Monday, 16 February 2009

The basics

When leaving the marvels of modern medicine to work at a hospital in a developing country, there are certain things you know that you will be giving up.  I only dream about ordering many of the fancy tests that are easily available back in the States.  Pathology results come back in 3-6 months, or not at all.  The nearest CT scanner is in the capital city, a place that patients can only reach by plane IF they can afford it.  Forget about MRI. 

Despite the lack of high tech gadgets, Kudjip Hospital does pretty well.  We have an x-ray machine and a nice portable ultrasound.  EKG is available.  I can order some basic blood tests such as CBC, chemistries and liver panel, ESR, HIV and Hep B, VDRL, urinalysis, etc.  And for what we don't have, I know will become a better doctor.  I am learning depend on my brain, my ears, and my hands to give me the information I may defer to a machine back in the US.

This week, however, has been interesting as we have dealt with challenges of the most basic nature:  electricity, water, and communication.  It started with the electricity.  Something somewhere that I don’t completely understand needs to be replaced, so power at the hospital has been sporadic.  Power begats both water pumps and phone.  So if electricity is out, so is the water and communication.

Let’s walk through a typical day under such circumstances.  I begin with B-ward rounds.  There is generally a laboring patient or two that needs to be evaluated.  Oh great... no water to wash my hands.  Thank goodness for hand sanitizer.  Step into the nursery where we currently have two tiny babies (about 2.5 pounds each) who need to be kept warm.  Hmmm... the current is not working in the nursery so the warmers don’t warm.  The babies are being kept warm by hot water bottles that are placed in their bed.  Where are the nurses getting the water and how are they heating it?  Move onto B-ward where there is very little light shining in through the windows.  My head lamp illuminates any post c-section incisions that need to be checked.  On to the out patient department.  Fortunately enough light spills into the exam rooms that I can see my patients.  Again, the head lamp proves to be an extremely valuable tool.  (Thanks, Narn!)  Without water to wash my hands, my little bottle of hand sanitizer is being put to good use.  I order an x-ray, but find out that even if they had electricity to run the machine there is no water to develop the film.  I walk to the lab to look at something under the microscope and find that the microscopes are also without power.  We can use the ultrasound machine if we move it to the ER, which for some reason still has electricity.  And finally I end the day back on B-ward, doing a D&C under the light of my head lamp.  Hey, how come the electricity is off but the water is working now?  Who knows.  I’m just thankful I can wash my hands with soap and water.  On call, phones become the issue.  Urgent messages are sent via nurses, students, or security guards.  Hopefully they knock loudly enough that I hear them and wake up.  Hopefully the something urgent doesn't require electricity or water or phone.

So it has been an interesting week.  The lack of these basic things has challenged me far more than the things I expected to do without.  But in missions you frequently encounter such challenges.  What do you do?  Know it is coming.  And pray for God’s grace to face whatever comes your way.


  1. Your post made me very thankful for what we have here in the States. Thanks for the reminder!

  2. For some reason, I'm reminded of the old show, "Mash".