A majority of the medications that we use to treat our patients come from a national formulary. Someone somewhere in PNG has decided what should be available to treat the conditions commonly seen here. Items on the formulary are then (theoretically) supplied by the government to aid posts, health centers, and hospitals across the country. When the system works, there is a nice variety of medications to choose from.
Unfortunately the distribution is not always timely, and we are frequently out of this or that. In fact, there is a white board on the ward to update us on what is out of stock. It may be easier to notify of what we DO have! For example, a couple of weeks ago we were completely out of ceftriaxone and gentamycin, and had a very limited stock of chloramphenicol. These are all antibiotics that are used to treat serious infections such as neonatal sepsis and meningitis. It was quite the challenge to look through our supply and find something that was appropriate to treat patients with these illnesses. Often we use a 3rd or 4th, or maybe even 5th, choice. This week the hot items are IV fluids! We have a reasonable supply of normal saline, but almost nothing with glucose at the moment. The docs have been adding D50 (sugar water) to the bags of saline, but we have used so much D50 it is now "nil stock" as well. Ah, the challenges of practicing medicine in a limited resource setting.
On a more positive note, we have a wonderful supply of donated medications and supplies given by people across the U.S. and around the world. These arrive several times per year in containers sent by Nazarene Hospital Foundation (www.nazarenehospitalfoundation.org). The donated items definitely keep us going, especially in lean times! Thanks to those of you who have given.