Training Archive: triple-doubleIn the 7 days ending 2008-04-19:
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Sunday Apr 13 | ||
| Note | |
| Dumela! Today officially marks my two weeks in Gaborone. In some ways it feels that time just flew, in others the time has been dragging.
After the incredible introduction to Gaborone healthcare system on my first night, while waiting in the local emergency room while two of my classmates were being checked after the bus they were in was hit by another car, things have been more normal. (Of note, the student who had his face sutured here had since left to the US, was found to have a facial fracture with an entrapment of an eye muscle, and has since had surgery. None of this was discovered here) Botswana has a universal healthcare system, and being severely affected by HIV with roughly 40% of population HIV positive, it is one of the most progressive countries in the world in providing its citizens with free HIV medications. To be able to offer all its citizens healthcare, Botswana offers a limited number of medication types and procedures. There is a handful of available antibiotics, with whole classes of antibiotics unavailable, or severely restricted in their use. There are a few blood pressure medications, basically one from each class, compared to several-fold more available in the US. In terms of imaging/radiologic studies: it is relatively easy to get an X-ray or an Ultrasound, it is possible but difficult to get a CT scan (because of limited availability). However, other studies (e.g. MRI) have to be referred to South Africa, and are typically not done at all. While in most countries politicians overspend or steal money, in Botswana politicians are rewarded for conserving and returning the unused funds to the countries coffers at the end of the fiscal year. Hence, despite a dearth of resources and their great need in healthcare, the Health Ministry has returned a huge sum of money last year. This is in the context of the hospital routinely being out of life-saving antibiotics (last week, we could only use ampicillin and metronidazole for people with overwhelming infection. A combination of only these two drugs do not provide a thorough anti-bacterial coverage). For two weeks there was no soap or towels in the hospital. A patient was bleeding out, because the platelets (a donated blood product needed for clotting) was not available. A person with a severe asthma attack died because there were no intensive care unit beds available. In short, if one takes time to process the whole experience, it is overwhelming and maddening. Because of the historical lack of medical education, Botswana has an incredible shortage of physicians, with the vast majority of its doctors foreign-born and/or trained. In my stay here, I've met doctors from South Africa, Congo, Ghana, China, India, Russia, Canada and US. Most of the nurses are Batswana, however there is also a great shortage of nurses. Due to a combination of factors: lack of resources and manpower, overwhelming numbers of patients and severity of their illnesses, a more relaxed and laid-back Botswana culture, and lack of accountability, the care one sees in the medical wards is substandard by American standards. The system is fraught with opportunity for mishap and error. There are no support services such as phlebotomy or a unit secretary/clerk, and doctors spend half of their time drawing blood samples, transporting patients, tracking lost samples, re-writing lost forms and re-ordering tests that were never completed. What an amazing opportunity cost! Last Wednesday I had a huge fight with the lab after they refused not accept a blood sample from a critically ill, anemic patient with a blood count of ~35% of normal (Hemoglobin of 5 instead of over 12) because, while the test was ordered in the computer, and the blood tube that I hand-delivered had a proper label, the ward notebook (the kind that you purchase from an office supply store, and into which you handwrite the patient's name and the lab test name) was missing and they could not put a checkmark in the book next to the blood sample that I had brought. The book re-emerged 4 hours later, yet the patient had not received his transfusion for 2 more days. It is hard to remain positive, but there are many things that are amazing and awe-inspiring in Botswana. The air, the landscapes, the wildlife are incredible. There are several success stories in the hospital that I had witnessed in my two weeks here. The experience in caring for sick patients and in doing procedures will undoubtedly be very helpful next year. And, in our orientation to Botswana at Penn, we were told that the at the end of the first two weeks people generally hit the low and wonder what exactly they are doing here, but it gets better in the following weeks. I hope it's true for me! | ||
| orienteering (street-o) 35:00 [3] 3.9 mi (8:59 / mi) | |
| http://www.gmap-pedometer.com/?r=1787044 with Amanda | ||
| C • Healthcare 3 | ||
| trail hiking (hill) 1:00:00 [3] | |
| shoes: pink reebok | ||
| Climb Khali hill.
http://www.gmap-pedometer.com/?r=1789005 Photos at: | ||