Tuesday, June 30, 2015

A wing and a prayer ain't cutting it

Now enjoying the temporary respite from exams, left wondering how on earth to apply what I've learnt to the Guyana situation.
Absolute tragedy in the making ... a mother of six, ages ranging from 26 to 7yrs is dying.  This being Guyana she/they haven't even been given the courtesy of a diagnosis of what is wrong-- or maybe they are not saying. I can only surmise that perhaps she got gestational diabetes from the last one which developed into the full-blown disease and with the characteristic lack of information attended the local rural clinic on a regular basis for 7yrs and ended up with damaged kidneys.  The rural clinic referred her to the district hospital where she languished for a couple of weeks and where they thought she had cancer but as she was experiencing abdominal swelling and the consultant from the Capital City  never turned up, she was transferred to the main Public Hospital in the said Capital city, having to make her own way down.  Appallingly, she was made to sit in a waiting room chair of the Emergency Room for over 36 hrs (unbelievable!) then they were unable to diagnose the condition, cancer being the main suspect.  She finally got some form of relief when they drained the fluid from her cavity wall, then the family was told they had to pay for a scan-- which they were unable to afford.
After a day or so, it was discovered that because she was from an indigenous tribe they would waive the fees. In the meantime, the two daughters were kept on their toes getting foods that she was used to as the hospital food was not to her liking.  Distressing for me to hear was that the woman's simple request for a cup of hot water was a problem for the nurses who had both a kettle AND a microwave at their nurses' station at the end of the Ward... how inhumane.. I can't imagine that being such a problem-- and being that this is Guyana .. the assumption for this unfriendly behaviour was rooted in racial terms.. but in fact, it was an institutional idea handed down from the early 20th Century-- that patients follow rules convenient to the staff and not rooted in any clinical reason.  The nurses offered the patients a hot cup of tea when it was convenient to them-- our patient made her daughters get her a flask so she could have her tea when she wanted-- the nurses were a bit annoyed to provide the said hot water so it meant one daughter lugging in a flask of hot water every evening after work so as to 'not bother the nurses'!   Likewise, (and I am in agreement with our patient) she didn't like eating cold food, but apparently the simple request to warm the food brought in by the daughters in the nurses' station's microwave was not met with approval.
 So feeling better having the fluid drained and apparently not finding anything on the scan, the woman was discharged! With instructions to attend the local clinic if the swelling occurred again as there was nothing else the Public Hospital could do.  She went back home and got accumulation of fluid after about a week-- the presumably inexperienced doctor (one of the many Cuban-trained ones) was wary about doing the procedure and only did a partial drainage meaning that she had to disrupt the family's routine to revisit the clinic more often.   I wondered about the communication and transfer of patient files and whether the Georgetown specialist had given any advice to the doctor in the rural clinic?
As I write, she has not eaten for two days as she is finding it hard to swallow down anything and has lost a lot of weight... stomach cancer? failing kidneys?  I don't think we will ever know but the human tragedy of the loss of a mother is one being repeated many times with its ripples of expanding unhappiness.

Wednesday, June 24, 2015

Dis is Guyana!

Was reading the sad story of the shock of a US-based doctor coming to Guyana to find three relatives dying from sepsis - an preventable condition if sufficient care is taken- Good grief, 'they' discovered ways of prevention since the 18th Century.


So this is the bind the hospital administration/government is in... to criticise the staff would be adding to the demoralisation and knocking those who genuinely care and make huge efforts w ith whatever resources they have... however to ignore the problem-- such as basic hygiene due to laziness-- such as inserting a needle without cleaning the site and not ensuring cross-infection is setting yourself up for further slackness. I know GPHC have a quality-control department but wonder if it is allowed to function-- we hear so many of these stories.  I also hear of the older nurses complaining of the attitude of the younger ones and poor training. At the end of the day, no matter how well the docs have performed..poor nursing care will result in speeding up the ultimate end.

The concept of targeting the causal organism also seems beyond the reach of common medicine here and woe betide you if you have something uncommon!  It sounds like a given that the machine would be broken-- would the way ahead be some form of cost-recovery for tests needed to be carried out? I am sure people would not mind a lower fee rather than the hassle of having to get a private Lab at an exorbitant rate or not at all--- there must be a middle ground between all or nothing!

Monday, June 22, 2015

Americanah by Chimamanda Adichie

A book that would resonate with any Third World person who had to eke out an existence in a 'first-world' country.
Her views on US society were interesting: 'In America, tribalism is alive and well. There are four kinds—class, ideology, region, and race. First, class. Pretty easy. Rich folk and poor folk'. 'Second, ideology. Liberals and conservatives. They don’t merely disagree on political issues, each side believes the other is evil' ' Third, region. The North and the South. The two sides fought a civil war and tough stains from that war remain. The North looks down on the South while the South resents the North. Finally, race. There’s a ladder of racial hierarchy in America. White is always on top, specifically White Anglo-Saxon Protestant, otherwise known as WASP, and American Black is always on the bottom'
The bottom-line is a love story that seems a perfect blend of personalities and intelligence, but Life happens and they go their separate ways..the reason that they do seems a bit contrived.. but towards the end of the book one of his friends makes this sage observation: '....many of us didn't marry the woman we truly loved. We married the woman that was around when we were ready to marry.'
It got me musing about the whole 'love' thing..both protagonists get on with their lives and have sex and relationships with other people but one rather got the idea they were 'settling' and I wonder really.. do most people just 'settle'.
Some ideas and characters were not so well formed but it was a fairly longish novel whose main purpose, it seemed was to explain Nigerian ambivalence about traditional roots and modern Western culture.

Carbon Conversations

So remembered about the lecture about 20minutes late and decided to go check it out. Didn't have anything new to say.. apart from warning Guyanese to use the revenues to invest in education and sustainable policies-- mmm-- like if anyone in the room would have ANY say in that!? A couple of 'new' ministers were sitting and still awake at the end of the talk, but seeing as the rumours that the allegedly previous holder of Natural Resources was happy to leave, I wondered if this new lot were going to follow in his very lucrative footsteps, allegedly.

Drilling for oil was assumed to be a given, and I guess as the lecture was sponsored by one of the exploratory oil companies, he didn't mention that China has done a great job on 'cleaner' alternatives: 'installed 5.04 GW of new solar capacity in the first quarter of 2015' and that the G7 nations recently agreed to phase out fossil fuel dependence by the end of the Century (http://www.theguardian.com/world/2015/jun/08/g7-leaders-agree-phase-out-fossil-fuel-use-end-of-century).  Mind you he did mention that the world, as we know it, would not be able to shake its dependence on fossil fuels anytime soon.

He touched on the difficulties of finding new sources of silver and other metals required for electronics and that Guyana had potential as the world was now at a desperate level of recycling and recovering.. to the extent of scraping the walls of buildings for platinum deposits from catalytic converters.

Attendance was good but I left before the free food.

PS Nothing was said of any Health, Environment or Social Impact Assessment and afterwards I wondered if this exercise counted as a scoping exercise... limited to the few who had to means and inclination to attend the exercise at 7pm in the evening.