In the Life of a Fickle Intern

March 18, 2014

Hospital Life

Filed under: Daily Lowdown — dailymedicine @ 11:23

A little more than two weeks in and I have already seen more sick patients than probably all of my residency years! Ok, maybe I’m exaggerating some, but the patients here are sick. They come to the ED only when they’re on the brink of death, literally. The people here are very resilient! Because patients wait so long, the pathology that they come in with are really interesting. I’ve seen patients with cerebral malaria, metastatic tuberculous, and the list goes on. Moreover, they don’t complain; they don’t yell; and they are all very pleasant…if they’re awake enough to be pleasant.

The ED experience is similar in many ways to the ED at home, but it’s very different in basic function. They have less resources and their practice is different due to this. When I say less resources, I mean, VERY little resources. Patients’ families are sometimes given a prescription for a medication to take the pharmacy to buy to bring back to the ED for the patient.  And this is a tertiary referral teaching hospital for the country! I wonder what it’s like in the rural parts of the country.

It took a few days for me to determine what my role here was since I don’t speak very much swahili, but now, I think I have established my role as an observer/consultant. Now that the residents know me a little more, they are pulling me into the rooms when they have questions about the patients to get a second opinion. They’re asking a lot of questions which is great. Even though I can’t communicate to the patients, all the doctors and nurses speak in English to each other so I can actively participate. They’re also pulling me into rooms just to see an interesting case.

Patients who come to the ED in Tanzania must pay for all the services provided. This definitely plays a part in the delay of getting medical treatment, but it is kind of nice only to see sick patients. There are very few alcoholics or drug seekers here. It’s a great change of pace. The ED has a total of 9 rooms, but 4 of those rooms can fit up to 5 beds. It definitely can get a little crowded at times. There are only 4 cardiac monitors in the whole department and only two ventilators so they have to be careful who they intubate. They don’t intubate anyone who has a low chance of surviving – HIV patients, TB patients, Hepatitis patients. That would include at least half of my patients in Baltimore!

One of the Peace Corps personnel took us on a tour of the rest of the hospital today. The “ward” consists of a single large room filled with beds that are about 2-3 feet apart. There were 27 beds in one room that was slightly bigger than my living room! There is no separation, no privacy, no anything. There were patients laying on mattresses on the ground. This was a bit overwhelming, but a nice reality check. Americans are so spoiled and the majority of the people don’t realize it. The next time a patient in the ED ask me why they don’t have a TV in their room for their cold and cough, I’m going to show them pictures of the wards in Tanzania! Maybe not, but I would be tempted. 

I am learning so much here, medically and culturally. It is making me realize how little i know of the world outside of work. I just need to remind myself to always keep things in perspective. This has been such a great opportunity and I am so glad to be here. I am already planning my next visit back to Tanzania, but at that time, maybe I’ll just come vacation and climb Kilimanjaro and do more safaris!

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