Storm's a-brewing...
I haven’t written in a few days because there has simply been too much going on this week in Debre Berhan.
I arrived on Monday afternoon and met my host, Dr. Aelaf Worku. A former Mt. Sinai student and resident, Aelaf has been working in Debre Berhan since February on a joint project with Dr. Joseph Mascii, head of ID at Elmhurst Hospital in NYC. Although initially a slightly intimidating figure, it became quickly apparent that he is a driven, passionate, and thoughtful person who is burning it at both ends here to affect some of the change he knows is possible. To be sure, there is no shortage of room for improvement. Likewise, there is no shortage of things that I could write about my experience here. However, the true excitement began yesterday (Thursday) around 10 AM…
Wednesday night, two prisoners from the town prison had been brought to the hospital for uncontrollable, watery diarrhea. Dr. Aelaf was able to stabilize his patient, giving him 8 bags of fluid in order to finally get a detectable blood pressure. The patient was stable at midnight when Dr. Aelaf left the nurses and doctor in charge detailed instructions of how to proceed with the patient’s care (mainly keep giving fluids and check his vitals regularly). Had they followed his protocol, who knows what would have happened, but they didn’t and the patient passed away around 5 AM. The 2nd prisoner, who was in a different department, suffered a similar fate. Two patients dying from diarrhea-related illnesses is hardly newsworthy here. That is, until eight other patients are brought from the prison and then ten more after them, all with the same symptoms. Uh-oh.
We noticed a few policemen/guards walking the hospital grounds with their AK-47s before anyone mentioned to us the possibility of an epidemic. 18 patients at our hospital, not a huge deal. 60 more patients still being triaged at the prison, very big deal.
Dr. Aelaf warped into serious GSD mode (“Get Shit Done”) and went to work drawing up a treatment protocol, a logistics plan, staffing, and infection control guidelines. By 2 PM, we managed to place the eight most critical patients in isolation in a cleared out room of the surgical ward. Around 4 PM, the first vital signs were recorded on the patients’ sheets (why did it take 2 hrs? good question – that is super fast in Debre Berhan hospital time); and we managed to scrounge up a few protective masks, gloves, IVs, bags of fluid, a bleach solution for killing possible bacterial spores, stethoscopes, and blood pressure cuffs. I immediately went to work with two nurses taking vitals on the patients, hanging fluids, and organizing their charts/management plans. One patient required five bags of fluid before we got any BP measurement (of 70/50) and we could only take a pulse by listening to his heart with a stethoscope. A few other patients presented in bad shape as well, however by the time I left at 9:15, I can safely say that all 8 patients were in (borderline) stable condition.
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