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 Re: Are We good citizens?...Health care .. We are to blame (Re: Abdalla Ali Abdalla)
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When I see my fellow doctors talking about patient mortality and
morbidity in Khartoum Teaching Hospitals, I frequently ask my self, what
are they talking about?. We have no respect for pateints in sudan!?!?!!. We
have respects for their important relatives who are either our friends,
relatives, or our local VIPS ...etc... In fact we have no respect to the
human being as such if you look deeply into the matter. When I was a
medical student, I saw a doctor, upon the insistance of a patient to review
his X rays for him, he grabbed the films from him in a hysterical manner,
throw them to the floor, and crushed them with his newly polished shoes,
and ordered him to leave the office immediately. I didn't believe King
Henry the VIIIth would do that to his poorest of subjects.
The last time I visited my local town, our neighbor's wife gave birth
to a not very premature baby (1900grams) at home. The little baby started
having seizures few ours after birth. His father came rushing to our house
asking for help. I told him: your baby needs to be seen in the emergency
room for a likely hospital admission. That was a 3.00 PM. At 7.00 PM Their
little daughter came out running. Her newly born brother is seizing again.
I asked his father: For God's sake, why is your child still in the house?.
He told me: You don't know how things are run around here. We waited until
the private clinics open at 5:30 evening for the pediatrician to see him in
his private clinic, if we were to insure quick action> (this is how locals
trust the health system) They went to see the pediatrician who was away on
vacation. His Medical officer was covering for him. He told the Dad: your
son has Malaria,. He sent the baby home on chloroquine. An hour later, the
baby started seizing again. This time I went with them. to the ER ( one
junior newly graduated houseman is residing in the ER. At the same time, he
is the sole lone doctor in charge of all the hospital inpatients in this
alleged Regional Hospital. The young doctor listened to what I have to say
and ordered admission to the pediatric floor. There is no receiving doctor
at the other end. The only nurse available had the honor of occupying the
only sheet-covered bed in the ward. Her bed is situated in a strategic
place, under a large tree , about five minutes walking distance from the
second floor where the poor child is to be admitted. His father brought his
bed sheets with him from home. ( common practice, are you kidding? he said.
When I saw the huge floor(originally built by the railway engineers as a
gift to the hospital, two fans running fully, single large sink full to its
mouth and nose with dirty water, five or six beds scattered around, old
mattresses, some old and torn, some with urine making geographic maps, no
bed sheets in site. Depressing, isn't it?. The father and the Haboba layed
out the sheets. I layed out my plan to the nurse> IV line, IV fluids, IV
antibiotics, Basic stuff. You must be kidding. She is not prepared for
that. Plastic syringes re-boiled several times. Penicillin is the only
thing available. You don't have little rooms for such tiny kids?, Where is
your weighing scale? ( the only weighing scale available is in the medical
directors office (closed after five). Are you going to take his vital
signs? How are you intending to visit him if your nursing station (the bed
under the tree) is miles away?. I tried my best not to be offensive( you
know the consequences for sure). CBC, Electrolytes, Septic work up for that
baby?!, imaging studies!? this is luxury,don't dream. I told the haboba
what to do, if he seized again or if he does any thing unusual. Monitoring
?, Isolette? I read your mind, don't offend me. At seven am next day, tears
were dripping silently from his father's eyes. They lost their crown
prince. Late the night before, the baby started seizing. The haboba rushed
down the stairs to alert the nurse. She was sound asleep. Better have a
good night sleep before she goes for her other job in the morning. Yes, she
works two jobs. She has her own problems, you know. The nurse came to see
her patient more than half an hour later. He was already in heaven. I told
you doctor, the father said. There is no use in taking him to the hospital.
The haboba was giving the ant-malarial with a spoon. He can't suck. I told
you he is a sick premie.
One week later, my diabetic uncle refused to eat. His enthusiastic
daughter kept giving him his oral hypoglycemic in time. She puts all kinds
of foods in front of him and goes to her school. The whole block was
awakened at 3.00 am with the crying of his wife and children. He is in
coma. They thought he is on his last hours. The whole city was in black
out. Except in the affluent elite part. Their lights are always there. You
can count on that. The hospital is rapped with darkness. The moon is
absent. We drove him to the ER. There is no direct access road by car to
the entrance. New buildings are raised around it. We asked for stretcher.
The only available one was taken hours ago to transfer a dead patient home.
The hospital is completely in dark except for our torches. The only nurse
is sleeping in a near by room. The young doctor is sleeping too in another
room. He seems articulate. What can he do?. Is the hospital theatre working
at this time? do you have lights there?. What happens if you have a
surgical emergency?.. The generator is not working. The doctor ordered
prescriptions for IV fluids. The patient's son went to the hospital
pharmacy across the corridor. He has to be first , yes, believe it. The
pharmacy is in complete darkness. a large table in the middle of the room.
a nicely sheeted mattress on top of it. The young pharmacy assistant is way
asleep on top of the mattress on top of the table. We gave him our torch
and our money to get the medications. The nurse is trying hard to get a
vein on this dehydrated atherosclerotic body. No mediswabs, please don't
offend me. He tried his large-pored needle several times before he
succeeded Glucometer? (it cost 50 Pound Sterling, $100?). The blood sugar
result showed up at 1 PM the next day. Yes, my uncle lived to see the
result). Electrolytes?. You have to take the blood sample to a private lab
tech. across the street to get them done. The respected Pathologist who
came to town and worked hard to establish a regional pathology lab. was
transferred to another city, as requested by the local authorities, after
several imprisonments for his believes. This is a regional hospital in a
major city. not in um-bukol or shalaoha ########da. I am sure many of us
have many sad stories to tell. Is it a problem of funds or economic
hardships?, or rather lack of respect for the fellow humans? what is going
on there far south, north, east and west of Khartoum is a forgotten world.
Kulo sanna wa into Taibeen
A. Abdalla
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