Second day back at the hospital & there doesn't appear to be enough syrup & evap milk to soften the blow.
There was a lot of activity at ICU medicine first thing - crowds of people & two of the deputy directors were over there, one of them had a stethoscope around his neck. Curious I joined the crowds. A doctor from the hospital was sick, literally dozens of doctors, nurses & midwifes milled around them - there was a lot of shouting, fussing, an awful lot of arm & leg squeezing but no one had taken blood cultures, done an ECG or thought about requesting an chest X-ray.
ON was talking about shock index (thanks to the recent Emergency training by an american delegation - I of course have been talking about the treatment of shock for 15 months but as we are all well aware by now, I clearly know nothing about anything) & he was agonizing over giving the patient more than 10 drops a minute of normal saline for fear of overloading them (the pulse was 130 but we didn't know what the rhythm was because everybody was ignoring my suggestion that we do an ECG). The patient had been given their own private room. Obviously every other patient in the hospital was being ignored - business as usual then....
J joked with ON that perhaps if the nurses treated all patients as if they were members of staff it would improve patient care. I chipped in that it could also be the hospital motto "Here we treat every patient as if they were one of our own family". Oh, how we laughed.
J, R & I then went to the paediatric ward which is currently heaving with children with dengue fever. Not the mild clinical syndrome that expats get & are admitted to private clinics for IV fluids & the clinics profit. This is the much more serious Dengue haemorrhagic fever & shock from which many Cambodian children will die as a result - this years epidemic is a bad one. Visiting the paediatric ward is not a very cheering thing to do right now.
In the NICU was a premature new born. Two student nurses stood, like statues, over the baby holding a bag valve mask 10 cm away from its mouth. We asked them what they would do if the baby stopped breathing, their response "Chest compressions". We asked them what instructions the trained staff had given them, their response "None". We asked the trained staff why a newborn premature baby with respiratory distress had been left with two year 2 student nurses unsupervised. We were told they were only able to record vital signs. It didn't really feel like the answer to our question.
We went for lunch at the new hospital canteen, work commenced on it 3 months ago. The ER still remains unfinished, work commenced on that before I even arrived here. Good to know that everyone has their priorities straight.
After lunch there were more throngs of people outside ICU, this time an Ambulance was taking the same staff member down to Calmette Hospital in Phnom Penh. Again every staff member it seemed in the whole hospital was there to shout & fuss & limb squeeze.
It was only after the ambulance had pulled away & the crowd had dispersed that I noticed the dead young man laid out on a stretcher outside of ICU - not on the porch but on the path, uncovered in the mid day sun. As I am suffering from concussion & a dose of psychosclerosis as we walked past him I mentioned to J how it was nice they were leaving corpses outside fully exposed now.
He had been there the whole time that the throngs of people had been transferring the staff member into the ambulance - ignored by everyone. R had already been informed by the hospital main gate security guard (AKA triage) that a patient had come a while ago with an electrocution. He had probably been dead on arrival.
His family then arrived & the father afforded his son the dignity in death that none of the staff had considered to do, he covered him with a sarong. He then held him & wailed.
Its days like these that really put things in to perspective.
There was a lot of activity at ICU medicine first thing - crowds of people & two of the deputy directors were over there, one of them had a stethoscope around his neck. Curious I joined the crowds. A doctor from the hospital was sick, literally dozens of doctors, nurses & midwifes milled around them - there was a lot of shouting, fussing, an awful lot of arm & leg squeezing but no one had taken blood cultures, done an ECG or thought about requesting an chest X-ray.
ON was talking about shock index (thanks to the recent Emergency training by an american delegation - I of course have been talking about the treatment of shock for 15 months but as we are all well aware by now, I clearly know nothing about anything) & he was agonizing over giving the patient more than 10 drops a minute of normal saline for fear of overloading them (the pulse was 130 but we didn't know what the rhythm was because everybody was ignoring my suggestion that we do an ECG). The patient had been given their own private room. Obviously every other patient in the hospital was being ignored - business as usual then....
J joked with ON that perhaps if the nurses treated all patients as if they were members of staff it would improve patient care. I chipped in that it could also be the hospital motto "Here we treat every patient as if they were one of our own family". Oh, how we laughed.
J, R & I then went to the paediatric ward which is currently heaving with children with dengue fever. Not the mild clinical syndrome that expats get & are admitted to private clinics for IV fluids & the clinics profit. This is the much more serious Dengue haemorrhagic fever & shock from which many Cambodian children will die as a result - this years epidemic is a bad one. Visiting the paediatric ward is not a very cheering thing to do right now.
In the NICU was a premature new born. Two student nurses stood, like statues, over the baby holding a bag valve mask 10 cm away from its mouth. We asked them what they would do if the baby stopped breathing, their response "Chest compressions". We asked them what instructions the trained staff had given them, their response "None". We asked the trained staff why a newborn premature baby with respiratory distress had been left with two year 2 student nurses unsupervised. We were told they were only able to record vital signs. It didn't really feel like the answer to our question.
We went for lunch at the new hospital canteen, work commenced on it 3 months ago. The ER still remains unfinished, work commenced on that before I even arrived here. Good to know that everyone has their priorities straight.
After lunch there were more throngs of people outside ICU, this time an Ambulance was taking the same staff member down to Calmette Hospital in Phnom Penh. Again every staff member it seemed in the whole hospital was there to shout & fuss & limb squeeze.
It was only after the ambulance had pulled away & the crowd had dispersed that I noticed the dead young man laid out on a stretcher outside of ICU - not on the porch but on the path, uncovered in the mid day sun. As I am suffering from concussion & a dose of psychosclerosis as we walked past him I mentioned to J how it was nice they were leaving corpses outside fully exposed now.
He had been there the whole time that the throngs of people had been transferring the staff member into the ambulance - ignored by everyone. R had already been informed by the hospital main gate security guard (AKA triage) that a patient had come a while ago with an electrocution. He had probably been dead on arrival.
His family then arrived & the father afforded his son the dignity in death that none of the staff had considered to do, he covered him with a sarong. He then held him & wailed.
Its days like these that really put things in to perspective.
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