Evangel Hospital has two main operating rooms. There is not much fanfare about the area or it's entrance. We just walk from the hall through an ordinary door into a large back room where there are patients waiting on gurneys, a sink for scrubbing, storage cabinets, and at the back a large electric autoclave. Water shortage is a chronic problem, so there is usually none from the tap. Instead, we scrub using a tiny stream of water flowing from a large plastic water container above the sink.

A warning and red line painted on the floor mark the point where shoes must be removed. There are no shoe covers, so we have to wear clog-like "theatre" shoes. They never seem to fit! Going through the swinging doors we enter the surgeon's inner sanctum itself. There is just an ordinary  window screen between the OR and the world outside. There are an old operating table, a reasonably good operating light, and an anaesthesia machine.

One remarkable feature of the OR is the way everything is reused. All sorts of "disposable" supplies and equipment have a long and fruitful life here. We use paper gowns until they fall apart, endotracheal tubes until they get too stiff, stopcocks until they start leaking or won't turn. We even reuse surgical gloves, after sterilizing them again. Where the bill for a major operation may be $20-$30, we're forced to be very economical both with drugs and supplies. One reason we can keep prices low is that many supplies and pieces of equipment are donated from overseas. 

A general surgeon who visited recently noted with surprise that here "general surgery" means all kinds of surgery, from orthopedics to urology to head and neck surgery. Certainly there are many limits on what we can do (no heart transplants yet!) but our surgeons and family practice residents really do stretch to the limit to do whatever can be done.