Wednesday, February 4, 2009

Life & Death at Guereda Hospital

Spend a day at a hospital in eastern Chad and you quickly will witness the life and death implications when doctors have sophisticated equipment available, and when they do not.

Take International Medical Corps' hospital in Guereda, which serves the local Chadian population, as well as refugees from Darfur living in nearby camps. Guereda Hospital is one of three IMC facilities in eastern Chad that soon will be receiving desperately needed equipment donated by the GE Foundation: x-ray machines, ultrasounds, electrocardiographs, fetal monitors, etc. But until the equipment arrives, patients must go without the diagnostic care they really need – and the consequences are dire.

Eastern Chad is one of the most difficult and dangerous places in the world for delivering health care. IMC's medical director at Guereda Hospital is a South Carolinian named Florence, who just arrived in mid-January and has been at a full sprint ever since, treating patients while training IMC's local staff of nurses and health care workers at the hospital. Her first day on the job she saw around 50 new patients – not counting another 30 or so children being screened for malnutrition and receiving feedings – and the numbers keep rising. In particular she's inundated by female patients; Muslim women customarily prefer not to be examined by a male doctor and many of the women had been tended primarily by IMC's female nurses and mid-wives til Florence arrived.

In her consultation room, one patient, a woman in her 20s, explains that she has suffered abdominal pain on her right side for four years. Florence tells me that doctors in developing countries like Chad, faced with this sort of complaint from women, and without an ultrasound or ECG available, perform an appendectomy, the most common cause of pain in the area. In the case of this patient, she had her appendix removed but the pain never subsided. Florence suspects the woman has either uterine fibroids or multiple ovarian cysts. But without an ultrasound or ECG there is nothing that can be done for her beyond some temporary pain relief. This patient simply will have to wait, and come back when the equipment arrives.

Another woman in her 20s suffered a compound fracture to her tibia and fibula in a fall. Doctors had tried to remove bone fragments, but after two months her leg has become dangerously infected and may have to be amputated. Florence needs to be able to view the damage, but without an x-ray, she must perform surgery under general anesthesia to explore the bones and see if there's any possibility of healing or if a bone graft is necessary.

Yet another woman, in her 40s, lifts her shirt to reveal her right breast, gnarled and bloody from a very advanced tumor. Her treatments have consisted primarily of seeing a traditional healer who, as is often done, rubbed mud and straw into the open wound. This, sadly, has made it much worse. No modern equipment or chemo can save her now. Florence says there is nothing she can do for her. Had the cancer been caught earlier, things might be different.

With each patient I ask myself, will we be able to help? And will we be able to help in time? Fortunately, most of the patients Florence examines she is able to provide at least the band-aid that will hold in the interim with a minimal amount of suffering.

For the woman with the infected leg, the bone graft was successful. Her leg will heal, but given the severity of the damage, it will take a long time. Time is exactly the luxury that some patients can afford, while others cannot.

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