Learning the system - Day 2

 

We kicked off today with morning report. Two C.O.s presented patients who were admitted overnight. The head nurse, Rita, was not impressed with their presentations and made sure they knew what to improve for next time.

Next we rounded with Gloria, one of the physicians, on the inpatient wards. The women's ward was full of patients, one of whom had come in with a hemoglobin of 3 mg/dL - yes I said 3! She received 2 units of whole blood and was being referred to a bigger hospital in Iringa due to the limited ability for further work-up of her anemia in Ilula. Another woman came in for headache and epigastric pain, but was incidentally discovered to have high blood pressure.  She was started on treatment overnight but still had elevated BPs (174/107) so additional medications were being added.

I got a kick out of the paper charts used on inpatient wards, including the vital signs 'flowsheet' - the back page of the paper booklet with hand drawn lines to create columns. I also learned that patients take the booklet with them when they discharge, so if they seek additional care - they have their records.

After lunch, we got a tour of the lab from Emmanuel. Considering their overall resource level, Ilula has a fairly advanced laboratory. They have a machine to run 'whole blood picture' (aka CBC) and another that can do many chemistry levels along with various enzymes & hormones. They also have GeneXpert, which is a machine that does PCR testing for several types of infections such as Tb and HIV. The government sponsors this equipment and testing costs (so patients don't have to pay) due to the benefit to public health.

We also got to see the blood bank (pictured right) where the 2 units of blood had come from for the patient we saw this morning. The bag you see on the top shelf is the only remaining unit Ilula has ready for transfusion. 

BUT when a patient needs blood, family members are asked to donate 'replacement supply'. And yesterday they got 6 units donated (bags you see on the bottom shelf). Those units have to have testing for infections sent out to another facility before they can be used. They are sequestered until test results are known. If any units are positive for infections, they are destroyed. Regional hospitals also share their limited blood supply with each other. Recently, Ilula requested & received more blood from Iringa. And Ilula will reciprocate when able. If a unit is close to its expiration, the hospital will find another facility nearby that can use it. It is great to see how they work together to share & make sure none of this precious resource gets wasted.

So far I am fascinated by everything. I can't wait to see what tomorrow brings!