Transfers and Bathrooms

 

I have now been here over a month, and am feeling very settled in. I know most of the staff now by name. Most days I feel pretty good about my clinical knowledge and decisions, but am also continually confronted by new cases I don't know much about, or conditions that I need to study up on.

During our first week here, we got to attend the birth of twin girls. Each day after, until they went home, we did a full assessment, monitored their labs, and made sure they were ready to go home. They were so cute. Most of the time, they were huddled together in a basinet, under piles of too-big clothes and blanket, and all you could see were their little faces peaking out. Faces in photos have been blurred for privacy of the patient.

 

 

Mike puzzling over a patient's chart during morning rounds trying to decide the best course of action, with our hospital medical director, Dra. Anita. Our little patient in the background on an oxygen nasal canula.

Daily, I find myself wishing I could do more for many of my patients, but am limited by resources or referral options. For example, I have seen several children with very complex eye conditions, such as congenital glaucoma or cataracts, that they have had for some time. Unfortunately, the only ophthalmologists are over an hour away, and not part of the ministry of health system (in which all healthcare should be free), so most of our patients can't afford the initial consult, and if they do manage that, they are usually soon after lost again, with no follow-up.

Or sometimes patient's wait too long at home, before finally seeking care. One little girl had gotten a caustic material splattered in her eye. By the time her parents brought her in to be seen, a day and a half later, the entire white part of her eye and under her eye lids were bright red and her cornea had started to cloud over. By that point, irrigating her eye was of little use, and we had to send her onward another hour, to seen an ophthalmologist. She was so sweet and brave, and when we asked if it was hurting her, to give her some pain medication, she replied, "no, it just stings."

Mike and I recently completed our first weekend of being on-call. This meant that we would round on all the patients in the hospital once or twice a day, attend the births, and help with any pediatric cases that presented to the emergency room. Needless to say, we were kept busy, thankfully mostly during the days, and nothing major requiring our presence at night. The first child presented  to our ED in an ambulance after having fallen out backward, onto his head, from a moving pick-up truck. He was fairly responsive when he arrived, but proceeded to vomit several times, became more confused, and eventually became unresponsive to verbal stimuli by the time we got the ambulance back to our hospital to take him an hour to Latacunga (the next largest hospital with CT scan and surgery capabilities). Mike went with him and his mother in the ambulance to make sure that he made it there safely.

The next day Mike got to take this 2-3 hour round trip journey again with our on-call obstetrician, when he had a potential breech delivery. We do not have surgery capabilities here, so any pregnancy complication that might warrant a c-section need to be transferred. We had just finished cleaning up lunch, and were in the midst of doing laundry when we got called. He went ahead, and by the time I got up to the hospital a few minutes later, he had already been whisked away in the ambulance again.

I tell this next part of the story, with Mike's permission mind you, because he made me laugh so hard when he told it, that I just had to share it. As he arrived an hour later, after being in the back of an ambulance with no windows and curvy roads, he delivered the patient into the other hospital's emergency room, then urgently had to use the restroom. The first bathroom he tried was clogged, and not usable, so he proceeded down the hall till he found another. This one was available and clean, but he soon realized there was no toilet paper. So he proceeded back to the first bathroom to get the toilet paper. By the time he returned to the second bathroom a second time, he walked in on a child patient, with a parent accompanying, IV pole and all, who had forgotten to lock the door. At this point, he realized the parent and child had no toilet paper either, so he handed off his hard-earned wad of paper, so that the others could carry on with their duties. By this time, four bathroom visits later, and without success, he finally asked a custodian if there was  a third option. She kindly pointed him to a staff only bathroom which was clean and thankfully well equipped with toilet paper. After all this ordeal, he was finally able to rejoin the crew in the ambulance.

I find this story highlights a certain undertone of my time here. I find I am way more aware of my bathroom habits here, than I ever am in the states. You always need to be prepared with your own toilet paper, have 15 cents available, because they aren't always free, and when you encounter a place that has a very clean looking bathroom, use it now, even if you don't really have to go, because you don't know what the conditions will be like at the next one :)