4/10 – Dealing

Today was one of those days that you just feel frustrated.

We are continuing to monitor our tuberculosis patient who is severely malnourished. At least while she is admitted here in the hospital, she is compliant and takes her medicine. However, she did have to be scolded because of her refusing treatment while at home, she may put the public at risk for drug-resistant tuberculosis, which is a very serious matter! Dr. Jean has told her this in the past, but I don’t know why she doesn’t listen.

The moms who have just given birth have been instructed many times on how to feed and wrap heir babies, but even though we make sure they understand during rounds, whenever we check back on them, they have ignored every piece of instruction, their babies are getting worse, and now we had to treat them with antibiotics.

One patient was withdrawing from alcohol–his hands were shaking, had a magnesium deficiency, and was at risk for seizure or coma. This very old man was a regular patient to the hospital, and yet even with all the support his family had been giving, he still hadn’t quit drinking. We tried to tell him that the alcohol is killing him, and asked if he would stop drinking it. He said no.

Later in the night we were called in for a moto accident patient who was not wearing a helmet and had been thrown over his handlebars to land on his face. He was in fact very fortunate that road rash and some deeper lacerations were his only concern; he could have had a serious brain injury or even died, all because he wasn’t wearing a helmet. We sewed up the skin all around his orbital and in his lip, and carefully dressed the rest of his mangled face.

Dr. Jean scolds everyone to wear helmets when they ride their moto because it’s just good public health practice, but there’s a macho culture around here that glorifies the fast-driving, helmet-less moto rider, so we still get bad moto accident cases all the time. While Dr. Jean was stitching his face up, I just looked down at him and all the blood, and all his very worried friends standing around, and knew that most of the injury could have been easily prevented.

But I know all these frustrations are ubiquitous in healthcare. No matter where you are, you will always have to manage noncompliant patients. From what I’ve seen, the best thing to do is to just do your very best to inform and educate concerning the consequences, and then let the patient have their autonomy. Healthcare doesn‘t always have ideal results; I wish it did, and we should be striving to find new ways of improving patient care, but there is a huge amount of humility that I see doctors exhibit when they are forced to accept that they can’t be the ones to fix everything. That’s something I’m learning from Dr. Jean and Dr. Tabi during my time here. It’s been eye-opening to say the least, and I am grateful for all the things I am learning, and I pray that I can make them useful in the future.

Other medical procedures of note today:

– Another counseling session with our panic-attack patient, and an ultrasound on her baby, with the father!

– Lipoma extraction–awesome

– LP on a potential meningitis case, turned out to be negative, thank goodness!

I am so behind on all my journals, I’ll probably still be uploading them when I get back to the states on the 25–apologies!

– ATP

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