Last night was my first call shift in what is called the 'adult filter clinic' (AFC) in Zambia. Emergencies basically get sent to either surgery or medicine here, and the AFC deals with the medicine cases.
There were, again, a large number of unusual cases. You would expect lots of HIV / HIV complications + malaria + all those tropical diseases, but but you might not expect (I definitely didn't) was that there are a huge number of patients who come in to the emergency with organophosphate (OP) poisoning from attempted suicide. OPs are a common pesticide that basically act on the body in a similar way nerve gas would. It is unbelievable how many OP overdoses are seen - I would estimate 1/4 to 1/3 of the overnight emergency caseload! I've been told that rarely is the suicide attempt genuine, and that generally speaking the people who OD on OPs are doing so to draw attention to themselves. I really do hope that there is some sort of mental health follow-up for the truly suicideal ones :(
There was also a patient yesterday who came with decreased level of consciousness and a history of DM and HT. When we got the lab results back, we found that the GFR was 2 and his potassium was 8.3, and that the decreased conciousness was from uremic encephalopathy. Apparently, uremic frost is also quite common here... at any rate, my resident basically told me the following in regards to his management:
"In Canada, this fellow might be an ideal candidate for hemodialysis. In Zambia, he will not get hemodialysis - we only have a few machines and reserve them for people with reversible renal failure"
So, we gave him supportive treatment, but his prognosis is quite poor in the long run. Alas, an example of how deficient even the best-equpped hospital in Zambia is.
On that note, in our emergency room the only equipment we have for resuscitation is an oxygen tank. No defibrillator, no ventilator, no monitors, and we often run out of fairly basic medicines. I've been told that there isn't even a working defibrillator in the entire hospital.
you got to see uremic frost! yay, jia, that's like a dream come true for you =D hehe.
ReplyDeletei guess it shouldnt be a surprise to hear about the resource shortages, but its still very sad to hear...:(
ReplyDeletejia
ReplyDeletemakes you wonder about all those philanthropic organizations that send ridiculous amounts of money over for foreign aid - where does that money go? i heard from you that in the grand scheme of things, it requires v. little money to truly equip 3rd world countries with the necessary supplies to fend for themselves on the grounds of nutrition and health care, so then why is it still so backwards even though it seems like saving the world is such a big focus of attention these days?
i often feel inconsequential - the extent of my aid is probably donating my pocket change to the legless saxophone guy near tim hortons on campus. i really hope you can change the world jia, i truly do. i await the day you are in public health crushing aids like genghis khan crushed asia, like ellis crushes the bench press.