When I got to JFK I went to look for the primary care team because I had to tell Dr. Polifka about an interview but I couldn't find them. I later found them in the conference room where Cornel Moritz was giving a lecture to the medical students about diabetes and periodontal disease. I left my message and headed down the road to the physical therapy clinic to watch Julia work.
When I arrived at the physical therapy clinic Sam and Julia had just finished casting the legs of a baby with club feet. He was the cutest little baby and was just wailing because of the casting. They were casting his club feet in hopes that it would slowly rotate his feet enough so that he could have surgery on the Mercy Africa Ship. Because Liberia doesn't really have anyone to do club foot surgery they cast and recast the babies' feet which can gradually rotate the feet. It was cute to watch as the mother wrapped him up to carry him on her back and as she left all you saw were two little white cast sticking out from under cloth carrying him. While I was in the physical therapy clinic Sam, Josephine, and Julia saw one more baby with a club foot, two stroke patients, a patient with a back ache and also a young man who was being fitted for his prosthesis. With the stroke patients they did a couple of exercises to get the paralyzed muscles moving again. For the back ache patient Julia showed Josephine how to nudge the vertebrae that was causing the trouble so it wouldn't bother him anymore. Later a young man with a leg amputated showed up to try his prosthesis. He was unable to walk in it last time because he had an open wound. He put the prosthesis on and was a natural at walking in it. His balance was wonderful and it was amazing to see he was doing so well on the prosthesis.
I left the PT clinic and headed over to find Dr. Polifka for his interview. As I was waiting for the phone call I heard a woman wailing just outside the outpatient clinic. I watched from the window as she wailed, and threw herself on the ground. Slowly a crowd began to form all trying to comfort her as she wailed. I couldn't understand her but her pain and anger came through.
After waiting for the phone call for a while and learning a little about heart murmurs—Dr. Polifka was showing the med students he was working with how to listen and treat a heart murmur—I headed over to the ER to see Joy.
After waiting for the phone call for a while and learning a little about heart murmurs—Dr. Polifka was showing the med students he was working with how to listen and treat a heart murmur—I headed over to the ER to see Joy.
The ER is very small and makes me a little uneasy because you see all sorts of trauma come through the door. Joy worked for many years as an ER nurse so she was trying to help as much as she could. The ER at JFK looks very dingy and has a very distinct smell. As I walked in a man had just come in with a neck injury because he had been a motorcycle accident, next to him was robust woman who actually looked to be ok. I kept thinking maybe she needed to be in the outpatient clinic but who knows. Next to her was a girl who looked to be about 14. She had an IV in her arm and a doctor was trying to clean her face up. She had been hit by a car and had a skull fracture. Behind the three of them was another room with three stretchers, that room was really smelly. In the room where three men, two of them had head injuries and the conscious one appeared to have some burns that the nurse was dressing. Joy and another nurse tried to put an IV in one of the men. He was restrained to the bed but still very strong and didn't like having the IV needle in him so it took multiple tries and needles to get the IV in him.
Joy later told me the men on the stretchers were actually placed on the stretchers incorrectly with their feet on the end where their head should be and their head where their feet should be. She tried to explain this to the local nurses but they just weren't getting it so she eventually just had to show them by having them help her put them correctly on the stretchers. When they finally saw what she was talking about they were awed because they didn't know you could lift the patients head up on the stretcher, this way they avoid aspirating.
A volunteer had a similar incident with a patient. The patient had come in earlier and the volunteer sent her to the x-ray department to get a chest x-ray. Later the patient came back to the volunteer and told her she had gotten her x-ray but she didn't feel any better. The volunteer had to explain to her that the x-ray is just to figure out what was wrong with her and not treatment. It's the small things that we often assume everyone knows but in a country where health care and education isn't available you can't assume. I tried to stick around the ER as long as I could but the smell and the crowdedness really got to me so I headed up to the ward to see Dave Vuurman. Dave was in the general medicine ward on the second floor to the hospital doing rounds. While I was up there we wandered into a room with one patient, a very frail old man who was unconscious and whose mouth kept making a smile in his sleep. He was in the ICU, even though there were no meds for him and they didn't really know how to treat him, because he was too weak and needed constant care.
The nurse also kept saying she had malaria. She knew she had malaria because of the fever and weakness she felt but didn't want to take the malaria test because she was afraid of the needle prick. I guess once you've had malaria so many times you know what to look for, Faye did say that 95% of the pediatric patients at JFK leave with a malaria diagnosis.
After running around JFK all morning I headed over to the administration hoping I could get a good internet connection to send photos back to Project HOPE in Millwood. Sending photos from Liberia is really challenging because the connections here are so bad. Usually one photo will take me about 15 minutes to upload and send. I sat in the conference room with the med students and before long a male med student struck up a conversation with me. He was really nice and was asking questions about what I do for Project HOPE and where I was from so I talked to him for a little while. I got back to my work but every once and I while I would look up from my laptop and he would be staring. It was really funny and sort of uncomfortable at the same time but soon it was time to go so I packed my stuff up and headed out the door to meet the team.
Outside I noticed some of the nurses had not yet arrived. When Joy, David and Faye finally came out the hospital they told us a child had just died of malaria. The baby girl had been brought into the hospital by her grandmother and she had been ill all weekend. When she was brought in she had severe diarrhea and a very high fever. They rushed her to the emergency room. Joy said as soon as she saw the little girl she knew it was too late but they tried to save her. The baby just couldn't take it. They told the grandmother she had passed and the grandmother just shook her head in disbelief and then said she had to go get the girl's mother who was at work.
Later I asked Joy how she was doing and she said she was ok, that it is a reality of practicing medicine in a country like Liberia. The ER doctor, who is actually a medical student from an American university, seemed to take it pretty hard. According to Joy, Rachel was upset and frustrated. If only her family was able to get the baby to the hospital a day earlier or even hours earlier she may be alive today.
Tonight during our meeting I found out our gift-in-kind (GIK) donation of over $4 million in medicines and medical supplies will begin arriving at JFK tomorrow morning so I will be taking pictures of the GIK as it is unloaded. Some of the GIK will go directly on the shelves of the JFK pharmacy and some will go to the Liberian Ministry of Health for distribution in Liberia. On Wednesday, David Eddy, Sharon Steel and I will be going to Redemption Hospital to attend a ceremony to thank the folks participating in Africa Partnership Station. I am told the President of Liberia will be at the event as well as some other high ranking officials from the Liberian Government. -- -Marisol Euceda
--Marisol Euceda
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