Thursday, April 1, 2010

Another Day in Triage

Tema, Ghana - Another day in triage...

The heat in the outpatient department is oppressive and sweat rolls off my back. Sluggish children and their mothers crowd the benches waiting their turn in the “queue” to see the doctor. Most are here for fevers and body aches, most likely malaria, Beatrice, the pediatric triage nurse tells us. In the United States the word “lethargic” is reserved for our critically ill patients. As I look down the benches, I see lethargic children, with sunken eyes and fontanelles. It once again is a sobering sight.

Beatrice and I have been talking all morning about the need for standardized triage protocols at Tema General Hospital. “Sister, come and look,” as Beatrice motions me to a mother delicately holding her small child wrapped in a sheet. The 4-day-old boy’s axillary temperature is 40.3 degrees Celsius; this is roughly 104.5 degrees Fahrenheit. I recognize this situation as a true emergency and question Beatrice regarding the neonatal and maternal history. “I do not know,” she says as she places the child’s chart in the front of the queue. I think to myself, it is good she recognizes this as a high risk situation and places the child at the front of the line, but in our practice, this patient needs immediate attention; he should not wait.

It is a difficult balance as an outsider trying to mentor nurses while taking into account the vast deficit of resources that we have come to depend upon. In no way do we want to discount their standard of care but we also want to ensure patients get necessary and timely attention. I quietly suggest to Beatrice that it might be best if we send the infant back to the “baby ward” and alert a physician as to the patient’s condition immediately. As we walk toward the ward, I can appreciate the stress the nurses of TGH face. They are working with a high volume of acutely ill patients with few resources. As part of the Project HOPE team, I look forward to facilitating realistic goals based on solid practices for their triage system.

Thanks for reading-Elise Chamberlain

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