A night in the ER - 8/9/12

Our first overnight in the ER was eventful and a success. Right away we began helping patients that have yet to be seen. Some of them had been waiting for two hours or longer. If it wasn’t for us students taking the initiative to check up on the patients who knows how much longer the patients would have been waiting around to be seen. The doctors and nurses would just sit at the nurse’s station and chat rather than help a patient; I mean we are in the ER! Obviously the patients need urgent care, but yet they sit there and wait and wait. So, the overnight crew consisted of Allison, Chris, Joel, Lee, Trey, and me. As we begin to make our rounds in the ER, we start talking to the patients about what the problem is and then we referred to Dr. Abdulhussein on how to handle the situation. Our first patient seemed to be very lethargic and unresponsive. Our team drew up a blood sample that was sent to the lab to test for hemoglobin and blood glucose. Her results came back normal and so then we hooked up an IV to push fluids in her. I swear by the end of the night I became a professional at setting up IV bags. I think I put together about six IV bags of saline. The next patient who had been waiting around for two and a half hours had some type of severe vaginal bleed that had lasted for more than five days. So with so much blood loss, a blood transfusion was ordered for the patient, which didn’t arrive until almost an hour or more surpassed. One thing to note is the hospital staff work at a sluggish pace, thus why we see so many of the patients suffer in agony for a long period of time. Last night we were attending to one patient after the other as fast as we could. As the ER began to die down around 3am and ready to leave, a patient comes in that was mugged and stabbed multiple times, mainly on his head and hands. Right away when he walked in, we laid him on a bed to start cleaning him up and hurried to get an IV started in him as well as get blood drawn. Because the patient had lost so much blood, it was very hard to find a vein because of vasoconstriction. Each of us had a job responsibility from trying to get an IV started, cleaning his wounds, injecting pain medication, and doing whatever else was needed. It took almost a half hour of trying, but eventually it worked out. After getting a couple IV bags of saline ran through him, we cleaned up his wounds and put a dressing around his head until it was time for him to get an x-ray. We were with him for about three hours. After an exhausting night in the ER, we felt we did the best that we could and made sure the patients were seen by a doctor.

Day in Surgery

This morning I went up to the Major Theatre where the surgeries take place. The first surgery that took place was a transverse fracture of the right femur. The patient also had a large abrasion across his thigh. Before the surgery began, the surgeons sutured a piece of cloth on top of the wound, which seemed kind of odd but there reasoning was so it would not be interfered during the surgery. Preparing the patient for surgery, they used a spinal tap to inject a paralyzer medicine so the patient could not feel his bottom half, so yes, the patient was awake the whole time but did not see what was going on because a sheet was hanging up to cover his lower half. As the surgeons began the procedure, they first took a long metal rod with a sharp end and shoved it right through the patient’s kneecap going back and forth. After doing that for several minutes, then a scalpel was used to slice open the lateral side of the patient’s right upper leg.  As the surgeon was opening the leg, you could see each layer down from the muscle to the bone where the fracture had taken place. Furthermore, the surgeons had to cut done some of the bone to allow for a rod to be put in between connecting the femur back together. Once that surgery was done, I headed down to the Minor Theatre to see if any help was needed. Luckily, had the opportunity to assist with debriding some dead skin off the top of the hand that had 2^nd degree burn from steam. No doctors were around to supervise or bother to help, so it was up to us students to perform this procedure. One of the students is a 4^th year med student from London. Without his knowledge and skills, this gentleman might have been waiting a very long time to have that dead skin removed from his hand.  My job consisted of cleaning the wound with saline periodically as the hand would bleed with the med student from London was cutting away at the dead skin. The patient had about 10 shots of Lidocaine to numb his hand. The procedure went very successfully as the patient did have bleeding while the dead skin was removed. This indicated there was vascularization still going on underneath all of it. Once the procedure was done, we cleaned up the top of his hand and put a clean dressing and was told to return every two days to change his dressing and was prescribed three medications to help with the healing process. The patient was very happy and on his way.

Day 6

Today went to visit an orphanage and the kids were very excited to see us! We checked their vitals and we had just under 200 children from babies to teenagers. We took their weight, blood pressure, temperature, and then each person was seen by a doctor for further evaluation. The doctors would then prescribe medicines and any vitamins they would possibly need. All the medications and vitamins are free to the orphanage kids which is profited by International Medical Aid. Later in the evening, a few others and myself went to the ER. Had the opportunity in assisting to set up an IV as well as pronouncing our first death. Was not a very pleasant moment, but nothing either one of us could have done because the hospital has very very few monitors. We only saw one in the ER. It is very tough to see how bad the medical care and medical professionals are here in Africa. But to an extent, they have so little, and the patients are just left to suffer for no reason. Definitely makes you realize how well off we are in the States and how precious life can really be.

First few days in Mombasa

Sorry for the delay in reporting..need to get better at blogging every day. My first few days here have been quite busy, but very fun so far. I arrived in Mombasa, Kenya at 2:30am local time (6:30p CST) That night I slept until about 12pm. There were a total of 6 people prior to our visit; two from Canada, one from London, and three others from the States. Now in total we have 23 residence in our "compound." We have a few caretakers who clean each housing unit (sleeps 4 each) and cooks meals for us. At night, we have two security guards that walk around the compound. On our first two days we were shown around the town as we needed to buy minutes for our phone and modem for the internet. They have a nice little market village area where you can buy food just like in the states and electronics, cosmetics, etc..The part of Kenya we are staying in is very Westernized. Sunday we went down to the beach for a few hours as we are right along the Indian Ocean. The water is very comfortable, but very salty as well. Thus far, the Kenyan people are very friendly to us 'mzungus' (foreign people). Got to experience the night life and it was quite interesting as they listen to a lot of American music at the bars. The African beer is not too bad, kind of resembles Coors Light. Yesterday, we had our orientation at the Coastal Province General Hospital in Mombasa. We went at night time and boy was it kind of creepy looking. It is an open air hospital. We were given a tour by one of the main doctors and explaining how we will be split up into groups since there are so many of us. They have five main areas that include surgery, minor(sutures, changing dressings)/major (local anesthetics are used) theater, casualty (ER), maternity, and orthopedic. They also have clinics for diabetes, HIV/malaria, and TB. So we will have the opportunity to experience it all while time here. Today, was our start day at the hospital. Nothing like getting hands-on right away as I got to assist in changing a few supra-pubic catheters in the minor theater. This included taking water out of the balloon that is lodged in the urethra and once that is all emptied out then you can remove the catheter. Each wound site with every patient is cleaned with a gauze soaked in iodine. Then once you dab and clean the area the new catheter is lubed up and placed back into the the opening site. Once placed in correctly, water is injected into the catheter to blow the balloon back up so the catheter will not fall out. Then we would attach the urine bag. Besides changing a few catheters, changing dressings was the other main care and watching sutures be removed. So it was a great start to the program!

The nerves are starting to go through my body as I am about to leave for the airport in an hour! Wish me luck and prayers as I am about to endure an 18 hour long flight!