Another day at the hospital, which brings with it so many adventures. Lisa and I are starting to feel more comfortable with the medical independence we have here, and are more confident in the decisions we are making. We no longer feel the need to run everything by each other, and we’re spending our days doing different things, one of us in consults, and the other usually in casualty. It really is true that most people in consults have malaria or typhoid, so you really can’t go wrong with prescribing one of those two regimens (if not both) to any given patient. I heard somewhere, maybe from Cam, that about 40% of outpatient visits are for malaria. I also worry about my diagnostic abilities because of that, since I have malaria and typhoid in the back of my mind. I worry that I’m making snap judgements on cases when there could be something else to explain the symptoms. It’s hard to think about the fact that we’re both probably missing a lot of diagnoses on our patients, simply because we don’t have the training to recognize the symptoms. I just pray that I’m not missing anything life-threatening.
The independence is starting to be kind of fun, although still a little terrifying when I really think about it. I feel like I’m contributing the most to healthcare here when I’m working in consult, because then I’m able to help out the other providers by seeing patients, in order to lessen their loads a little. For better or worse, I try to keep myself from thinking about everything that these patients are missing out on by being here, rather than a country with more resources for healthcare, because I think that could easily drive me nuts. For example, Lisa is watching this newborn baby girl who has a temperature and an elevated white count (ie, infection). No one seems to be paying much attention, so she and I started the baby on some antibiotics to protect against the big infections that newborns are susceptible to, in addition to typical malaria meds. The mother can’t pay for the antibiotics, and the hospital won’t administer them without payment, so the baby is not being treated. It’s totally maddening to think that this baby may well die from this infection that is so treatable with simple medications that are available in the hospital, all because the mother does not have money. And I’m sure there are tons of other patients not getting their treatments because of similar situations.
I know that the US is a payment-based system, but we have things like county hospitals, and things like emergency rooms, that cannot turn patients away, and that will treat without paying attention to ability to pay. Lisa and I have had many discussions about whether healthcare is a right or a priveledge based on our time here. I’ve got to be honest; beacuse of what I’ve seen, and the huge impact that poor healthcare has on people living in poverty, I lean towards healthcare being a right. But maybe it’s more correct to say that healthcare is a priveledge that we should work our rear ends off in order to make avialable to all. I don’t know, all I know is that witholding care due to lack of ability to pay does not seem humane in the least.
Ok, I’m off my soapbox. If any of you have anything intelligent to add to my ramblings, by all means, please speak up. 🙂 There was a heat lightening storm tonight that was totally beautiful. Reminds me of being in Honduras, and makes me miss it a little!
The stir-crazy factor is getting stronger. Maybe it’s a little bit of culture shock kicking in, or maybe I just don’t have any attention span to speak of, or maybe Lisa and I have been spending just a LITTLE too much time around each other lately, considering we don’t really do anything without each other 🙂