Monday, September 16, 2013

Working in a resource limited setting

 Tenwek is a fairly well equipedhospital and we can do a lot. We have a total of 13 ICU beds, a CT scanner, a well-equipped OR with talented surgeons, an inpatient and outpatient medical service that also boast wonderful physicians. However, we also have challenges that are unique to mission hospitals. We are one of a handful of ICU’s in the country: the next closest CT scanner is a two hour drive. We don’t have STARS air ambulance to fly patients to another critical care site. When patients come to our door they are ours and we have to treat them the best as we can. We can occasionally transfer patients out for dialysis or other care but these cases are few and far between.
                I mentioned that we have 13 ICU beds but for these beds we only have four ventilators, and five fully functioning monitors (more monitors are coming – Praise the Lord). Doing care in this setting has its challenges. We have many sick patients, and not all will recover. So we ask ourselves: can we intubate and ventilate the 70 year old with a stroke who may not recover? Probably not. What about the young man with meningitis and brain abscesses? The man with meningitis might not recover and if he is on a ventilator does that mean I can’t ventilate the young lady who tried to commit suicide because she found out she is pregnant and has no support? The suicide attempt has a high chance of recovery and finding the Lord and hopefully a support network when she recovers. These are questions I am asking every day. As well as the question: is this patient getting better – does he need a ICU bed? What about that young man he has not improved, will he recover? Should we send him to the normal floor. As I work with every service (medicine, OB, Peds, & Surgery) I am facing the pressure of the resource crunch every day. When a Doctor/Resident needs a ventilator they turn to me. Sometimes I can say yes; other times the answer is not now but I will see what I can do. I walk away thinking, what am I supposed to do, make a ventilator out of thin air (there is some irony in that statement). Every time I have received that request, by the grace of the Lord, we make something work. The patient who has been on the ventilator for about two weeks and was recently trached as he was a difficult wean breathed on his own all day. So at 3 am,  we try him again on trach cradle and he does well. Another time I was able to get a new ventilator working just before another one broke keeping the census at 4. (Our machines are old and it does not take much for one to quit working). These are just some of the challenges I face regularly. It does not cover the other problems we face such as an inconsistent supply of blood for our blood bank, lack of certain labs, lack of beds, lack of pillows etc.

Don’t get me wrong, I love working here and the challenges keep life more interesting, however, there are times when I envy my life back in Canada where I had a storage room full of machines, extra ICU beds across the city and the ability to safely transport patients to such ICU beds. Please pray for wisdom and patience as the staff and I deal with these problems on a regular basis. Also praise the lord, as I have a few new (to us) ventilators that have been donated and will hopefully arrive here within the next six months. As a side note if anyone has a BEAR 1000 ventilator sitting around that they are willing to give me some parts for let me know. 

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