Hello again, coming to you from paradise, well, almost paradise!
On some days it is difficult to remind myself that I am living and working in a third (or fourth) world environment. The doctors working here are very conscientious, well trained and qualified. The clinic, though dirty, moves patients through in a productive and orderly fashion. The x-ray department provides good quality films and the portable ultrasound machines are nearly as good as what I am used to working with back home. The surgical suite is clean, well stocked and air conditioned. Anesthesia service functions much the same as in the states. All is well, until the doors fly off. Here is the tale of my last night on call:
The daylight hours had gone well with 3 major gynecology surgeries and a late afternoon Cesarean. I was able to stop work at 5:30 and come home to relax and have one of Tyronza's fine suppers. I was tired and went to bed at 9:30pm only to be awakened by the telephone at 11pm. The emergency room was calling with a patient that had an acute abdomen and they were requesting my presence, so I hurried in to the hospital.
The patient was indeed in great distress with a rapid pulse and low blood pressure. A quick urine pregnancy test was positive and her hemoglobin was 7.6 gm. A few steps over to the clinic allowed me to retrieve my portable ultrasound machine and two minutes later her problem was obvious. An abdomen full of blood confirmed my fear of an ectopic pregnancy. We started two IV's and requested two units of blood for "stat" cross match. It seemed just like the big city; but that was when reality struck and the third-world medicine thing came home to roost.
The power around here is notoriously unreliable. It seems to go off and on multiple times each day and we are use to the big generator kicking on when this happens. This time when the power went off, the big generator didn't come on. A quick check showed that Dixon, one of the station's trouble shooters, was on generator call. He only carried a cell phone, which was also out and so I had to send the hospital guard out to find him. Meanwhile the patient in shock is needing blood; but, without power the cross match is stalled! Dixon was finally located and was able to start the little generator. The big generator could not be resuscitated! I thought my problems were solved. I had power in the ER and in surgery, but soon discovered there was still no power in the lab. The lab guy, Andy, was sitting over there in total darkness and was still no help. He reported that he could do a group and Rh on the patient, if he had a flashlight. I retrieved my headlamp from the clinic and gave it to him with my blessing. In a few minutes , he discovered that the patient had 0 negative blood. He handed me two units of blood and I headed back to the ER. On inspection, I discovered there was no Rh factor on either unit. Both the ER staff and Andy said this was alright, because all people in Papua New Guinea are Rh negative. Andy said, "We never check the Rh factor on any blood we use." I had seen several locals that looked like there was a "honky" in the wood pile, but said nothing. We finally gave the patient the two units without difficulty and surgery, two hours late, took care of the problem. By 2 am I was back in bed, only to be awakened at 3:30.
This time it was a nurse in delivery who had just delivered a term baby with meconium aspiration. The power had again gone off at a strategic moment and she was not able to suction the baby very well. I tried to suction the child out and do percussions and drainage as best I could, but he was retracting a lot and I felt sure he would die. In the third world there are no respirators; even if we had reliable power to run them. The baby would have to "take a chance".
The next morning, the nurse seemed pleased and the baby did seem to be breathing easier. I peeled back the diaper for a closer look and was met with a big stream of urine followed by a full arrest. He would not resuscitate!
Life is cheap here in the bush and with unreliable power it doesn't show any sign of getting better. It is fortunate there is always reliable power with God. He is always there to make our light shine; we need only to believe and ask.
I hope your day goes better than mine. I think about you guys a lot.
God Bless,
Scot & Tyronza
No comments:
Post a Comment