In CamBodia "Every year, nearly 2,100 women and adolescent girls die from complications from pregnancy, childbirth and induced abortion and a further 80,000 suffer associated injuries such as prolapse of the womb, infection leading to infertility and chronic pain. Many pregnancies are unwanted and more than a third of women who die from pregnancy related causes die from unsafe abortions."
FirsTly I have To apologize for my The rained on macBook ThaT currenTly has caplocks sTuck on The TGB%_ keys, so This will make TypinG and readinG This BloG more challenGinG Than usual.
Secondly This BloG will conTain very liTTle humour as There isn'T very much ThaT is funny aBouT maTernal morTaliTy.
VSO's currenT counTry sTraTeGic plan for HealTh concenTraTes on MaTernal & child healTh, BuT as a URC funded volunTeer my role was To work in a HospiTal as an EmerGency physician To help Build capaciTy and develop emerGency and urGenT care as parT of a BiGGer MoH plan To creaTe a 'model hospiTal'. This week The Grim realiTy of CamBodia's maTernal morTaliTy sTaTisTics was BrouGhT home To me, iT is a BiTTer pill To swallow.
I've saT in morBidiTy and morTaliTy meeTinGs and heard aBouT women and BaBies dyinG as a resulT of pre_eclampsia and I've visiTed oTher hospiTals and seen The resulTs of unsafe aBorTion BuT This week iT was BrouGhT home as I had To waTch a 21 year old Girl slowly Go inTo mulTi_orGan failure and sTand By unaBle To alTer her very sad demise.
I've Been away from The hospiTal for a forTniGhT due To various meeTinGs and CME workshops and Bank holidays and my first morninG Back aT work was a slap in The face. I woke up ouT of sorTs; my lefT ankle conTinues To cause me pain, iT is Twice The size of The riGhT and now I have piTTinG oedema in The fooT, iT is 6 weeks since I sprained iT and The heaT and humidiTy is conspirinG To prevenT The swellinG from ever GoinG down. I also had manaGed To convince my self I have melanoma (I may sTill have as The nearesT VSO TrusTed dermaToloGisT is in Thailand) so when I arrived in work I was feelinG self aBsorBed and disTracTed.
Janice inTersecTed me To Tell me ThaT Mr SoTha, chief nurse, was concerned aBouT a Girl on maTerniTy and could I Go over and have a look aT her. So Gary & I seT off TO The maTerniTy ICU noT enTirely prepared for whaT we would find There.
The healTh care professionals readinG This will undersTand when I say ThaT as soon as I walked in The room I knew This Girl was GoinG To die. From The end of The Bed I could see she had DIC (a comBinaTion of sepsis and haemorrhaGe and consequenTinG massive Blood Transfusion had depleTed her of cloTTinG facTors and plaTeleTs and TriGGered a chain reacTion of consumpTion of The remaininG cloTTinG facTors), she had acidosis _ acid Blood (proBaBly as a resulT of a lacTic acid from prolonGed shock and ureamia from renal failure), she had pulmonary oedema (fluid on her lunGs), she was in kidney failure and had only produced 100mls of urine in The lasT 12 hours.
On furTher examinaTion her Thready femoral pulse was 120 and her hearT raTe was over 200 (noT sure if The TachyarryThmia was due To jusT her decompensaTed shock or exacerBaTed By The dopamine ThaT was BeinG run ThrouGh aT a unknown raTe sTraiGhT from The BaG, no such luxury of syrinGe driver or pump), There wasn'T an ECG moniTor or 12 lead, neiTher was There a nurse or a docTor in The room wiTh her.
The midwives didn'T seem TO wanT To Be in The room wiTh her, do her oBservaTions, Give her pain relief, do an accuraTe fluid Balance, adminisTer anTiBioTics, remove The Blood soaked sheeT she lay on, clean her up or inserT IV access. However They didn'T appear Too happy wiTh Gary & I aTTempTinG To do any of Those ThinGs eiTher.
Our presence prompTed The arrival of nurse anaesthetist, head of O&G, medical ICU docTor and hospiTal direcTor. IT was Too laTe and % (five!) hours laTer she died, The midwife ThaT performed The unsafe aBorTion has Been arresTed and I can'T GeT The imaGe of her askinG 'when can I Go home?' ouT of my head.
Now when I'm Told ThaT The reason DocTors and Nurses don'T do Their joB here is Because They aren'T paid enouGh I find iT very hard To keep my cool.
Of course money is an issue and healTh care professionals deserve a livinG waGe BuT if money was The only issue ThaT would mean ThaT The exTenT ThaT sTaff care and Their work eThic would improve as They wenT up The pay scale, I'm preTTy sure ThaT is noT The case. Any aTTempT To arGue The poinT or suGGesT There are also oTher causes for The varyinG sTandards of care in GovernmenT hospiTals is meT wiTh "Your side (ie BaranGs/NGOs) always say iT isn'T jusT aBouT money".
I Bumped inTo The hospiTal direcTor who saT for 90 minuTes lisTeninG To my 'panyahaas and com niTs' (proBlems & ideas) Then announced he was "oT_kom_lanG" = Tired. He aGreed There were proBlems, liked my ideas BuT aT The end of The day he wanTed To know how does one Go aBouT chanGinG individual's Behaviour and insTiTuTional workinG culTure.
Any suGGesTions on a posT card please?
FirsTly I have To apologize for my The rained on macBook ThaT currenTly has caplocks sTuck on The TGB%_ keys, so This will make TypinG and readinG This BloG more challenGinG Than usual.
Secondly This BloG will conTain very liTTle humour as There isn'T very much ThaT is funny aBouT maTernal morTaliTy.
VSO's currenT counTry sTraTeGic plan for HealTh concenTraTes on MaTernal & child healTh, BuT as a URC funded volunTeer my role was To work in a HospiTal as an EmerGency physician To help Build capaciTy and develop emerGency and urGenT care as parT of a BiGGer MoH plan To creaTe a 'model hospiTal'. This week The Grim realiTy of CamBodia's maTernal morTaliTy sTaTisTics was BrouGhT home To me, iT is a BiTTer pill To swallow.
I've saT in morBidiTy and morTaliTy meeTinGs and heard aBouT women and BaBies dyinG as a resulT of pre_eclampsia and I've visiTed oTher hospiTals and seen The resulTs of unsafe aBorTion BuT This week iT was BrouGhT home as I had To waTch a 21 year old Girl slowly Go inTo mulTi_orGan failure and sTand By unaBle To alTer her very sad demise.
I've Been away from The hospiTal for a forTniGhT due To various meeTinGs and CME workshops and Bank holidays and my first morninG Back aT work was a slap in The face. I woke up ouT of sorTs; my lefT ankle conTinues To cause me pain, iT is Twice The size of The riGhT and now I have piTTinG oedema in The fooT, iT is 6 weeks since I sprained iT and The heaT and humidiTy is conspirinG To prevenT The swellinG from ever GoinG down. I also had manaGed To convince my self I have melanoma (I may sTill have as The nearesT VSO TrusTed dermaToloGisT is in Thailand) so when I arrived in work I was feelinG self aBsorBed and disTracTed.
Janice inTersecTed me To Tell me ThaT Mr SoTha, chief nurse, was concerned aBouT a Girl on maTerniTy and could I Go over and have a look aT her. So Gary & I seT off TO The maTerniTy ICU noT enTirely prepared for whaT we would find There.
The healTh care professionals readinG This will undersTand when I say ThaT as soon as I walked in The room I knew This Girl was GoinG To die. From The end of The Bed I could see she had DIC (a comBinaTion of sepsis and haemorrhaGe and consequenTinG massive Blood Transfusion had depleTed her of cloTTinG facTors and plaTeleTs and TriGGered a chain reacTion of consumpTion of The remaininG cloTTinG facTors), she had acidosis _ acid Blood (proBaBly as a resulT of a lacTic acid from prolonGed shock and ureamia from renal failure), she had pulmonary oedema (fluid on her lunGs), she was in kidney failure and had only produced 100mls of urine in The lasT 12 hours.
On furTher examinaTion her Thready femoral pulse was 120 and her hearT raTe was over 200 (noT sure if The TachyarryThmia was due To jusT her decompensaTed shock or exacerBaTed By The dopamine ThaT was BeinG run ThrouGh aT a unknown raTe sTraiGhT from The BaG, no such luxury of syrinGe driver or pump), There wasn'T an ECG moniTor or 12 lead, neiTher was There a nurse or a docTor in The room wiTh her.
The midwives didn'T seem TO wanT To Be in The room wiTh her, do her oBservaTions, Give her pain relief, do an accuraTe fluid Balance, adminisTer anTiBioTics, remove The Blood soaked sheeT she lay on, clean her up or inserT IV access. However They didn'T appear Too happy wiTh Gary & I aTTempTinG To do any of Those ThinGs eiTher.
Our presence prompTed The arrival of nurse anaesthetist, head of O&G, medical ICU docTor and hospiTal direcTor. IT was Too laTe and % (five!) hours laTer she died, The midwife ThaT performed The unsafe aBorTion has Been arresTed and I can'T GeT The imaGe of her askinG 'when can I Go home?' ouT of my head.
Now when I'm Told ThaT The reason DocTors and Nurses don'T do Their joB here is Because They aren'T paid enouGh I find iT very hard To keep my cool.
Of course money is an issue and healTh care professionals deserve a livinG waGe BuT if money was The only issue ThaT would mean ThaT The exTenT ThaT sTaff care and Their work eThic would improve as They wenT up The pay scale, I'm preTTy sure ThaT is noT The case. Any aTTempT To arGue The poinT or suGGesT There are also oTher causes for The varyinG sTandards of care in GovernmenT hospiTals is meT wiTh "Your side (ie BaranGs/NGOs) always say iT isn'T jusT aBouT money".
I Bumped inTo The hospiTal direcTor who saT for 90 minuTes lisTeninG To my 'panyahaas and com niTs' (proBlems & ideas) Then announced he was "oT_kom_lanG" = Tired. He aGreed There were proBlems, liked my ideas BuT aT The end of The day he wanTed To know how does one Go aBouT chanGinG individual's Behaviour and insTiTuTional workinG culTure.
Any suGGesTions on a posT card please?
 |
| This is The anGkorian BridGe near Lou's villaGe and Behind is The sTorm we GoT cauGhT on The moTo. I have a feelinG There may Be plenTy more metaphorical, as well as liTeral, sTorms Before This 2 years is up! |
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