To Code or not to Code?

This week we spent our time on the Female Ward at Lewanika General Hospital.  Here, we cared for a combination of all female medical, surgical, and gynaecology patients and collaborated with nurses, students, and physicians. The nursing students are knowledgeable and more than happy to educate us on the illnesses specific to Africa (malaria, HIV, TB) and the different treatments available. We assisted with procedures, listened to the doctors as they did their rounds, and completed assessments.  Right away, we noticed the acuity of the patients here is much different than what we would consider an “acute” patient back home.  In Canada, almost all of these women would belong in the ICU.  We saw insanely high temperatures, elevated heart rates, and many low and high blood pressures.  There does not seem to be a sense of urgency when dealing with a declining patient, code statuses rare non existent, and death is common and frequent. 
 

During rounds on our first day we had a death occur.  As we were listening to the doctor doing his rounds, we noticed some commotion by one of the beds.  We went over to investigate and found a young woman gasping for air.  Her mother was at her bedside and was wailing and chanting in Lozi.  We quickly took out our stethoscopes and began assessing the patient.  We couldn’t find any peripheral pulses and the carotid pulse was growing weaker and more bradycardic. We tried to call for help, but no one would assist us. The nurses seemed to turn  blind eye and told us that they were going to call the doctor, and with about 4 doctors on the unit at the time, one eventually came over. We had no idea how to console the mother, and watched helplessly as the woman took her last breaths.  By the time the doctor came over to us, she had already gone and he pronounced her dead.  When we questioned the students about CPR, at first they did not understand what we meant; as we mimicked compressions and they finally understood, they said that that is not something they do here.  There is no resuscitation.  We later found out that this young woman had extra pulmonary TB, which is indicative of fourth stage HIV. 

Today we inserted a catheter into an incontinent elderly woman,  followed by a nasogastric tube because she was unable to eat.  It kind of mkes you question their rationale for things.  Even though the death that occurred on our first day was a young woman with fourth stage HIV, they did not help us resuscitate her at all, and here we are inserting an NG tube into a woman almost in her 80’s.  The average life expectancy in Zambia, so we’ve been told, is about 50 years old, which is a tough thing to wrap our heads around.  Back home in Canada we are performing full codes on 90 year olds.  The traditional wailing after a person passes away is not something we will ever get used to either.  It is an eerie, haunting sound that gives us goose-bumps every time we hear it. It is not something that will easily be forgotten.

Meagan M & Nicole S