I don’t know if I wrote previously about a little baby with a raging infection, but Lisa is watching this little newborn girl born to an 18 year old with HIV, unknown whether or not she took her HIV medications during pregnancy or not. The baby was running a fever and had an elevated white count, both things that Lisa discovered through being assertive, things that would otherwise never have been found, as newborn care is one of the areas that is in need of improvement here (it’s currently almost nonexistent). Well, the baby obvioulsy has an infection of some kind, but we have no method of finding out where. We cannot do blood cultures to find out what bug is the culprit. Lisa and I decided to start ampicillin and gentamycin to cover everything, and we write the orders. Come to find out, the next day, the orders had not been done, because the midwife “didn’t like” putting IVs in newborns, and she said the mom couldn’t pay for the medications. In talking with Cam later, it was probably mor eaccurate to say that the midwife didn’t know how to put an IV in newborns, and was covering over her lack of knowledge, and that it wasn’t the standard of care to withold antibiotics on the basis of ability to pay. So the baby is in the hospital, probably infected, and is getting no treatment. Once we alerted Cam to the situation, he talked to one of the Ghanian docs, who went and saw the little girl the next day and put her on antibiotics, and she’s doing better now. Such a broken system, yet so much better than what was available before this hospital existed (ie, nothing).
I wonder why I’m not getting more worked up about the sub-standard care here. Does that reveal apathy on my part? Should I get angry about my diabetic patient, or about the septic newborn? Sometimes I wonder if my lack of outrage is representative of a failure on my part to totally emotionally involve myself here. But then the other side of me things that getting outraged about those things, first of all, is going to accomplish nothing for anyone. This is the system that is in place, like it or not, and we need to be able to function within it as best we can and deliver the best care possible while we’re here. These patients are still better off getting care that we Americans view as substandard, than having no care at all. So maybe my unemotional response to things is just my rationalization of the situation. Maybe I’m just intellectualizing the situation. I don’t think of myself as a callous person, but am I being callous? I think I would argue that I’m not being callous, that I’m choosing to focus on the good in the situation while doing my part to remove the bad with the best healthcare that I, as a 4th year medical student, can provide.
Just a peek into the inner workings of Crystal’s mind. Run scared, I know I would 🙂
I still think about whether I could do something like this full time. I know that a big part of why everything is so fun for me is because it’s all so new and exciting. When the newness wears off, would it still be fun? Could I function long-term in a hospital setting like this, where there would be so much change that needed to take place, and I would have to pick and choose what was most important for now? Sitting in church today, I was struck by how hard it would be for me not to have my “traditional”, “American” church services, with the sermons in English and delivered in a style that spoke to me, with the worship music of a kind that I was familiar. Also, to not have a community of belivers with whom I shared a common culture and similar way of life, selfishly, would be excruciating. Maybe all of that means that I would need to be somewhere not quite as isolated as this. Maybe it means that I’m not meant for long-term mission work–I don’t really know. Maybe my interest in critical care means I’m bound for the ICUs of the states! I’m sure that all of this will become more clear as the years go on….God tends to be good like that!