A Hospital with no drugs.
Yesterday on my ward round I took a
moment. A lightbulb went off in my
head.
I sat and stared at yet another floppy baby
who was having diarrhoea and vomiting. I have about 3 of them on the ward, they all look the same –
and I can’t do anything for them.
I’m just watching them daily, hoping that they will turn the corner…
hoping that they don’t die….. please don’t die little ones, not of dehydration,
not here, not now.
I will share with you The lightbulb moment:
“I simply can’t do this anymore, I can’t watch children die when I have no
drugs to help them” …… “I’ve got to leave”
What’s happened I hear you ask?
Sigh.
It’s complex. Basically the
way it works here is, the patient buys health insurance for a year. It costs
about $10 NZD for an adult and $3 for a child. Once you have insurance the hospital I work for will provide
you free health care and drugs.
Then we claim the money back from the government…..but here’s the thing.
The government is simply not paying.
Granted I can send the family to a store to
buy the medicines needed, we are not in the middle of nowhere like some
facilities, but this means them leaving the hospital (taking the extremely sick
and dehydrated baby with them) and roaming around town, trying to find a
pharmacy that will sell them. As
you know too most of the patients are living in extreme poverty so asking them
to mobilize cash is often difficult and takes time for them to phone their
village and get someone to send money…. Meanwhile the little girl waits.
Cut to me …..now: I’m staring at this 3
month old floppy baby and have no clue what to do. My options are limited. We have no fluids, no oral rehydration salts, no oral
malaria treatment and no oral antibiotics. I have only two IV antibiotics at my disposal – I call
them husband and wife and use them on a daily basis (Penicillin and
Gentamicin). Ok I gotta be
creative. Hmmmmmmm – I beg the
next door patient who no longer needs her normal saline, for it and find a bit of
50% dextrose from the emergency box and mix them together. Whew.
Cut to next baby; fever of 40 - At least we
still have paracetamol I think. I
will watch and wait.
Number three: hmmmmmm – floppy baby – this
one has infection in their lungs – is it pneumonia? Hard to say as the CXR has
spoiled. Bring out the husband and
wife again. They are so reliable.
Number four: one year and no symptoms
besides fever – hmmmm shall I do investigations? – oh hang on ….what was that
lab? No urine strips, full blood
counts, blood sugars, typhoid tests, and no containers for a stool test, huh…?
Ohhhhh No malaria tests either… what?
Ok….. I scratch my head…. Come on Creativity come onnnnn…. Husband and
wife plus malaria treatment.
perfect cocktail, yes! oh
what? Oh yeah that’s right no fluids to put the malaria treatment in…. sorry.
Number five: Febrile convulsion – quick
it’s an emergency – everybody rally around. Keeps going. IVL check. Still going. Diazepam, no. Phenobarb,
nope. Fluids, ahhh nope. Treatment
for meningitis just in case – ha ha ha now universe you are laughing at
me. Convulsion not
stopping. At least I can inject
you with quinine. At least I have hope that you are young and it won’t be
serious. At least I still I have
two fingers I can cross with. It’s
these times I kinda wished I was religious.
Seriously though – I hear the loud
carpenters banging away building our new radiography area that will be first
rate in Bolgatanga…. And I’m sitting once again staring at a baby trying to
work out how to save them…. can I live with myself if he/she dies because I
couldn’t give the treatment they needed, because I couldn’t live up to my Hippocratic
oath of ‘do no harm’, can I watch them die as the xray area is being built in a
hospital that simply has NO drugs.
Lightbulb moment
When is the next flight back to NZ? ……..
this is a true example. - look at all the 'Nil's
