My first lesson on the Wards at MOI hospital in Eldoret is that
resources are limited. As the title of this post indicates,
we do not have the luxury here of tossing broad spectrum
antibiotics to all of the 'really sick' patients (which make up a
great number of the ward patients). Instead, we are forced to
determine what antibiotics are available at the hospital on that
day. Currently, we are limited mainly to penicillin and
gentamycin. I've been told that there is a small stash of
Vancomycin, but I've only seen it used once thus far. If the
patient really needs something other than what's on hand, the
patient is instructed to have family members go to the local
pharmacy and purchase the other antibiotics. If the funds are
unavailable, then things get really difficult…
These limited resources extend beyond medications too.
'Urgent' echos can sometimes take several days and certain lab
tests (ABGs in particular) are quite dependent on the operational
status of the related machines. The hospital is out of IV
contrast for CTs and even simple items like lubricating jelly for
NG tubes are a scarcity (it took me 4 different stations to find a
tube). For many patients, diagnosis of treatable disease does
not necessarily equate to treatment/survival. The ICU is
nearly always full and resuscitation necessities like central lines
and AEDs (Acute External Defibrillator) are unavailable on the
floor. Even the most crucial of treatments, Oxygen, is
difficult to come by as there aren't nearly enough tanks or
condensers in the hospital to support all those in need.
To say that things are different here than in the States would
be a gross understatement. The mortality rate on the WARDS
here is roughly that of the US Intensive Care Units and losing
patients overnight is an occurrence so common that, after only 1
week, I have unfortunately come to expect it.
We do everything we can for the patients, and there are
many success stories on the Wards as well. Even some
extremely sick patients come back to health and are discharged from
the hospital. Unfortunately, even once 'discharged', they
must stay at the hospital until they can pay their bill. This
often leads to a new infection or disease (pneumonia, Tuberculosis,
Deep Venous Thrombosis) that requires readmission and new
treatment. It's a sad merry-go-round that can sometimes
swallow a patient whole, turning a happy 1 week recovery into a sad
6 week hospital stay, bankrupting a family and leaving them to try
and pick up the pieces.
But for every sad story, there almost always seems to be one to
re-boost morale. For every deadly meningitis I see, there
seems to be another case that we successfully treat. For
every heart I watch fail, I see another that is helped. It
can be a sad experience being surrounded by disease and death, but
being able to help even the occational patient makes all the
difference in the world…
Quote of the Post
How wonderful it is that nobody need wait a single moment
before starting to improve the world.
~Anne Frank