Liberia#13
“Doc, kom up ward. M fowa B five gaspin” I’m coming. I hung up the cell phone. I know this patient well. I admitted him. I diagnosed him with HIV, what I think is encephalitis, and abdominal pains ? He has been doing poorly, so it doesn’t surprise me. I’ve heard Dr. Seton say that when they call for gasping, it is usually to pronounce death. I got up there and that was the case. So I did some of the paperwork on that patient. Then went for my breakfast. Today, since it was early enough, and the power hadn’t been cut off yet, I made some oatmeal, and cut up bananas into it. That and about a liter of water started my day.
Will the pain ever end? I did another full day of medicine. I again have respect for my wife and all you other docs who see medical issues every day. Some want to tell me their own diagnosis, or tell me what tests they want. After a particularly demanding woman, I asked her, “if you have your diagnosis and your treatment, why did you come to see me?” you can go to any pharmacy here, with any slip of paper and pick up whatever medicine is available.
Dr. Seton and I decided to split the work as usual. Today I made rounds on all the inpatient and she worked the outpatient department. The two burn patients are slowly doing better. More bleeding tissue at each dressing change, means that things are starting to heal and new vessels are growing. The patient I explored and reclosed her abdomen, is doing wonderfully. I’ve forgotten how fast intestines start working after a large surgery without any narcotics. Hers started the day after surgery, most in us seem to take 5-7 days. The 18yo girl with a symphisiotomy, is up and walking down the halls. Her baby, who got a neonatal infection and malaria in utero, is doing well, and breastfeeding now. 60 year old guy we did a prostatectomy on is doing great and I send him home with his urinary catheter. The HIV woman with the lung infection, I though had been getting steroids for the past 4 days, had not. I ordered them and the mini pharmacy on the floor didn’t have it so they said it was out. When I asked if the main pharmacy downstairs or stock had it, I found out they did. Just didn’t ask for it. So it will be interesting to see if she starts improving now that she will really be getting treatment. The pediatric room is always bothersome to me. They are either bouncing back and eating and playing, or getting worse and dying. They go rapidly one way or the other. Had both sides today. A convulsing little girl of 2 years, got medicine, and stopped convulsing, then 30 later went from normal respiratory rate to zero. Nurses called me about 8 minutes later. The delay didn’t help, but made the inevitable, final.
“De boy kip falling daun. In de mornin he fine. Afta servic he wak wif me. Den he fall daun. Now he wik an very tird” I look at him last night, he looks drugged. Mom says he had a runny nose, so she gave him erythromycin and Tylenol. Then within a half hour he was falling over. I admitted him with supportive IV fluids. This morning he is the opposite of the last child. This boy did gorge himself on breakfast, and throw up, but is playing, whacking the wall with his feet, and asking to go home. Much better!
After seeing about 25 inpatients, I eat PB and jelly for lunch, and of course much cold water. Then I go replace Dr. Seton outside. Each patient has waited for 4-5 hours to be seen. Some are unhappy, most are just happy to be called and progress in the process. I deal with back pains, numbness and tingling, coughs, malaria, typhoid, sexually transmitted diseases, inability to conceive. I get called to see someone in a car.
“Yestaday, he swel up.” Has her leg done that before? Is it both legs? “He swell up yestaday! Yestaday!” Both legs? (Im trying not to get in and touch her till I get more of the story) “Bof leg swel up.” Has it happened before? “Yeh, one tim de say he hav hart probem. Dis tim much pain.” Any other symptoms? “Hed pain him, n he wik over body” Weak? The whole body or the leg only? “He wik! Wik! I determine there are not really any other symptoms. The legs are both swollen, but the left much more. And it’s quite tender with cellulitis. I do the paperwork to get her in and give her antibiotics IV. They wheel her in and then carry the wheelchair up the two flights of stairs to the ward.
At about 5PM I am finally done with all the patients, and I head back to the ward. Dr. Seton is taking care of some patient issues, and said a foley needed to be palaced in a man in a private room. I go to each of the pharmacies, one on the patient floor and the one downstairs and eventually collect all the necessities. They had attempted to place it, I found out with catheter and non-sterile gloves and KY jelly. Not even an attempt to prep the skin and do it sterile. I guess Foleys aren’t done sterilely buy nurses here, or that’s the feeling I’m getting. (number two patient). So it took a little while to find betadine to clean the skin with. Plenty was in storage, just not on the floor.
I walk with the tray of supplies into the room. An old man sits on his bed leaning against the wall. Legs wide apart, with a small towel between them. I ask him to remove the towel. He has a scrotum the size of a womens volleyball with genital to match. I clean and insert the catheter in a short distance. He must have a stricture. I was trying with the smallest size we have. He says he can urinate. I cancel the urine sample, as it will just leak all over his skin and be a useless sample. He is treated for a urinary infection, without the test.
Of all these medical issues! And not many hospitals are treating anything. Part is they don’t have many workers just like us. With the non-governmental organizations paying 10 times higher than the previous prevailing wage. Workers are going to them and the ebola treatment units in droves. Very few remain to provide other types of care. The NGO’s help but at a significant loss in the system. How will the country recover. Likely when the NGO’s pull out. Then who will work for 1/10th the salary again at their previous hospital? Only very discontented workers that have no other options.
Please pray that the workers here will stay and provide the care that is desperately needed here.
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