I apologize in advance that there might be a lot of venting for this post. I’m sure my heart will soften and can see a wider perspective in a few days but not at this current moment. I can’t remember the last time I’m so frustrated and angry about something. This all started last night when I’m on call for the hospital.
Taking call alone for the first time for BMC was a scary thought. Over 200 beds with male, female, pediatric, OB and isolation ward. People are sick, resources are lacking and staffs are not very attentive. Staff not being attentive have been somewhat frustrating to me since day one, but last night it got to a whole different level.
Let me explain the staffing situation of BMC hospital briefly. They are two missionary doctors from the U.S, they have been here for the past four years. Heidi is a general surgeon, well she’s the only orthopedic, plastic, general, trauma, colorectal surgeon for this whole region. Tim is a family med doc, who is also doing the c-sections for the hospital. In Ghana, medical school are 6 years, students go straight from high school to med school. After med school, people don’t go straight to residency. Mostly because there are only two (maybe three) teaching hospitals with residency programs in the entire nation. They work at local hospital with close to none supervision as house staffs. After they completed the 2 years of housemenship they become medical officers. Medical officer or MO are completely independent, doing surgeries and all in Ghana. BMC was a Baptist mission hospital for the past 60 years, but 4 years ago it was turned over to the local government. All I can put it is that it’s not the best hospital administrative. All the meds are provided by the government. Most all of the supply are provided by Baptist convention and volunteers. But hospital don’t have sufficient money to hire enough staff or keep equipment in working condition. The two missionary doctors are probably among the two most hard working individuals I’ve met. They have such a big heart for the patients and are working beyond their max capacity. On the other hand the house staff and MOs are a hit and miss. But majority of the staff have attitude that patient care is not their business. A big issue is that there seems to be no consequence or accountability for bad outcomes. When patients died, that’s expected by everyone. There at times patients don’t have to die, BMC definitely have the capability to save more people. Patient have to pay up front for everything. On admission, if you don’t have enough money you sleep on the concrete floor with rats all kinds of other things. You have to pay for water, oxygen, medications, gauze, labs (there’s total like 5 labs we can do here), xrays or anything else you can think of. If you can’t pay even its critical no one would do anything. Family members feed, change, do PT for the patients. The only thing nurses seems to do are give the medications. Vitals are check 1-2 times a day, usually only temperatures were checked. You’ll get a weight and BP on admission. Just take a second to think about how frustrating this could be. As a patient is dying in front of you, nurses just stand around and look at you. You ask them to do something, they respond okay but keep standing there. The patient died, and everyone just move on. This actually happened. Multiple times already. I’m sorry again to be so negative today.
Okay so let’s move on to what happened last night. It was a busy call, but I handled it fine until around 4am. A nurse from female ward called me saying a pregnant patient is admitted for abdominal pain and want me to come see. After walking to the ward, I sweet talk a nurse to get up and help me translate, and I finally get to speak to the patient. Her story is that she started having abdominal pain with minimal vaginal bleeding since 4 days ago. Upon further questioning her symptoms started after she fell off her motorcycle. She doesn’t know how far along the pregnancy is. I ran to grab the ultrasound machine, I identified the placenta position, and see fetus was about 25 weeks, and see the four chamber heart but it was not bleeding. At this time patient started screaming in patient and have large amount of vaginal bleeding. All 50 patients in the same room in female ward, children and elderly women were staring at us. I escorted her to the OB ward. Long story short, baby was half way out of her body, I had to deliver the baby in breech presentation (head up), on the floor. No nurses were helping me. After baby is out I yelled for people come help me with the mom. Baby was limp, no heart beat and not breathing. I did a round of CPR and gave rescue breaths. The nurses then asked me to stop because anything before 28 weeks of gestational age is consider an abortion here. Baby would not survive. Miraculously when I stopped the resuscitations, baby is now breathing spontaneously and heart rate of over 100. Baby is tiny weighing 0.7kg (1.6lb), but she looks perfect and has a fantastic chance to live a healthy life to adulthood. I called Tim (the missionary doc) for help and told him the story. We put the baby in the only working incubator with two other babies. Working for about an hour to improvised to give baby some oxygen using duck tape and submersing tubes under water to see if it’s working (as there’s only one oxygen tank).
The part that makes so so sad and frustrated is that. After doing all this, and the child doing so well. She is most likely going to die. And that make so so upset. Mom is not very excited about the baby after seeing how small she is. She is not trying very hard to express breast milk. After searching the whole hospital I finally came to term that there’s no correct size NG tube. And nurses are not placing the IV line. Mom is not willing to go out and buy formula to feed baby.
As I hold the baby, I can feel her heart beat and breathing by my chest. Baby is getting cold, looking more lifeless. I’m so angry that people don’t seem to care. I’m angry that she’s going to die and I can’t do anything. It’s a mere miracle that she’s even alive now, after having no heartbeat for at least 5 minutes but she’s not given a chance to fight to live.
So that’s my call last night, the most dramatic call I’ve experience so far…