A bit medic-ed out

Wowser! I’m really feeling quite burned out after this week. It’s been pretty non-stop, with 8.30 ward rounds lasting until 11.30, clinics from 2pm to 5pm, then I’m back in the evenings to keep an eye on the kids mostly. Not finding much time for blogging, finishing my research, or just relaxing. I’m finding that I’m craving a cold bottle of coke each day to get me through the day! Ugh oh…

I’m learning a lot, and there’s a lot more to learn. And not just pure medicine either. As with any patient, clinical and medical science aren’t the only toolboxes used to treat people. The social, cultural, and physical environments play a large role in the treatment of any patient, but over here, they’re very different from the UK.

I’ve seen a lot of very sick young children. 4 have died this week in the hospital. A few things I’ve picked up:

Children are generally at the bottom of the pecking order when it comes to the food. Men eat the best bits, cos they ‘work the hardest’. Malnutrition is widespread and an be very severe, making children more susceptible to disease and reducing chances of survival. This is the ‘hungry season’ when people don’t have a lot of stored food/money available, and food is expensive. Many people eat only 1 or 2 meals a day.

When sick, many patients will first try the local medicine (I haven’t managed to coin a phrase that doesn’t sound like I’m trying to mock it). This is cheaper than going to the hospital. Everything must be paid for here (thank you NHS/‘socialised medicine’). Patients’ families are generally very shy about disclosing use of the local native medicine, or ‘country medicine’. They have denied its use despite seeing the remnants of herbs smeared on the patients. This may be because healthcare staff scald them about using it, embarrass them, and adopt a very ‘told-you-so’ attitude.
So, patients are often delayed.

The management of healthcare: you can’t blame poverty for everything. I’ve seen that there can be miscommunications, mistakes, and poor organisation. There are no drug charts by the bedside, no whiteboards to give ‘at-a-glance’ views of patients, and there are very real language barriers (Krio, English [British and American], Limba, Temne, Susu, Fullah, uncommunicative). Patients’ records are basically small index cards, leaving little room for expanding on histories, and making clear procedures that have been ordered etc.

There are a lot of things that can be done that require little money, but could make a big difference in morale, efficiency and communication – all vital for safety and healthcare delivery. You can’t just throw medicines, equipment, doctors and nurses at people and hope for the best. There have to be good systems in place that can make full use of all resources for patients’ safety (first do no harm), and for effective treatment.

There are reasons why many of those seemingly straight-forward things aren’t in place. In the past, local wannabe doctors used to come to the hospital, look at drug charts/patients records, and remember how they were treated, so that they can treat patients illegally outside of the hospital. Emergency drugs are locked away, and access given only to very few people – not because they want to make life difficult for emergency patients in the middle of the night, but because they will be stolen and sold. Sometimes by healthcare staff who make a pittance and want to boost their salary.

I promise a less medicy entry next.