Physical Therapists and Pharmacologists Wanted!

 

A little plug about my favorite international organization: 

BRAC one of the largest NGOs in the world based out of Bangladesh is a tremendous organization which has done so much to further the people of Bangladesh. One of their initiatives was to use recycled hand made paper to help prevent environmental degradation by targeting the corporate urban market in Bangladesh and to recycle their paper waste. This enterprise had a second function which was to support a small group of drop-out female students from BRAC's education program by providing them jobs at the production facility of this enterprise.  With this paper such creative products are being made like this tiny notebook which I then purchased at one of the plant nurseries that BRAC has in the city. 

Fast forward to today, as I scribble my thoughts and ideas on this beautiful recycled paper about what else we can do to better the delivery of care a few things stood out. First off I should mention that I rounded in another ICU with the father of critical care medicine here in Bangladesh, Dr. Mohammed Omar Faruk. The set up of this ICU was similar to Dhaka Medical--much like an emergency room bay with beds separated by a curtain. A few differences, there is one bedside dialysis machine available, an ultrasound at the bedside is available. Obtaining imaging is most certainly easier(I discovered as the team without hesitation appropriately ordered a repeat CT head on a patient) which is likely related to the patient population here being financially more stable. That said I noticed three things in particular. 

1. There were no families at the bedside

2. The number of "big gun" antibiotics being used far surpasses what most of our US patients are started on for similar diseases 

3. There are no chairs for able patients to sit in and very limited physical therapy 

Issue #1: why are there no families at the bedside? I shall need to investigate this further as the thought of not being able to spend time with a critically ill family member, conscious or not seems a bit difficult to fathom

Issue #2: as it happens multiple studies have shown that multi drug resistant organisms here in Bangladesh are quite prevalent, is this secondary to years of  an absence in antibiotic stewardship? Possibly. This will need to be a huge area of development and I call on my friends in the pharmacy world to help us come up with some solutions 

Issue #3: as more medical advances are made people are living longer. A stay in the hospital let alone the ICU can cause prolonged fatigue and weakness. A stay in the ICU which is often prolonged can lead to severe, measurable weakness, a state which has been deemed ICU-acquired weakness. Just getting out of bed to chair let alone extensive physical therapy can be useful  and yet the mechanism does not really exist here. The need is most certainly there and we need to put this on the future agenda!!!