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It is an unfortunate fact that, should you be admitted to the public hospital here in Blantyre, Malawi, you have a 20% chance of not leaving with a pulse. With odds like that, taking care of six patients becomes almost a lottery, and today the inevitable happened.
For some reason, presumably my skin colour and air of arrogance, people keep assuming I am a full-blown doctor. A minute or two after I arrived on my ward, one of the junior students ran up and asked me to look at someone in a critical condition (which is medical for "about to die").
His mattress was on the floor, crammed in the space between two beds, and as the family cleared away I heard the soft gurgling sound stop. Trying not to panic, I asked why he had been admitted and tried to rouse him. "Get one of the interns", no breathing, roll him onto his side, head back, still no breathing, no heart sounds, no pulses. The intern arrived, a quick summary, she says "no breath sounds? What about pupils?" and they are dilated like little marbles, fixed wide open despite my torch, and his chest is warm but his hands are cooling quickly.
"What should we do?"
"Tell the family," who are hovering in the aisle, and she turns to do that, in a quiet voice. The wailing starts after a longer pause than I expect. The intern covers him up, and the morgue staff rattle in with a trolley as I try to focus on a chest X-ray.
There is no CPR here on the adult wards, no Code Blue, no MET staff hurrying to help. There is nowhere to put them if resuscitation is successful, so arguably there is not a lot of point in traumatising the family and scaring everyone else.
Obviously I didn't just walk away from this untouched. It came up surprisingly naturally with the consultant, who sighed and said he thought we tried too hard in the Western world to save the unsaveable, and that in ten years in Britain he'd had one patient walk out of hospital after resuscitation.
Why did this patient die? I don't know, directly, only glancing at the notes. He came in with vague symptoms like everyone here, HIV positive like 80%, had a bunch of observations and investigations ordered and was admitted to the ward. I was the next staff member to see him, almost 48 hours later. The previous day the intern and I were on-call, admitting other patients. I don't know who wrote an oxygen saturation of 74%, well below normal, in the notes, or why nothing was done about it. Unfortunately it is not just physical resources like lab reagents that are in short supply here, but minds and hands too. Plenty of patients go unseen by medical or nursing staff for days, especially when the interns are on-call and the students are in classes.
I came to Malawi for a challenge. I am getting it.
One comment
Brigida :: Friday, January 29th
Oh God - such evocative writing, David. How protected we are in comfortable Australia .... I wonder where you will end up after all this??
So very sad .....
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