If You Want to Sing Out, Sing Out

I realize I haven't blogged in a while, so I'm going to try to knock out a formidable amount in the next hour and a half or so. First, I'll talk about how being at the hospital has been for the last couple of weeks.

Where do I begin. This is shaping up to be one of the most frustrating but rewarding experiences I will probably ever have in my career. Let's start with the aggravating aspects first and then we can move on to the rewarding tidbits.

First, let me preface the following statements and say that what is done at this hospital is nothing short of miraculous. It is like any other hospital in that it comes with risks, but as I have noted in previous posts we do the best we can (and probably then some) in the environment we're in with the budget and commodities we are afforded. That said, there are some particulars that we have to overcome on a daily basis that can certainly become a source of irritation and aggravation; however, like our awesome preceptor tells us every week, it's good to get frustrated. Frustration can fuel you and make you a better learner and in the future a better practitioner. He reminds us continuously: if we ever stop getting frustrated with these things, it could mean we've stopped caring, and the biggest victims in that case aren't us--it's the patients.

For the past couple of weeks, the Moi interns and some of the registrars have been on strike. Moi is partially a government funded hospital, and apparently the federal government allocated a certain amount of money to the county to be spent on health care. The county government, which has never been in charge of the health care budget before, mismanaged the funding and as a result the interns and some registrars have not been paid for the past five months. The county government claims that the federal government should pay them, and visa versa. I can't say I blame the strikers; they have living expenses. Some are close to losing their homes, others have mouths to feed. Unfortunately, it's the poor patients that can't afford to leave and go to a private hospital that suffer in this instance. You see, when I say they're on strike, it literally means they don't come to work. It would be one thing if they were construction workers like my dad; traffic signals wouldn't get installed, roads wouldn't be paved, etc. Nobody unrelated to the issue really suffers. But these men and women are doctors and pharmacists. How it relates to us Purdue people is that we have to work a tiny bit harder to pick up the slack. I could care less about working harder. I just know that as a result our patients probably aren't receiving the level of care they could be if these men and women came back. It's a difficult situation, and hopefully it gets resolved soon. We still have doctors who are paid by the hospital, not the government, that come in, but there is talk of even more of them joining the strikers. Here's hoping it doesn't come to that.

Frustration number two: disorganization. If there is one word to describe the most irritating aspect of working at Moi compared to hospitals in the U.S., it is disorganization. Understandably, when you're using paper records instead of electronic ones, it's going to be a little more chaotic at times--I expected that. What I did not expect is what feels to me like what has become an acceptable culture of complete lack of organization when it comes to patient files and treatment monitoring sheets. I've looked into it a bit and talked to some of the "long-termers" here about it. According to them, many people--IU, Purdue, long-termers, and students alike--have attempted to implement any number of primitive filing, storage, organizing systems with all of the paper records here at Moi. Some have been met with initial success, but it always regresses into this haphazard, anarchic comedy of errors--sans the humor. I know my classmates and I have discussed this ad nauseam, particularly as it pertains to their treatment sheets. Remember those really important pieces of paper that have all the medications each patient is supposed to be taking? Some days we'll come into the hospital and, according to their T-sheets, our patients haven't received their medications. It'll usually turn out that the nurses just forgot to tick off that they gave them; to be fair, the nurses here (not unlike in America, but I would say definitely worse so) are overworked and under-appreciated. Some days they are responsible for administering medications for up to twenty patients at up to six different times a day, and they don't have any of the nice Alaris infusion pumps we have in the U.S. Still though, it's frustrating for us because then we have to track down the nurse responsible for our cube, ask them if they gave patients their meds that morning, and then believe them when they say they did--which while true most of the time is not true all of the time.

Those are the two main frustrations, so I'll move on from the more irksome facets of Moi and talk about the most rewarding part: the patients. There's success stories and not-so success stories. I've had a patient die because he was transferred to the wards from the ICU before he should have been because there's so many patients who need a bed there. I've had a patient die from DKA (diabetic ketoacidosis: it means his blood sugars were way too high) possibly simply because he needed potassium and we just didn't have any in the hospital at the time. For every patient that I lose or simply have to watch suffer--such as an HIV+ patient who's been here since before I have and has disseminated Kaposi's sarcoma--I try hard to find one that brightens my day. I usually don't have to look very far; many of the patients here are so grateful for the care they are receiving. When I talk to them, they could care less that I'm switching one of their HIV meds because it has an interaction with one of their TB drugs. I mean hopefully they listen (and I think most of them do), but more than that they're just excited that someone at the hospital is talking to them and treating them like a human being. Whether you believe in God or not, when someone says "God bless you" and you can hear the sincerity in their voice, is there truly any higher praise or gratitude? I don't know, maybe, but nothing reassures me more that what I'm doing here is making a difference than the guileless words and ways that a patient will occasionally use to display his appreciation for things that in my experience people in America simply feel entitled to receive. The patients are what keep me waking up at 5:45/6 every morning, and I'm honored to represent Purdue and get to help them, in whatever minute fashions I can muster.

Well there's a rant for you. Until next time!

"However long the night, the dawn will break." ~ African proverb