Day 25 - A sleepless night at Viedma Hospital ED
We did our best to try to sleep-in this morning hoping that the stored sleep would give us the stamina we needed for our approaching night shift. We didn't know what to expect in the ED at Viedma. When we had peeked in on our tour it was small but very busy. Through the curtain I could see a group of doctors trying without much success to intubate a patient. We knew that if all else failed at least we would see some wierd and wacky stuff...and we certainly did.
On arrival we were introduced to a few busy doctors and then were left to our own devices. We followed around some Brazilian students. We have discovered that the brazilian's are always friendly! They seem to be culturally overtly flirtatous in everything they do and say. They can turn the most dull inquiries into a flirtatous question. There favourite line is "So how bout you teach me some english, and i will show you how to speak portuguese?" It is a little disconcerting but for the most part is pretty hilarious!
The doctors quizzed us endlessly on our first patient's x-ray. This was especially difficult because we had to try and teach Leticia the correct medical answers in spanish. He didn't seem very impressed with us. He told us we should examine him as it was a very interesting case. Just as we drew up to his bed and were about to start the examination he revealed the diagnosis...TB! We quickly withdraw eager not to be infected by this terrible disease. A confused Leticia queried "Don't you guys want to examine him?" We quickly filled her in on the perils of TB infection, primarily, "We may not be able to re-enter our country if we are infected". She caught on quickly and backed away herself. It was interesting to be in a country where TB is so common place and almost everyone is likely to have been exposed to it. In Australia, the patient would be isolated, full sterile gown and glove precautions in place, and placed in a negative pressure room. This guy was parked in the bay next to a mother and child.
We then watched a intern struggle with some stitches. I felt for her. She was obviously out of her depth. She had a deep head wound that wouldn't stop bleeding and she had no one but over eager brazilian students to help her. I was surprised that she did not even know to apply pressure. The interns really do have too much responsibility in Bolivia.
A pungent smell wafted over the curtain divider from the room next door. The brazilian students were eager to show us the origin of this awful aroma. The poor patient had necrotising cellulitis of his scrotum. The ulcer it created was huge and looked horribly infected. We couldn't believe how bad the patient had let it get before presenting. He will be lucky to escape the terrible complications an infection like this can cause. He would have been in sooo much pain!
Overwhelmed by the smell we did our best to try and escape it but discovered that it polluted the whole ED. Surprisingly, this coincided with the realisation that we were quite hungry and decided to make a trip for some sustenance. We set out into the busy Friday night streets of Cochabamba city. We walked a few blocks when we happened upon Super Pollo (Chicken) which looked like KFC. We made a quick evaluation; it was busy (good sign), busyness meant quick turn over of food- less time for unwelcome organisms to grow, food was fried (few organisms could live through that kind of test), a new batch of chicken had just been dumped into the heater...it seemed to a winner. Before scoffing down our fried and extremely salty chicken (another good sign) we prayed fervently over our food hoping that all bugs would be repelled in the name of
Jesus!
Back at the ED things had slowed down quite considerably. Our friendly brazilians had left and in their place was Pablo. Pablo was a really lovely Bolivian guy who was also studying medicine. He hailed from Potosi. The official highest community in the world. It is extremely cold there and the altitude sickness is terrible. The main industry is mining and there has been a long history of horrific working conditions for little wages. Pablo seemed glad to have our company through the long shift and we made sure to teach him and pull him in on interesting cases.
Over the night we saw a number of traumas. Most car accidents, one bashing and one poor medical student who's friend had dislocated his shoulder. His friend was also a medical student and got to help the doctor pop it back in. Doctors always tell us that this is an easy procedure. However, every single case of shoulder dislocation has required a mammoth effort of pulling and tugging and pushing to get the stubborn dislocation to return to its rightful place.
The highlight of the night was when some of our animated Brazilian medical student friends from Hospitals of Hope arrived in a flurry of excitement. They were the last people we expected to see in at Viedma. With sirens blazing an ambulance pulled into the bay and with much clattering and clanging a trolley rolled out and started veering toward the entrance. Our two frazzled friends drove that trolley like a rally car it rolled this way, veered that way, narrowly missed that patient, but didn't miss that nurse. With a sharp reprimand for a nurse they seemed to come out of their frenzy and steered the trolley into a bay. It was like something out of a bad slapstick comedy. We were doing our best to suppress laughter. They competently stabilised their patient and then spent some time reassuring her family. I was impressed with their bedside manner after their dramatic entrance.
Pablo and the three of us did our best to stay awake when their was a lull in the action. Tiffany even shared around some caffeine tablets. They seemed to push me over the edge in the other direction and by 5am we were asleep on our feet. We farewelled our new friend Pablo and caught a taxi home.
In the cold, dark, early hours of the morning we stumbled toward the hospital entrance to discover the gate was locked and there was no sign of a guard. We made a quick decision to scale the stone wall and drop down into the hospital grounds. It was a slipperly climb but we dropped in just in front of the Bomberos (Firefighters) house. I am glad we didn't wake them because they have been known to shoot at things in the dark with a bird-fright gun!
When we got to the front door we realised with dismay that we had been locked out! We had resolved to climbing once again over the back fence when I leaned over to turn on the porch light. DING DONG! Apparently the door bell had disguised itself as a porch light. A startled looking Leta opened the door. Just before the sun came up we flopped into bed!
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