Last night, I discovered that getting blood from the government hospital might be more of a challenge. I apologise, this post is quite medical, but so is my life here. I want to tell you about a patient who I have been looking after and some of the challenges which we face here, as well as my feelings and reflections on it. I'll try and write in normal language, but will put some geeky medical details in for those that care.
Two nights ago, I admitted a patient who had been suffering from bloody diarrhoea for nearly a week. Over that time, he had lost a significant amount of blood (his Hb had gone from 10 to 4 g/dL in 4 days) and had become quite unwell. He was severely dehydrated, as well as suffering the symptoms of anaemia - breathlessness, lethargy, and just generally being quite unwell. I did all the simple things and requested some blood to transfuse; this has to be collected from the government hospital blood bank in return for donations from friends/relatives to replenish stocks. After about 4 hours, a single unit of blood appeared for transfusion, with the news that no more was available until the following day. The patient was stable, so I let the doctor on the night shift know all about him and finished my shift.
Last night I was on the night shift, and very early on I was called to the ward to see this same patient. If you're particularly sensitive/squeamish, you just need to know that things had happened which meant that he needed more blood, and I'd probably skip the rest of this paragraph. I found the patient face down on the floor in a metre-long pool of blood and clots, which he'd just deposited as a bowel motion. He was still just about conscious (and somehow had a reasonable BP, but was very shut down).
I'd discovered that on top of this new issue, nothing had really been done for him all day, and even when I arrived, there was no particular hurry to do anything. I decided that wasn't really good enough, so surprised the ward staff by running round the ward finding cannulae and fluids and administering them within a couple of minutes (usually a fluid challenge will take about 30 mins to be given, unless you do it yourself). Without any clever plans to stop the bleeding until the morning, all I could do was give him more blood to replace the losses. After the previous night's issues, I decided to go to the bloodbank myself with 7 donors to request the blood that the patient needed. After a lot of discussion with the staff there and about 1 hour, I returned with 1 unit of blood, having been told that I wouldn't be able to get any more until the morning, despite all my best arguements.
Making the most of what we had, I made a plan for overnight and he recieved the blood and fluid. Thankfully, he was a little bit better by the morning, and I managed to get a second unit of blood for him in the morning (it did take another 2 hours though). The doctor who is currently in charge here took over from me in the morning, and we discussed a plan for the day to ensure he had more blood and was reviewed by someone who could possibly investigate the source of the bleeding. I went to see him this evening, and although he's still stable, nothing has been done for him all day.
Last night was one of the very few occasions where I've become outwardly frustrated/angry in a medical setting. It happens very rarely, when I feel that patients aren't receiving the care that they need for no good reason. I'm not proud that I got angry, it never helps anything happen any quicker, and I think sometimes it might even make people more obstructive, thankfully it didn't last long and the calm me got a lot more done than the angry me. Having slept and thought about it, some of the problems last night were not solveable, but some really were.
In the blood bank, there were many other samples waiting to be matched for units of blood for transfusion for patients who had been shot, had fallen off their motorbikes, had just given birth, and had severe malaria. The 'blood bank' is in fact a fridge, which is barely larger than the one in your kitchen, and serves the whole of the city. If I'd got all the blood I'd wanted last night, it's quite possible that I would have exhausted their stocks of that blood type. So I probably was a bit unrealistic and demanding to expect to get so much blood last night, given the limited-resource setting that I've found myself in, remembering that my patient probably wasn't even the most unwell patient in town.
However, the apparent lack of interest from my colleagues, and the constant excuses of why things can't be done (I had to convince the nurse that the electricity going off in 3 hours was not a reason not to give a blood transfusion, and that the pool of blood which had recently formed on the floor was a very good reason why we should give it now). Maybe I'm too emotional, but I get a bit upset when people don't seem to care. It isn't a problem I have to deal with too much at home, but I don't know how to change the attitudes of a whole hospital (or so it seems). If anyone has any bright ideas, there are many people here who would love you rather a lot.
Anyway, that's enough for today. Sorry it was a bit of a medical rant, I promise my next post will be about my hunt for the best coffee in Juba or something like that.
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