Thursday, July 29, 2010

Another day in the hospital...

The day started with a flat tire and lots and lots of rain. Fortunately for us, we had a spare tire. Unfortunately it was a different type and the bolts were missing. However, the driver managed to find and buy bolts and changed the tire. By 8:30 we were finally on our way to the hospital.

Shortly after arriving, we went to the wards to check-up on the staff. The power was out and sadly the generator was not working. Hence, the children in the ER and ICU were not getting oxygen. Arriving in the ER we found one of the doctors ventilating a neonate. Luckily after about 30 min, the neonate started breathing again.

Only minutes later we were assessing a 1-year-old malnourished child. She had come in the previous day, in shock. Her breathing was now very shallow and her pulse slow. We started ventilating with bag and mask and doing chest compressions. Adrenaline after adrenaline and continued CPR proved to be unsuccessful. Another child gone.

As we were leaving the ER, a man with a large video camera rushed in. Before we knew it about 30 people were standing in the ER with a lot of press. It was the honorable Mary Robinson (former President of Ireland) and the Vice President’s wife. Having been caught up in the resuscitation only minutes before, I had forgotten about the visitors. After brief introductions and handshakes I hurried off to the neonatal unit.

After our informal ward check we headed back to the office. Fortunately the power was back on and I could send out some important emails. After catching up on a few emails I quickly checked facebook. Yes, Welbodi and Rebecca won the Vodafone Competition – second place.

Next I had to check up on our monitoring/evaluation/statistics staff. And what I thought would be a quick check-up turned into a meeting. It was a meeting with three groups, all collecting and reporting hospital data. Surely there is a way to make this system easier, more effective and more accurate. I am hoping they will see that the Welbodi system is the most efficient way to do it.

As I stepped out of that meeting, it was time for another – the pharmacy meeting. A brief meeting to discuss the way in which patients on the wards get their medication. Do the nurses go to the pharmacy to collect the drugs for each patient? Do the mothers need to go to the pharmacy? Do they need to show the charts as proof of what was prescribed? It is a very complicated system. The only real solution is of course having the medication on the wards at the nurses’ station. However, this is a huge step from where things are at now. A deeper level of trust needs to be reached, before this can take place.

Next was a meeting with the doctors. A chance to relay information to them and help them improve. A time to listen to them as they discuss problems on the wards affecting patient care. I’ll spare the details but let’s just say a lot was discussed. And there is a lot that needs to be done in so many fronts.

My meetings were done for the day. I had one more thing I had to do. Bring some extra (newly introduced) fluid balance sheets to the neonatal unit. A five minute job. In the unit, I saw the child that had been resuscitated in the morning. He looked awful. Grim, shallow breathing, very distended abdomen. All around poor. I quickly went to alert the medical officer in charge of the ward. As we were assessing the child, he quickly deteriorated. We started ventilating the child and shortly after we had to start compressions. I already knew this child had very little chance of surviving. As the granny watched on from a distance we continued the resuscitation. But after about 15 minutes, we knew it was over. Sadly I had to tell the granny that her grandson had died.

At 5:30 pm we headed home for a few hours before returning to the hospital. Our mission for the night was to do a surprise formal ward check. So, at 9:30 pm we headed back to the East side of town. I was anxious as to what we would find during the night shift. And, sadly, many of the rumors I had heard were confirmed.

Needless to say, it was a tough day. Busy, frustrating, discouraging, sad – all of it. But, as I look back on the day, at least I know I did what I could. And although the day was awful, I am still very glad to be right where I am. I am still hopeful that slowly but surely this place will change.

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