Today was exceptionally warm. Having access to clean water I chugged two bottles of water prior to leaving my air conditioned hotel room. I sat with my colleagues in an air conditioned van, with our designated driver weaving skillfully through traffic. We passed beautiful scenery on the way to the camps, as usual. Not for one minute of that 70 minute commute do I stop thinking about the daily amenities we have that are beyond a luxury for the Rohingya—it makes me uncomfortable and more apt to minimizing my life. It’s to the extent that often we don’t even like to drink or eat in front of them in the clinic.
Unlike other days I was stationed in the “emergency bay” of the clinic. This was basically where sicker patients were triaged and where the other clinic docs would send their sicker cases. At my disposal were the following : tools to start an IV, a good supply of IV fluids and a handful of IV medications, an oxygen compressor, a few oxygen tanks and nebulizers. It’s not a bad supply of tools to help treat some of the sick patients, but if we can’t turn a patient around in a few hours we have to refer them and that process is difficult given where the clinic is situated.
The first few hours were pretty straight forward and then I received a patient with low blood pressure and a horrible cough that started a few days ago. The emergency bay was starting to get busy as it doubles as the lab where we can do a few things—a malaria smear, a hemoglobin, and a urinalysis. As my nurse and medical assistant were busy I had to do something that some of us are not entirely used to anymore—fending for ourselves! I placed an IV in her right arm and spiked a bag of saline, I hung it on the pole that this patient shared with the woman in the next bed. Her oxygen saturation was low and she required oxygen..and all of a sudden I worried that the electricity source would give out for the oxygen compressor—but luckily the generator held. Her heart rate was a staggering 150 beats per minute and she has a slight fever. She was also wheezing so I administered a nebulizer, but, I was unable to provide her oxygen while giving the nebulizer so every few minutes I would interrupt the nebulizer to give her oxygen. After two hours of this and continuous fluids her blood pressure had improved as did her heart rate but her oxygenation was not ideal. We were left with no choice but to transfer her. As I was wrapping her case up the nurse and medical assistant with me were stabilizing a patient with a severe asthma attack who also required transfer.
I wondered how both elderly, currently critically ill patients would be transferred to the closest hospital. And then someone brought this forward:
Each woman was put into this and carried down the mountainside.
The trek is about 30 minutes. Now remember, we don’t have real portable oxygen tanks, and access to water on the way may be difficult as clean water is still not a guarantee despite wells that were built for the Rohingya. I hope I get a chance to know how both of these women fared.
The day eeked forward at a staggering slow pace today as if the heat of the sun was willing the clock to stop or slow down. As we got to the end of the day a 21 year old female was brought to the emergency bay for a urinalysis, she was pregnant and writhing in pain. She had a fever of 104 degrees and was holding on to her right flank. Her urine was positive for an infection and given her flank pain we were all convinced her urine infection had spread to the kidney. We were able to quickly give her some IV fluids and one dose of IV antibiotics and after some time she seemed much better though still with a fever of 103. Luckily, she lives quite close to the clinic and can come back every day for the next few days for fluids and her daily dose of IV antibiotics until she shows improvement. It was not a situation I would have opted for had we been in a fully functional hospital but she demonstrated she could walk with assistance and that was enough for us to stroke up this compromise.
Each day poses a new challenge that forces us to be both creative and realistic about our capabilities and what we can offer but more so accepting what we cannot offer. As we continue to gather data so that we understand the needs of the population we can then tailor the supplies and medications accordingly.
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