All I can say is, I don’t know how they do it. I have finished my time in A&E and have been on female medical ward for the last week and a half. The female medical ward is housed in a new facility that opened several months ago. There are approximately 8 patients per room. Patients have to bring their own sheets, clothes, toilet paper, water, and any other supplies that they might need. There are many nurses and even more nursing students around, but I have yet to figure out exactly what they do. Care by the nursing staff is haphazard at best.
It is so busy here! There are two interns who take care of 60-80 patients at any given time and every 3rd day they do a 36 hour shift. Rounds every morning are quite exhausting and interminable. We either help the interns pre-round (this may involve checking vitals, starting IVs, updating orders) or we round with the sole internal medicine consultant (in the country!) during bedside teaching rounds. There are about 20 medical students who attend these rounds and it is the only semi-structured teaching they receive during their internal medicine rotation. I spent some time going over a few cases with them and though they are eager and enthusiastic to learn medicine I worry about how they will develop the skill sets needed to identify and manage disease processes.
Unfortunately, because the wards are so busy and it is often only the interns around to manage patients, many things are missed or overlooked. Labs take a long time to return and once they do show up may be forgotten until the next day on rounds. A patient’s clinical status may deteriorate without anyone recognizing or alerting a physician of the change for hours. There is a lot of death and, unfortunately, sometimes it seems all but inevitable.
Despite all the obstacles present, the best part about being here is the patients I get to work with. There is such a sense of gratitude and appreciation for the care that they receive and readily acceptance and trust even when things do not go quite right. There is such strength and resilience in the human spirit.
Yesterday was the last day of the rotation and I spent part of the day in medical records going over a couple charts of patients that I had heard about or taken care of. As I sat on the hard wooden bench, in the cloying sticky heat waiting for them to pull the records, I looked around and saw the tall shelves of recorded births and deaths at GPHC for the last 50 years. It was particularly striking to me at that moment that somewhere amidst all of that paper, the record of my birth could be found. Looking at GPHC currently, it is hard to imagine what it must have been like so many years ago. Nonetheless, I feel like I have come full circle and I never could have predicted it. I am grateful for the opportunity to be here and I look forward to creating opportunities to come back to teach, work and help build up the healthcare of Guyana.