Nothing really mattress

Doctors are gods: it’s time you all start acknowledging that fact. Not because we have super powers and are worshipped by many, but because we are never around when you need us. At least that’s how the nurses must have felt last week in Shirati.

It’s Monday and of the four doctors that should be doing rounds, only one is at the wards. I join him and together we make our way through Female, Male and Pediatrics. The doctor told the nurses “tell me if anybody needs urgent care or attention now, otherwise I will start with the discharges” and since nobody stepped forward, that’s exactly what we did. Unaweza kwenda nyumbani leo, you can go home today. But I must have known that the concept of ‘urgent care’ is not something that is easily picked up here. Does the 21 year old with heart failure need urgent care? Is it alarming that the young AIDS patient doesn’t wake up and hasn’t had a drink in three days? Is a blood glucose level of 24 mg/dL (1,3 mmol/L) enough of a reason to call the doctor, or should we first send the nurse in training over to practise measuring blood pressure? And I wonder why that baby keeps crying, could it possibly have to do with the fact that the tourniquet for tapping blood was left on it’s arm for two days?

I don’t want to sound like doctors and nurses have no idea what they are doing, because that’s not true. I have seldom seen better care under these circumstances, a higher amount of compassion and positive out look. I would trust these people with my life in case of an emergency. But the thing that prevents this hospital from excelling is not the lack of training, staff, funds, logistics or vital drugs, it’s the lack of feedback and accountability.

Keeping face is more important than learning from (your own) mistakes. The low blood sugar guy’s test results came back deadly low, but the nurse didn’t inform the doctor until the patient was comatose in bed. By that time he ordered an infusion of dextrose to get the blood sugar levels up, STAT! (Which means it should be done immediately), when I got to the patient to check on his condition I saw that the dextrose infusion was sitting on the bed side table, and was never connected to the patient. Hooking the patient up to his IV line, I went back to the doctor to ask if there was not something else we could do. While we were discussing the different options (glucagon, not available, glucose 50%, not available, nasal gastric tube, not available), the nurse came over and said “the patient passed away”.

She was furious. “This patient did not die of hypoglycemia (low blood sugar)”, she said. “The lab technician must have written down the wrong number, it must have been 124mg/dL instead of 24mg/dL. Let’s go to the lab and check.” So there we went. I was positively surprised that the nurse was even trying to figure out what just had happened. In the labs logbook the blood sugar value actually was 24mg/dL. “This can not be true, he was squatting in his bed pan when he came in” the nurse says. “I didn’t do the test, but if that’s the case, the lab technician has done no work” says the other lab technician. That statement is eagerly written down. “What is the patients condition now” he asks. “He’s dead” I say with a dead straight face. “Dead? No, then this lab test must be true!” The whole yes-no-yes game continued for a good 15 minutes when I suggested a post mortem blood glucose test, to put an end to the discussion. A useless test, and a waste of 20 cents, but invaluable if a lesson was to be learned here.

Of course the test wasn’t done. And of course this case was not discussed during morning report. Of course nobody looked at the train of events leading up to this 25-year-old dying. In the doctors eyes it was the fault of the nurse, in her eyes it was the fault of the lab technician and in his eyes it was the fault of the doctor. Since everybody found somebody to blame, they rested easily and continued their work.

On a more positive note: Tigo, the mobile banking company has decided to sponsor two hospitals in Tanzania, of which one is Shirati. And when they visited they didn’t come empty handed: 16 new mattresses for the wards have been delivered. No more old ladies sleeping on the bare bed springs from now on!