This is How We Do It

Every now and then I'm reminded of the vast differences of practicing medicine in the USA and in rural Africa. This morning I had another one of those little reminders.

Before moving here I had worked in an emergency room for a few years. Whenever we had a patient come in by ambulance we would get a phone call ahead of time. Before the patient arrived we would know the age, sex, chief complaint and some vital statistics on the patient. The patient usually had an IV in place by the time they arrived. Once the patient arrived a team would practically pounce on him/her drawing blood, giving medications, prepping for x-ray/CT scan etc.

This morning one of our nurses, Percival, came and got me from my office. "We have an emergency on the way. It's a child maybe about ten-years-old." I was surprised that she had this info in advance. So I asked her if someone had called to let us know that the child was coming. "Oh no, I just looked out the window and saw the mom carrying the child here." By the time we got to the front of the clinic the mother and child were almost here.

Sure enough it was an 11-year-old girl with severe malaria. Fever of 103.6, vomiting, weakness, headache, body aches etc. When I first moved here I probably would have motioned to send such a case to the hospital immediately. But with time I've learned that our clinic can manage a much higher acuity than I would have expected. Time and time again I've seen these cases turn around with just a few hours of treatment in our observation room.

Don't get me wrong, we do refer patients to the hospital, just not as quickly as my American mindset originally thought that we should. Yesterday we sent a 12-year-old girl to the hospital. After an hour of treatment it was clear that she was not improving and was possibly even getting worse. We all started working the phones looking for a vehicle to take her. It wound up being our ELI Kipkaren director, Peter who drove her to the hospital in a vehicle from the Training Center. As our staff carried the girl to the car and tried to make her comfortable the thought crossed my mind "This is how we do it." No fancy Western-ambulance transfers, no medical transport team, no frills, bells or whistles. But we always do the best we can with what we have to work with. And our awesome little team saves lives every week.

Peter later reported to me that the doctors who first saw her told him that there was nothing to do for her at the moment because our clinic had already done so much. The last update was that they would admit her for observation and do lab tests continuing the treatment we initiated in a few hours.

Our little girl today got some IV fluid, quinine, antibiotics and medications to stop the nausea and bring down her fever. After an hour her fever had broken and she was resting much easier. We will keep her for a few more hours to make sure she is really on the mend before letting her go home. She'll have to return for another injection tonight and again tomorrow morning.