Monday, March 28, 2016

Kyle in OPD

As always, times have been interesting in Zambia. I was able to experience the healthcare here both as a nurse and as a friend to a patient.

I began this week working in the OPD. For any North Americans this is equivalent to the emergency room. Monday was tough. To my understanding the hospital accepts urgent cases on the weekends but does not accept non urgent patients until Monday morning. Therefore there was a huge crowd as I entered. It was incredible the amount of patients that were seen. The diagnosis was fast paced and often had to rely on intuition rather than the advanced diagnostics that I've become accustomed to in Canada. I remember several patients were admitted with the presenting symptoms of upper abdominal or lower chest pain. In Canada these cases are all treated as severe and there is an immediate rush to rule out heart attack or other cardiac problems. However, in Mongu, cardiac marker blood tests are not done and chest xray is the only thing that the clinicians can rely on for cardiac diagnoses. Most of these cases were treated as gastrointestinal based on intuition by the clinical officers present. It is amazing how much these healthcare workers know and and how much experience they are able to gain in a short time. Several of the clinical officers that I worked with had 6 months of experience and were already incredibly knowledgeable. They are kind and patient teachers who I admire for their intelligence. It is frustrating to witness how hampered their diagnoses are by the lack of resources here. I remember my jaw dropping when i learned that blood culture and sensitivities were not performed routinely at lewanika. This test diagnoses blood infections like sepsis and the best antibiotics to treat them.

I saw many patients who I would have immediately expected to be place at a level 2 CTAS triage score in Canada. They would have been seen by a physician within 15 minutes of arrival, but in Mongu even though they are rushed to the front of the line they have to still wait in line for their turn to be seen.

In terms of witnessing the healthcare system from a patient's perspective I was able to accompany one of my peers to the hospital to get stitches after we went white water rafting on the Zambezi river in Livingstone. The clinical officer did an amazing job of stitching up Mark's forehead but it was shocking to see that services are charged for immediately after completion. I will have to investigate whether Zambian healthcare is universally provided or not in this next week while at Lilimunga health clinic.



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