A TEACHING HOSPITAL ?

Thoughts about a third world teaching hospital

‘Give people what they need: food, medicine, clean air, pure water, trees and grass, pleasant homes to live in, some hours of work, more hours of leisure. Don't ask who deserves it. Every human being deserves it.’-Zinn

Medical school was bad enough. It ripped my academic genius image of myself off the wall of my mind. It stripped me naked of my self esteem leaving me with  the first three items on marslow’s theory of needs ,food ,shelter and security. Security which I barely had in a school where students frequently suffered  at the merciless hands of thieves and robbers. I barely survived. My daily prayer was to get 50% in every exam, pass the final exam and run away in one piece. I did get away in one piece but I did not have peace afterwards.

 I started working in  a teaching hospital  few months after passing my final exam.

On the first day I was sent to the emergency department . As soon as I entered  two young men and a lady  involved in an RTA (road traffic accident) were rushed in. They were all bleeding form deep lacerations on their scalp. The lady started vomiting when she was asked to stand on a scale for her weight to be measured. All three had swollen and puffy faces with what looked like water coming out of their nostrils. These were cases of base of skull fracture and the lady had a raised intracranial pressure as well. She had arrived  at the emergency  just in time. She needed quick primary survey and resuscitation. There was no bed or stretcher left in the ER(emergency  room) for her to lie down. The single MO (medical officer) on duty was sweating profusely as he tried to prevent a five year old girl with a gunshot injury to the chest from bleeding to death. The nurses were running around trying to get plaster, intravenous fluids , Intravenous cannula and giving sets, items which otherwise should have been abundant in an ER to help save lives, they were completely finished and the nurses had to borrow them from other wards.That was the obstacle I encountered when I made an attempt to set a line for the lady, so I had to just wait. 

The lady had a seizure and died minutes before the intravenous cannula and fluids arrived, from another ward of course.The nurses explained to the relatives that she had been brought in too late and that was why she had died but I knew she had died only because she  came to a hospital in third world country where healthcare is a joke and brand new  sports cars were a priority.

The next day I was sent to the pharmacy. A middle aged male taxi driver who was  a known diabetic and hypertensive had hypoglycemia. He had an above knee amputation of his left lower limb the previous day. He was heard making a random comment that without his leg he was better off dead since he wouldn’t be able to do much. Soon after, he had been found unconscious after gobbling up all his anti-diabetic medications at once, tipping him into hypoglycemia. 50% dextrose was nowhere to be found on the ward , I had to run to the pharmacy to get it before the man dies.In the mean time we had to ‘improvise’ with  5% dextrose. 

I got to the pharmacy in less than a minute , the pharmacist wanted all the details about the man from the time he was an ‘embryo’ to date. I did not have that information, as such I pleaded that he gives me the infusion and the details will be provided later. He vehemently refused, saying that that was against the laid down rules and doctors always don't obey the rules, they come and take medications away everyday and the pharmacist ends up paying. It took me about twenty minutes to get what I needed. I rushed back to the ward. My boss called me on my phone to tell me not to worry since the patient had passed on . After making the call he turned around to go only to see me standing right behind him with two liters of 50% dextrose which had no use any longer.

I was completely burnt out by the third day. Medical school had trained me for the stress but this mental stress was devastating. It was so bad that I had a relapse of the vicarious ptsd (post traumatic  stress disorder) I had about fifteen years ago after watching on tv children having their limbs cut off  during the Liberian and Sierra Leonian civil wars. I had to stay out of the emergency room, seeing an open fracture could trigger flashbacks of what I watched.

Nonetheless I still had to continue my work. I went to the blood bank to retrieve blood for a patient. While I was waiting for the laboratory scientist to finish the paper work a strange incident occurred. A house officer rushed into the blood bank. A 24 year old man who was involved in a fight had been rushed in with laceration on his right upper arm which had transacted the brachial artery. He had lost about two liters of blood and was still losing more when he was rushed in. That was the information the house officer provided in one single breath. The lab scientist did not lift his head from the notebook he was writing in as he answered that there was no blood and that the house officer was just making a mountain out of a mole hill, he was probably not going to even use the blood and it will be wasted. The house officer did not waste his breath to argue, he quickly opened the fridge that contained the crossmatched blood, looked through and picked four bags of O negative  blood and run out of the blood bank with the lab technicians hot on his heels.

I found out later on that the patient had been saved by that bold and reckless but necessary act. There had been talks too of suspending the house officer but  the relatives of the patient had threatened legal action against the hospital for  attempting to deny their relative a life saving intervention. They agreed not to pursue that course only if the house officer went scot free.

After a week my relapse had completely shut me down. I could not sleep without hearing voices of screaming children and people lying in the streets bleeding to death from limbs that had been chopped off. I had to  go for psychiatric review and go through a series of  treatments, that cost a lot of money which I did not have .There was no healthcare plan to support any health worker in such cases where the nature of the work itself made it a health hazard, after all the relapse was all caused by the job.

In the end what had broken my heart  was not my own poor working conditions but watching on helpless as my fellow human died a preventable death.

E.Y.