Tuesday, June 30, 2015

A wing and a prayer ain't cutting it

Now enjoying the temporary respite from exams, left wondering how on earth to apply what I've learnt to the Guyana situation.
Absolute tragedy in the making ... a mother of six, ages ranging from 26 to 7yrs is dying.  This being Guyana she/they haven't even been given the courtesy of a diagnosis of what is wrong-- or maybe they are not saying. I can only surmise that perhaps she got gestational diabetes from the last one which developed into the full-blown disease and with the characteristic lack of information attended the local rural clinic on a regular basis for 7yrs and ended up with damaged kidneys.  The rural clinic referred her to the district hospital where she languished for a couple of weeks and where they thought she had cancer but as she was experiencing abdominal swelling and the consultant from the Capital City  never turned up, she was transferred to the main Public Hospital in the said Capital city, having to make her own way down.  Appallingly, she was made to sit in a waiting room chair of the Emergency Room for over 36 hrs (unbelievable!) then they were unable to diagnose the condition, cancer being the main suspect.  She finally got some form of relief when they drained the fluid from her cavity wall, then the family was told they had to pay for a scan-- which they were unable to afford.
After a day or so, it was discovered that because she was from an indigenous tribe they would waive the fees. In the meantime, the two daughters were kept on their toes getting foods that she was used to as the hospital food was not to her liking.  Distressing for me to hear was that the woman's simple request for a cup of hot water was a problem for the nurses who had both a kettle AND a microwave at their nurses' station at the end of the Ward... how inhumane.. I can't imagine that being such a problem-- and being that this is Guyana .. the assumption for this unfriendly behaviour was rooted in racial terms.. but in fact, it was an institutional idea handed down from the early 20th Century-- that patients follow rules convenient to the staff and not rooted in any clinical reason.  The nurses offered the patients a hot cup of tea when it was convenient to them-- our patient made her daughters get her a flask so she could have her tea when she wanted-- the nurses were a bit annoyed to provide the said hot water so it meant one daughter lugging in a flask of hot water every evening after work so as to 'not bother the nurses'!   Likewise, (and I am in agreement with our patient) she didn't like eating cold food, but apparently the simple request to warm the food brought in by the daughters in the nurses' station's microwave was not met with approval.
 So feeling better having the fluid drained and apparently not finding anything on the scan, the woman was discharged! With instructions to attend the local clinic if the swelling occurred again as there was nothing else the Public Hospital could do.  She went back home and got accumulation of fluid after about a week-- the presumably inexperienced doctor (one of the many Cuban-trained ones) was wary about doing the procedure and only did a partial drainage meaning that she had to disrupt the family's routine to revisit the clinic more often.   I wondered about the communication and transfer of patient files and whether the Georgetown specialist had given any advice to the doctor in the rural clinic?
As I write, she has not eaten for two days as she is finding it hard to swallow down anything and has lost a lot of weight... stomach cancer? failing kidneys?  I don't think we will ever know but the human tragedy of the loss of a mother is one being repeated many times with its ripples of expanding unhappiness.

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