Sunday, February 22, 2009

shifting

I just got back yesterday from another 10-day stint at a provincial hospital. As I lay in my bed completely maxed out all I could think about was that I was happy.

During my stay in the hospital I kept thinking I should keep a log of the cases I see. Common cases such as acute gastroenteritis, intestinal parasitism and pneumonia might not warrant too much attention. On the other hand, I certainly would like to look further into malaria, extensive PTB, TB meningitis, rabies infection, tetanus, sepsis, stroke and MI, and how to manage and recognize these diseases with limited resources.

X-rays and peripheral blood smears are readily available in the hospital. Ultrasounds can be scheduled or done on-call. Blood cultures are not available. For a 12-lead ECG you have to call private diagnostic centers in town for the technician to come to the hospital and do the ECG. Most of the time they are not available in the middle of the night. For a CT Scan you have to send the patient to Batangas. To get to Batangas the patient has to take a 40-minute drive, a 2 1/2-hour boat ride plus another 20-minute drive - a trip that not all of them might survive.

But I am not complaining. I cannot complain. At this point I am giving the best that I can give. It may not be the best care the patient can get elsewhere, but it is close to being the best they can get at that hospital.

People travel six to seven hours for a consultation. Some take a 4-hour trek down the mountain to bring their ailing children. You cannot blame these people for not coming to the hospital at the first sign of disease. You cannot blame them when they arrive at the hospital dehydrated, weak-looking or in cardiorespiratory distress. I know something has to be done to improve the health system. But at this point I am only capable of making do with the available resources.

This does not mean I am satisfied with what I'm doing. I know something more can and must be done. But I need to study more, train more and get more exposure to know what else can be done.

It is too early in my medical practice to make big changes. But it doesn't mean I'm not trying to make small changes.

Tired as I am, I'm looking forward to my provincial hospital shift next month.

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