About 2 weeks ago I had a VIP patient that suffered an inferior wall MI. Fortunately, because he was well connected, we were able to get aspirin, plavix, lovenox, and keep him connected to the one monitor we have in the hospital. His was the first EKG I've been able to get in the past 3 weeks. Its amazing what social status will get you in a hospital. I wish this didn't translate to home but it is just as prevalent.
Because we didn't have the capabilities to perform a formal
echocardiogram or angiogram, he needed to be transferred. Arrangements had been made 3 prior times, all cancelled for one reason or another. This time it looked like the trip was actually going to happen. I arrived 30 minutes late as to not be 2 hours early (Liberian time) which worked out perfectly. Our ride was another hour fashionably late. We made it to the airport just in time to catch a United Nations (UN) flight to Accra, Ghana. Fortunately we had an uneventful flight, and my only doctorly duties included denying my patient a cup of coffee and insisted that he didn't have sugar with his herbal tea. I'd say I earned my keep. It was able to bring on board a defibrillator, liters of IV fluids, medications, and needles. Last time I took a flight I wasn't able to cary toenail clippers! These rules were of course waived when I told them that I was a doctor on a special patient transport.
Accra is a much larger city than Monrovia, complete with well designed and paved streets, large city buildings with modern materials, and the most horrible traffic in West Africa. Unannounced to me an ambulance had been arranged to pick us up at the airport. Mind you my patient has been up and running around the hospital for a week now and is more stable than many people walking on the street. Because he was the patient, he had to climb in the back of the ambulance, which was actually a Land cruiser with a bed in the back instead of the seats. Being the doctor, I uncomfortably climbed in the back with patient and sat with all the luggage. To my surprise, he turned on the lights and sirens and began driving like a bat out of hell, barely missing the hundreds of cards, motorbikes, and pedestrians that dare to stand in our way. At times we were on the sidewalk and going the wrong way down traffic. I told the ambulance driver that this was dangerous and highly unnecessary, to which he replied, "you pay, I get through traffic. Why else take an ambulance?" True to his word, the 1 hour trip would have easily taken 5 hours otherwise. I leaned over to my patient, by now with a look of terror on his face, and kindly pointed out that we were 10X more likely to die in this ambulance as a result of a car crash than he would of another heart attack.
When the dust settled and the coach stopped moving, I opened my eyes and we were at the doorstep of the Korle Bu Teaching Hospital. This is one of the larger teaching hospitals in West Africa, and is similar to many county hospitals in the US. It had a more modern looking area with clean grounds and no overt signs of prior struggle or shelling. We were taken into a room at the National Cardiothoracic Center. Our guide barged in on one of the unsuspecting cardiologists to introduce me, to which I apologized and introduced myself. I learned that they could perform an echo and angiogram, but not place a stent. They could perform a bypass graft if needed. I could see this leading to another trip to the US.
After dropping off my patient, I had a more sane return trip to the airport. I ate a chicken sandwich and coke while waiting for my return flight to Monrovia. I slept the entire way. I had told my driver to be there 1 hour earlier than I actually needed (remember Liberian time), and to my pleasant surprise, he arrived an hour late, right on time.
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