Sometimes the System Stinks

May 19, 2009

Sometimes you wonder why things just can’t get done. I mean, I know I procrastinate on certain things unless I know that there is a close deadline or that it’s really important to somebody else. I think that going in to medicine, I’m making sure that my focus is not on doing things for myself but on getting things done for patients. By getting things done I mean conducting tests, making a diagnosis, and starting treatment on the patient to make them better. These don’t seem like a whole lot to ask and I would think that most health care professionals back home would agree that this way of thinking and acting is not out of the ordinary, but here that’s not the case. Both Monday and today have been full of roadblocks, not because there medical complications, but because the people or the resources are just not there.

Rounding on patients is interesting, although I don’t know if what people saying is accurate or not. That’s why I like following on rounds when Ross and Troy are there because I can ask questions or at least get an idea of what is happening based on what they say. The doctors will come in a group of 4 or 5 to discuss the patient and then recommend actions to take place. This seems pretty standard and that it would work, but generally we will leave and go to another patient and 10 minutes later there will be another team of doctors rounding and repeating what was just said or done. It doesn’t seem to be that efficient. Some patients will arrive on a Friday and then they will stay in the hospital waiting for the attending doctor to make grand rounds the following Thursday.

Today we saw a patient we is basically paralyzed in his arms and legs, but was normal about nine months ago. He was admitted on Monday and hasn’t been seen by anybody other than the rounding interns who haven’t given him any treatment. Luckily he’s not really getting worse, but he just sits with his mom all day, knowing that he has to wait for the doctors to show up at some point. He is a precious boy but you can tell he is very sad. He’s pretty much trapped in his body because he can’t move is appendages. I hope that somebody sees him soon so that at least his mom knows what is going on and what they can do to hopefully reverse his condition.

Another girl that has touched all of our hearts is Priscilla. Ross had taken us to meet her on Friday after him and Troy had seen her on rounds. She came in unable to walk and had difficulty controlling her bladder. They suspected that the cause of her problems is mostly likely a brain tumor. She’s an adorable little 8 year old who smiles every time she sees us. We gave her a little pink stuffed pig to sleep with. She’s missing her two front teeth and her hair stands up on her head as if she were Albert Einstein. She had a Lumbar Puncture to relieve some pressure and to run some tests. Since the pressure was relieved, she is not able to walk and isn’t having any other main problems. Her CT results took four days to come back and they confirmed what Ross and Troy had said. She has a tumor in her brain that is completely operable and removing it should cure all of her problems. The only issue is that she is poor. There are two options; Priscilla can get a shunt put in that will keep the fluid at bay, but won’t fully cure her problem or she could drive 6 hours to a hospital with another neurosurgeon who can completely remove the tumor and cure the problem for good. If she gets the surgery here at Mulago it is free, but it is not the proper course of action. At the other hospital she will have to pay but won’t be cured. Her mother wants to get the surgery at Mulago because she can’t afford to pay the bill somewhere else. I don’t know if the doctors will have the ability to convince her to go and get the surgery somewhere else, but I really hope that they can. This lovely little girl deserves to have that tumor removed and there is only one place in the whole country where the doctors are trained to do it. Hopefully the doctors will send her off for surgery soon, but for now she is the shining little smile on the far end of the ward that we always go to in order to brighten up our day!