Monday, July 6, 2009

First day of elective

Finally monday the 6th of july has come around. This day marked the beginning of my 5 week elective in the National hospital Abuja. I woke up brimming with excitement and expectation with a slight dose of uncertainty as to what to expect. I left home with enough time to get to the hospital for 8.30 am. Took a taxi and arrived there within 20 minutes of leaving my home, the hospital turned out to be closer than i expected. I found my way- with the help of a couple of people- to the office of the director of clinical services., where i was expected to report. Emmanuel welcomed me into the office with a cursory greeting. He gave me a letter to pass on to the secretary of clinical medicine, the department to which i had been requested to be attached.

I proceeded to the aforementioned office only to meet a locked door. As i waited on the secretary, I ran into an aunt of mine whom i hadn't seen in a while. Small world! The secretary finally arrived and took my letter. We chatted for sometime, afterwards he introduced me to the head of the department: Dr UE. He was nice and asked his registrar: Dr F to device a roster for me for the rest of my stay on the elective. He asked what my expectations were and stated what they could provide me. I left with Dr F to the wards to be introduced to the rest of the team. Up until this time i was impressed with the hospital enviroment. It appeared clean and relatively well kept. On reaching the wards i met a house officer (Dr O) in the middle of educating a newly diagnosed diabetic patient. The following conversation took place between us
Dr O: Where you from?
Me: Here
Dr O: I mean where do you go to med school
Me: Dublin
Dr O: Oh ok. What language do you speak there
Me: English
Dr O: Do you still remember our pidgin english?
Me: Of course!

She then turned to the patient and behan to explain the intricacies of diabetes in Pidgin english. It was quite a feat. Her communication skills were good and her way with the patient admirable. She simplified the concepts for the not so literate patient. I wondered to myself if i would be able to do same if put in the same position. After this patient education episode I met another house officer Dr B. He took me to accident and emergency to see a couple of patients.

The first A&E patient was a female with diaorrheoa and projectile vomitting. (stay out of her way did i hear you say!) We took blood cultures from her and the doctor instructed her to go pay and take the bloods herself to the lab. This was the first thing that struck me as odd. Asking a patient on intra-venous fluid to pay for and hand in her blood tests herself was harsh to say the least. Little did i know there was worse to come.

We moved to the next patient who was unresponsive and in pain with neck stiffness and an ear discharge. He looked in a very bad way. Tests came back to say that he was HIV positive. This was the first patient i'd met with HIV and i'm told to brace myself to meet many more. Sad part is that he had 2 wives who probably have the virus as well. to ascertain the aetiology of the patients illness, the doctor needed a scan of the brain which was quite expensive. There was a tussle between the doctors on the nurse on whether the scan should be done before it is paid for. The nurse didn't want it done but the doctor in a show of true concern and altruism, offered to give up a portion of his salary to see the patient have the scan. The hospital eventually agreed to perform the scan before the money is paid. Money was a constant issu in the care of patients through out the day. Nurses refused to clean up patients if relatives didn't have nappies for them. Relatives were sent to go buy drugs, needles and the like. The care was patchy and many times patients were left on their own in pain with no one to attend to them. Privacy was not a priority, patients were left exposed as different people trooped in and out. The casualty department was inefficiently run and the nurses and some of the doctors not the friendliest of people one'll ever meet. I can only guess that they're victims of their situation. Their aggression and impatience only an expression of the fustration they feel working in a harsh enviroment

While there two victims of road traffic accidents showed up with extensive injuries. An especially unfortunate case was the woman with a 9 month old pregnancy. I sure hope she didn't lose the baby as a result.

One Case that saddened me was Mr M.S in bed two who went to a hospital where his malaria and renal failure could not be handled properly on being sent to the national hospital results showed he had a creatinine of > 1000 which is associated with an increased mortality. Nothing against him but I think it's unlikely he pulls through. I hope i'm wrong. Back to the HIV patient i mentioned initially, he probably noticed some symptoms but paid them no heed as to do so would put a big dent in his pocket. Now he is quite sick and the outlook isn't looking great.

I left at the end of the day with a feeling that things could and should be much better. It's such a shame that one's ability to pay determines the outcome and standard of care delivered. In cases where time is of the essence, no soothsayer is needed to tell that morbidity and mortality will only go one way: not down!

It has to change!

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