I recently spent a week in a hospital in Fiji as part of a self directed placement, what an eye opening experience….
There were numerous events that could be reported on, however there were a couple of things which stood out.
We were on a ward round with the local health professionals, and visited the men’s trauma ward. Due to the lack of surgical supplies (pins, plates etc) as well as anaesthetic and antibiotics, most of the fractures are managed conservatively with the patient put on traction. This in itself was pretty overwhelming, as traction in adult patients is not done routinely here (as far as I know?) The most common were LL tractions, however there were a couple of cases where skull traction was applied for spinal patients.
We listened closely in the ward round, and found the conversations and Xrays fascinating. There were many high energy/impact accidents, so the Xrays were pretty remarkable. We reached the bed of one patient who had broken his NOF, he was fairly elderly but didn’t appear to be coping too badly (elderly has a slightly different meaning here, as we were told the life expectancy was approx 61 for men and 64 for women) As like many of the other patients, he was managed conservatively as the available anaesthetics were kept for higher priority patients needing surgery.
The following day we actually sat in during surgeries run by the Australian hand surgeon we were travelling with, so were not up on the ortho/trauma ward.
The next day we made our way back up to the ward to help out the ortho physio. Upon entering the ward, we were aware that a curtain was drawn around one of the beds and a woman could be heard sobbing hysterically. The physio told us that a patient had died over night and his wife was mourning by his bed. The rest of the staff and patients were getting on with their daily routines in the ward.
We found this very confronting for a number of reasons. We found out that the patient who died was the one with the broken NOF. Apparently it had either got infected and the infection travelled to other areas of his body, or it had been a fat embolus, the person who informed us was unsure. We were astounded that something that could be managed relatively simply in an Australian hospital, had caused a man to die. The second thing that amazed us was that they had kept the body (and the mourning family) in a fairly public place. There were heaps of people moving throughout the ward, walking around this family. I think here in Australia, death tends to be a very private affair to begin with, with a private room for people to grieve. The hospital didnt had the luxury of giving these facilities.
It made us really appreciate the facilities we have available at home. I guess until you are exposed to a completely different situation, you take little things for granted.
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Definitely it is easy to take many things for granted. I even took it for granted that my patients would still be there when I got back to the ward after the weekend. It was a bit of a surprise to find out one of my patient's whom i had briefly seen had passed away over the weekend. I then had two pass over to palliative care, which is essentially keeping them comfortable as they deteriorate in the final stage of their disease. We do have a very good health system here, with consideration for even the comfort of a patient who is beyond help to be given a private room, continued medical care and support to the very end. I now check a little tentatively on the oncology wards as to who is still around for me to treat and get a little excited when they are there (obviously more so if they were discharged). I just don't take their presence for granted anymore, nor the fact that they will discharge soon. It really does make you appreciate your health and opportunity to be involved in helping them.
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