Practicing medicine in a hospital with limited personnel and resources requires additional thought and focus to provide optimal care to patients. The local health care providers have a harder job than I do back in the States. On my second day in the hospital, the nursing staff went on strike because they were not receiving enough support from the hospital and nursing administration. The Accident and Emergency Department (A+E) is understaffed with nurses, at times having only 1-2 nurses for patients in 20 beds, about 10 chairs, in addition to many patients that are evaluated and sent back to the waiting room to await results. This leaves the few nurses available overworked and stressed to try and keep up with monitoring vital signs, administering medications, and coordinating patient care. Fortunately the strike was resolved by the end of the afternoon after the nursing staff meet with the director of the A&E, who continues to be a powerful advocate to the hospital administration on behalf of the nurses and staff of the A&E.

Supplies and medications are also of very limited supply. On my first day we had to take supplemental oxygen from a patient undergoing evaluation for shortness of breath, and instead give it to a new patient presenting with respiratory distress. Only a few of the beds have an oxygen attachment or monitoring devices, so they are always in high demand. And even then, finding the correct wires and tubing requires a fair amount of time and effort. Furthermore, the medications and antibiotics available changed on an almost daily basis. There was one week in particular where we were unable to provide aspirin in the hospital - this is certainly not ideal when treating a patient with a heart attack. And unfortunately the one ultrasound machine in the A&E was broken. The limits of space and resources make the triage process even that much more important and difficult.

Despite the limitations in the A&E, I am amazed at how well the system here can work. The healthcare providers are much more resourceful in using space and supplies, and the patients are much more understanding and appreciative of the care they receive. In the Unites States the emergency department waiting room is almost always overcrowded, but the strain on resources can be even harsher here, yet patients are more understanding. We frequently hear complaints related to patients that are unhappy being seen in hallway stretchers in the Unites States. In contrast, today I was caring for a 73 year old gentleman who was unable to walk for three days due to progressive leg weakness ongoing for two weeks, which we thought was secondary to Guillain-Barre syndrome. After putting the patient in a bed to start his evaluation including lab work and lumbar puncture, the patient then moved himself from the bed to a wheelchair with great effort, and then asked if he could wait in the waiting room for his results and hospital admission so that someone else could use the bed he had just vacated. This request is just one example of many kind and selfless acts that both patients and providers make on a daily basis, to help the entire system run smoothly and provide care for the greatest number of people possible.