Thursday, January 8, 2009
"Dr. Erin, you have a telephone call from the Health Center"
Amidst a busy afternoon in OPD, Judy, one of our clerks tells me, "Dr. Erin, you have a telephone call from the Health Center." Health Center calling me? What is she talking about? (I know they didn't really ask for me, they are just looking for a doctor, and I happened to be the only one around at the time.) I ask where I need to go and she directs me to the business office. In the business office, I find this isn't a telephone call, but a radio call. There was someone at a remote health care center, in the Jimi (a remote area, a long way away, only way out is plane or walking), who was looking for advice on a patient. The radio communication went something like this: Me: Dr. Erin from Kudjip here. no response Me: Dr. Erin from Kudjip here. Them: I am at ________, and we have a patient, is this a doctor I can talk to? Over. Me: Yes, Dr. Erin here. Them: Lady delivered a day and a half ago, and has a retained placenta (placenta hasn't come out yet), and she is still bleeding. You copy? Waiting for advice, over. Me: I copy, lady with a retained placenta. Them: Do you copy? over. Me: Yes, you have a lady with a retained placenta. What are her vital signs? Them: Do you copy? over. Another voice: Hello, who are you trying to talk to? Over. Them: Trying to talk to a doctor at Kudjip, can you relay? Over. Another voice: Yes, I am at Tinsley, I can relay. Over. (another hospital, a few hours from us and another mountain range from the Jimi) Another voice: Doctor, I am at Tinsley, I will transfer your messages, over. Me: Thank you. I was trying to find out the patients vital signs. Another voice: The doctor wants to know what is wrong with the pt, over. Me thinking: I didn't ask that, does this person understand vital signs? Am I suppose to be saying "over" when I am done? Them: A lady with a retained placenta . . . over. Another voice: Doctor, the patient has a retained placenta, over. Me: Thank you, I know that. I was wondering what the patients vital signs are. Blood Pressure, Pulse? Another voice: The doctor wants to know how the patient is doing, over. Me thinking: I didn't say that, does this person know anything medical? How do I explain vital signs to a nonmedical person who is relaying this information? Them: The patient has a retained placenta . . . over. Another voice: Doctor, the patient is bleeding because the placenta hasn't come out. . . Me (cutting in): Yes, thank you. What is the pt's blood pressure, pulse, heart rate? OVER, OVER. (I had to ask this about 5 times before I got the answer I wanted) Another voice: Oh, the doctor wants to know the patients vital signs, over. Them: BP 70/50, pulse 125, over. Me: They need to get 2 IVs going and give fluid boluses, have they given any oxytocin or ergometrine? Another voice: The doctor says yu mas putim tupela suga wara long tupela han wantaim na run hariap, over. Them: We have already given 8 liters of IVF, over. Another voice: What kind? Me thinking: Did I ask that? Me: Have they given any oxytocin or ergometrine? Them: 4 normal saline, 4 D4, over. Another voice: Tupela no kan tok wantaim, wanpela mas tok pastaim, over. Another voice: Yu gat sampela marasin, ergometrine, na oxytocin? Yu bin givim dispela or nogat? Over. Them: We have 20 units of oxytocin and 1 ampule of ergometrine, over. Me: Give more. When can you get the patient here? Another voice: The doctor says to give more medicine now, and wants to know when you can get the patient to Kudjip, over. Them: The plane doesn't come til tomorrow, what should we do in the meantime? Over. Another voice: Doc, they said the plane won't come til tomorrow, what should they do? Over. Me: If they have antibiotics give it. Have they tried to manually remove the placenta? Another voice: The doctor says to give antibiotics. Do you have a nurse there? Over. Them: No, the nurse is on holiday. We don't have anyone here with any training, over. Another voice: Oh, sorry about that. She is my wantok, yes, she is on holiday. . . Have you tried to manually remove the placenta? Over. Them: No, no one here has training. We are worried if we remove it, she will bleed more and we are far away from anything or anyone to help us, over. Me thinking: Do I tell them to do it, to try and manually remove it? The patient likely won't survive until tomorrow with a BP of 70/50 and continuing to bleed. How do I explain manual removal over the radio through another person to someone who hasn't done it or likely seen it? Is it better to try and possibly have the patient die there, or better to wait til the plane comes, knowing she might die while waiting. Another voice: Doctor, they don't have anyone there with training of manual removal. My wantok is the nurse there and she is on holiday, over. Me: What do they think about trying to do it? Another voice: The doctor wants to know if you think you would like to try it? Over. Them: We are far away from anyone, and what if she bleeds more . . . over. Another voice: They say no. Doc, is there anything else? Over. Me: Try to keep her stabilized with IVFs, give antibiotics, and the medicine to stop the bleeding, and get her here as soon as they can. Another voice: The doc says to keep her alive, and get her here when you can, over. Them: Can the doctor call MAF and see if they can come today? Over. Another voice: Doctor, can you call MAF and get them to go get the patient? Over. Me thinking: Call MAF? I don't know their number? Who do I talk to? Will the phones work? What about all the patients still in OPD? Me: Sure, I can try. to be continued. . .