anita and Brianna, Hong Mei, Jackie, Penney, and the others, who without these people, we clearly couldn’t function in any meaningful, patient safe and centered way.