First Days

I was introduced to the hospital and the medical staff on my first day. I am only allowed to work as an observer and educator until my meeting with the Liberian Medical Board in a couple days. However it turns out there is a lot you can do without writing notes or orders.

We took the afternoon to go to the Water Street

Market - a series of crowded streets where everything you wanted (and didn't want) is for sale. Kids stroll the curb s

elling sun dried, salted fish. I found several lapas, or yards of cloth, to have made into bags and dresses for my wife by a local tailor. I reminded me of the markets in Sri Lanka.

The emergency department is based on the old British system... a medicine and a surgery side. We are invited to help and care for patients in both, but act as attendings and are responsible for the "medical" side. Patients on the surgical side will eventually be seen by another physician. If the nurses feel uncomfortable or can't get help, th

ey know where to find us.

The nursing staff and techs are fantastic - they are eager to help and care for their patients. Many of them are interested in learning. There is a small pharmacy clo

se to the ED with NSAIDs, seizure meds, antimalarial and antibiotic medications. We are able to place IVs, and give fluids from plastic containers similar to juice boxes. There is one ultrasound for the hospital and of limited access to the ED... I would KILL to have a small, pocket portable ultrasound. I truly would save lives. We can get plain films, and a handful of labs. To give you an estimate, a CXR is about $30, 1 liter of oxygen per hour about $3, and one tylenol tab about 15 cents.

Last night we rounded in the ED before going to bed, just to make sure everything was alright. To our sorrow we discovered one of the sick children was not breathing. She was still warm, but didn't have a pulse. Nobody knew how long she had been dead - not even the mother or nurse who was sitting less than 2 feet away. There are no monitors like in the US - just chest rise and skin color. We coded the 1 year old baby for about 30 minutes before pronouncing her dead. It was time to go home.

Today we helped during case presentation rounds with the medical students. They are a bright bunch, often dedicated to their education and the future of Liberian medicine. We are careful in how we critique an instruct - often being later interpreted by the medical staff here as being too kind and blind to poor presentations, etc. My personal feeling is that it is not our place to criticize, but to share and reinforce things that are working well.

Tonight some people are packing up to go home. One of the EM residents that I have not yet met (taking a small vacation prior to leaving to the states) and a psychiatry attending who may be coming back to work on the medical staff here long term. We are going out to an Indian restaurant called Taaj - a local favorite.

Tomorrow we will hopefully continue working on the trauma resuscitation room and kit, largely supported by Stanford! We are doing this in between patient care activities in hopes of improving their infrastructure to care for their sickest patients.

** The internet is really slow today - so I will add the photos later **