Housekeeping Healthworker
The more things change the more they stay the same. Serena
Williams just won her 19th Grand slam title coming to within 3 of
the record holder and may you bet that she will change and start losing,
failing to surpass that magical 22 number? I wouldn’t dare place that kind of
bet. She walked onto the court one day with a racquet, a ball and a hope and
won 19 Grand Slams!!!
If you did not already know, this weekend all, but 2 of the big
guns in the Premiership won and Arsenal scored 5 goals. Okay, popular opinion
seems to suggest that that is a new phenomenon, however, we know they have
always beaten up on teams, so nothing has changed there. That is the gist of
life, the more things change, the more they stay the same. Or may be not,
That is why when my phone rang at 02h18 a few weeks back
from a number I knew all too well, and was conscious of the fact that I would
not receive a call from this number at that time save in an emergency, my heart
skipped a beat. What could be wrong?
“Hello”
“Hello”
“Elisha, aunt Y’s shop help has had a suspected snake bite,
they are in hospital and there is nobody to help them. Can I give them your
number and they call you? Do you think you can help? Sorry for waking you up
this late”
My mind racing, when did I last deal with something like
this?
"Yes of course, go ahead and this is why I went to school so don’t be sorry”
Meanwhile, I am trying to recall what we do with snake bites
and am thinking antivenom and this that or the other. Guess what am not all too
sure, don’t think I have had to deal with anything called snake bite!!
My mind races back to school, recalling the visiting
“muzungu snake expert.” He talks of snakes being friendly creatures and
cowardly, only attacking when feeling truly threatened. He even talked about
how they are kind enough to give a warning to the aggressor with a hiss or
whatever the species uses. If they could speak a language I understand, guess
they could be saying “I don’t want to fight so take a walk or I will strike,
and am quite deadly.” Kind of them, a warning before a deadly bite.
Oh! I remember in my ebook library there is a book on
snakes, I should check that out, what was the title again? [just checked: Venomous Snakes - Envenoming Therapy].
My phone rings again
“hello”
“hello”
Long story short, the boy may have been beaten by a snake at
about 23h30. The neighbor, as the first responder and local “medic” cut the
site up for blood to drain out. We are not sure if there were 2 bite marks
because it was cut up, we did not see any snake, the site is very mildly
swollen, just a bit of pain and bleeding. He is conscious, breathing well, just
a bit anxious and was breathing a bit badly but now is ok.
"He seems in no
imminent danger of systems collapse", I say to myself.
They got to the local
district hospital – no healthworker i.e. nurse, doctor or clinical officer has seen the patient.
The Shocker:
Okay, I know this is said to be rather common, but till it happens to
someone close to you, it is far-fetched:
“The cleaner (allow me call him housekeeping) was the only
one available. He started an IV and has given Normal saline. He has also given gentamicin
and X-pen. He has sent us to look for hydrocortisone, we have driven all over
the town and finally found it.”
“you see, we are thankful for his help, but we are not sure
if this is the best help and are looking for professional advice. He says the
medics will come in the morning, but we are not sure if this current treatment is all okay”
“do they have anti-venom there?” I ask
“No, he says there is nothing”
Okay, I have to believe that he knows what he is talking
about, he has, in all honesty done a remarkable job with what he has at his disposal, he seems a fast learner. He has given
normal saline in case the cardiovascular system begins to collapse. Am not really certain about the antibiotics, and there is an antiinflammatory added for good measure
“O-o-kay, call me back in 10 minutes” I reply.
You can guess where I went – Google, Medscape, and my book
above. But the book is 357 pages, I could not read that. I found an article
from Gulu online that I glossed over. Hmm, the treatment that this friend from
the housekeeping department gave, is similar to what they used.
More research, more questions for me and Google +
Medscape. I begin to think, if it was a snake bite, it was not really venomous.
I will assume it was anyway, better wrong that way.
The call comes back after the said 10 minutes, the patient
is eating, talking and laughing. The wound is not bleeding anymore, he is
himself and getting better. So I reassure them that it looks like there is no
immediate danger, we can wait till the morning and see where to go from there.
Indeed in the morning, the patient was discharged by 8 O’Clock by our
housekeeping healthcare worker.
The need for the growth of emergency medicine then hit me
hard, the realization that had it been a real significant envenoming snake bite
this patient would not have survived on this treatment. Additionally, I was not
prepared to deal with something like this and neither was our healthcare system
structure if the person starting IV lines has no formal medical training. I guess
there is space for apprenticeship, but this is all too fast and furious and
scary, and guess not exactly what patient safety experts would call safe
practice.
I have no idea where to find anti-venom in this country, my
bad, I must research. I had no idea on my fingertips how to treat this, but
thank God for very available resources that can change this situation quite
fast.
I have questions and more questions. I have fears for
emergency medicine in the country, its growth should have started 20 years ago,
but we are just starting. How many will suffer preventable harm with
significant residual adverse effects? How effective are our treatments? What if this was a bite by the deadly black
mamba, what would the end result be?
What if it was me? I shudder to imagine.
The more emergency medicine changes in Uganda, the more it
stays the same.
I have a dream that one day, it will be very different,
change for the better and stay better.
I have a dream that one day, within one hour, a patient like
patient X will receive appropriate evidence-based care.
I have a dream that one day, Emergency medicine Uganda shall lead the creation of an effective, efficient system where preventable harm and death are
minimized
I have a dream and like Serena Williams, a hope, that one
day we, Emergency Medicine Uganda will be Grand Slam winners!!
Elisha M. Okaisu
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