rokes, heart attacks, burns, children, and trauma
s. The acceptable miss rate for heart attacks has become 0%. As a result of our increasing expectation of flawlessness, we routinely spend around 5-10,000 dollars on emergency patients that we don't e
nd up finding any serios disease in... and they eventually go home to follow up with their primary care doctor. We order every test and image to keep things moving, and cast a wide net to help support our theory that we would have caught something serios had it existed.
The Emergency Room (yes I know Department is more PC... but this is truly a large room) in Liberia sees about 4-6 fatalities a shift, many of them children. Anyone over the age of 5 years old has to pay for medications and studies before anything will be done. Children <5 years are free. Could you imagine having a heart attack, forgetting your wallet, and slowly dying in your chair at the hospital unless someone else paid for you? Daily occurrence. The HEARTT doctors have brought many donated medications that the hospital can't charge fo
r in hopes we can give medications first, ask questions later for the truly sick people.
When it is clear that someone is about to die, we have to carefully weight the likelihood of that person surviving. Chronic disease? Probable underlying heart condition r
equiring ICU care following survival? If the person dies, their family must still pay the bill before the can claim the body and remove it from the hospital. This means that if you spend money on someone with little change of recovery, you could literally deprive the family their ability to bury their loved one.
On a lighter note, I had my interview with the Liberian Medical Board. I am now officially licensed to practice medicine in the country of Liberia with no expiration date. I'll get a card with my photo signed by the chairman of the board. I also had a patient today with the same last name (Constance). I had permission from her and her mother to take a photo together. I was joking around that maybe we were cousins! People got a laugh out of that.
My fellow HEARTT doctors have been excellent about introducing me to the expat community here in Liberia. We have gone out almost every night. When restaurants are just as expensive as groceries, it takes the guilt out of dinning out. There are several good places to eat, and an excellent bar in Mamba point called the Tides - sharing the name of my local bar in the hometown of Gig Harbor. Our local favorite is the Sajj House - excellent pizza and beer.
Life here is fun, interesting and full of surprises. One has to cultivate a positive mental attitude, and think of things "glass half full." Otherwise one would go crazy. I try to think about the patients we saved that would have died had we otherwise not been here, as apposed to the ones we couldn't save.
Ah well - more positive stuff in the future.
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