Hospital Blues

So the last few weeks at the hospital have had their ups and downs. The hospital services a region of about 100,000 people. It is missing what would be considered as fairly essential equipment back at home. No blood gas machine, limited imaging, limited treatments, even more limited pathology testing. Patients stay in small metal beds after walking up the stairs as there is no elevator. They bring there own food and linen. Nursing care is limited. Pain management non-existent. This results in a different practice of medicine. Doctors are left to guess patient's diagnoses, often unable to ever confirm via testing. It is frustrating for the Mongolian Doctors who are unable to fully utilise the knowledge for their patients. Even more frustrating for those who have worked in more developed countries and know how different things can be.

I have been rotating through several areas. ENT (Ears, Nose and Throat), Maxillary Facial Surgery (very fancy dentistry), Opthalmology (Eyes) and lots of Obstetrics and Gynaecology (lady bits). There have been some eye opening moments such as becoming acquainted with equipment that I wasn't sure existed past 1950. You know how cartoon doctors often have a headband with a big circular mirror on it? I was never sure what that was and never gave it much thought until I got here. Turns out it is a old school otoscope (ear checker) and muchin use in Mongolia. The user rotates the mirror over their eye so they can see through the whole in the middle. They then reflect a very big lamp onto the mirror and direct it down the ear canal where they are holding a small tube so the ear drum can be seen. Physics is not a strong point. I am frequently easily distracted during a pool game and mess up the angles. Anything that requires lining up light and bouncing it off way too many objects is not an instrument I am going to like using. Ever. At least my incompetence with this has provided much hilarity for onlooking doctors and medical students. While maybe not acquiring the most useful clinical skills, I have seen lots of advanced disease. This does take out much of the guess work. It is like playing Cluedo but instead of working out who the murderer is, they walk up to you and introduce themselves, possibly with an 'It was me. I did it with a candlestick in the Library.' t-shirt.

Today was sub par. A sick woman presented to the hospital a few days ago. She has been down in the very limited Emergency Ward. She has continued to deteriorate since arrival. Limited testing has made it very difficult to work out what is wrong with her. I popped into to see her this morning on arrival. She had gotten worse. Another key testing machine had broken and this limited our options even more. While I was there, she rapidly went downhill. I requested she was moved to somewhere we could resuscitate her if needed to be, thinking it was a bit odd this hadn't been done already. I would soon find out why. The patient crashed. I moved into resus mode. No one else did. It turns out resuscitation isn't a skill doctors here readily have. One other doctor knew how to perform basic resuscitation. The defibrillator then wouldn't work. The only instructions I could shout were in English. There were limited drugs on hand. With all these factors working against her, the patient passed away with all her family watching. To be fair, given her illness, I don't think caring for her in Australia would be easy either. But it is awful and unfair to watch people die because of lack of resources and education.

In Australia, we are currently in the process of deciding to send all asylum seekers offshore to Papua New Guinea. Regardless of what you think of asylum seekers (I am pretty sure no one risks their life and their families based solely on a desire for a free meal at the other end), they are people that sometimes have complicated health issues. PNG is a place full of people also with complicated health issues. This is combined with limited health resources and alternative governance. While there is no easy answer in the current debate, situations like the one above occur when stress is placed on a poorly resourced health system. Sure there may be legal opinion and polls that deign this not to be our nation's problem (the odd UN Convention may disagree with that). But supporting a decision that places stress on a poorly resourced health system and compromises the health of others is questionable at best. We have access to exceptional health care because we are born in a country that thinks that's important. Should the quality of your health care be determined by where the stork decided to deliver you?