Emergency care nightmare

A colleague and I arrived at the training venue and found two of our colleagues based in the field occupying one of the outer huts.  They were resting and waiting for us.  Altogether we were to be the training team for an activity over the weekend.

The terrible heat during our travel from HQ had sapped our energies and we arrived looking and feeling totally fried.  So were our colleagues who had also just traveled from their respective field offices.  One of them, we were immediately informed, was having high blood pressure.  When she checked before their travel, her BP was 190/110.

It was decided that the two immediately go for a check up.

We were told that the owners of the place were driving to Lagawe so we decided to go with them.  On the way, we dropped off our two colleagues at the health center which was a a good 15 minute walk from the training venue.  My companion and I rode on to Lagawe where we quickly made last minute purchases for the training.  On our return, we found our two colleagues already there.  They told us that the midwife diagnosed high blood pressure for both of them, in fact, one had 210/110.

What? I exclaimed, don’t you feel sick or something?

I’m fine, she replied.  But, her face was ruddy and her eyes blood-shot and somewhat glazed.

I asked her again but she was insistent.

So we remained inside the hut where it was cooler and watched the sun set, ate a couple of papayas and bananas and drank pineapple juice while talking about how good health is indeed wealth.  Suddenly, the colleague with the 210 BP sat up – she was trying to sleep off her high BP or whatever she was feeling – and ran out, yelling to us that she was going to throw up.  Chaos was the word for the next hours afterward.

The owner of the training venue drove us (like mad) to the nearest hospital, really a district hospital 30 minutes away.  As our colleague was being admitted, the doctor, the only one in the hospital we learned, jokingly congratulated our colleague on having neglected to medicate for her hypertension.  The doctor told us she was close to having a stroke.

On arriving at the hospital emergency entrance, a wheelchair was immediately pushed to the front passenger side of the car and our colleague assisted into it by a male attendant.  The lobby/receiving area set up was that my first thought had been ‘this place is seriously under-staffed.’  A colleague who apparently had a similar train of thought said, ‘this is the effect of PDAFs wrongly spent.’

We found the lady doctor, as I said, the only one, in the middle of an argument with a man (we later learned that the argument was similar to what my colleagues and I nearly had with the doctor.  The man had accused her for not doing anything and threatened her as well).  We heard her telling him that she has already called the police.  True enough, a couple of policemen who looked incredulous with their heavy arms appeared at the doorway and spoke to the doctor.  The conversation was loud and everyone who’s at the lobby were privy to the exchange.  Half my brain was processing the scene as scary– what if there was a skirmish and the police had to shoot? we could get hit.  I was also pissed, at both the doctor and the policemen who should know better than to start what to me looked like an ego-tripping scene in front of patients.  I wanted to yell for them to stop but I controlled myself.  I also should know better than to add more fire and besides I loathe public confrontations.

Meanwhile one of my colleagues got the nurse who was the only one on duty there to attend to our colleague.  The nurse examined our colleague who was already slumped in the wheelchair, and afterward left her note on the doctor’s table.  The doctor who was not at her table was still blowing off steam.

I waited for the right moment to get the doctor’s attention.  When I did, I said, “Doctor, hi.  My colleague here is sick.  Here are the details”.  I picked up the nurse’ notes from her table and handed it to her, almost shoving it to her face.

Perhaps because I spoke Tagalog (which locals here have difficulty speaking) without trace of a regional accent, or that I smiled at her, or I was the tallest woman in there with my wedges, or I looked like a non-local but thankfully she focused on me and momentarily stopped her ranting.  Perhaps she realized she has momentarily forgotten the lessons from years of medical training e.g. creatively handling difficult people, because she took the note without a word and got up to attend to our colleague.  Eventually she gave us a list of medicines we were to get from the hospital pharmacy.

When we returned from the pharmacy, we found she had resumed her rant.  Seeing us, she told the nurse to place our colleague on dextrose and the works.  An attendant came in and wheeled our colleague inside.  Meantime I and another colleague waited for the nurse to get up from her paperwork and attend to our colleague as what the doctor instructed her.

We waited 5 minutes which dragged to 10 minutes.  After that, I refused to wait any longer.  I butted into the doctor’s conversation with another, a patient for all I care, and in the same tone and demeanor as before I said, “Doctor, our colleague is already inside, can you already attend to her?  Otherwise we’re soon going to have a nervous breakdown.”

She stared at me then recovering chided me but she was laughing when she did.  “I know, I know.  Just give me a sec here,” she said.

She completed the paper work on our colleague and commanded the nurse who was still at her paper work to go and see to our colleague at once.

After our colleague was finally put on dextrose and oxygen, it was only then that we calmed down.  She was put put on a trolley bed parked on the corridor leading to the lobby and delivery room as all of the six private wards were taken.  We sounded preposterous even to ourselves when we asked if we could be given an extra trolley bed and we’d pay for it.  “As much as I’d like,” the doctor said, “there’s no extra bed or empty ward.”  The extra bed was for our other colleague with the 190 BP who was nearly admitted, but thank goodness three hours after taking the prescribed meds her BP went down to acceptable levels.

After another colleague went to the nearby village to fetch a local youth volunteer who agreed to keep watch over our colleague that night and having checked that everything else was taken cared of, I took the opportunity to lie down.  It was almost midnight.  The only available place was at the foot of the trolley bed.  I curled myself into a ball to fit in and tried to nap.  But considering our location and my position on the bed, I couldn’t.

Instead I went over the night’s events realizing a few things:

  1. Being treated like a rat reduces you.  There’s loss of dignity hence not surprising if one goes off on a rampage like that man who threatened the doctor.
  2. In real life, even doctors supposedly under Hippocratic oath discriminate against physical appearances and characteristics.  Whether or not a patient will get quality care tend to be dictated by this– the more provincial you look and less confident your talk, the more you’re ignored or given last priority.  You either allow yourself the treatment or be street smart.
  3. Inadequacy of hospital resources put patients at great risk.  This is happening every minute every day everywhere in the country.  Public hospital staff are overstretched thus liable to bark at patients who are only just expecting quality service and care.  The nearest tertiary hospital in the area is in Bayombong, Nueva Vizcaya.  But Bayombong is 1.5 hours away and our colleague needed quick emergency care.  At least the hospital pharmacy was stocked otherwise our colleague may have had a stroke and we’d just look at her die.
  4. When our two colleagues went to the village health center, they were both given nitrogylcerin (placed under the tongue) apparently an SOP in village health centers and rural health units.  The colleague with the 190 BP reacted well after taking it.  The one who was hospitalized, with the 210 BP, reacted negatively.  Later, making a quick scan online why this is so, I found that there are depending on a patient’s medical preconditions adverse effects of nitrogylcerin.  This implies that the midwife at the health center was not skilled in making such a diagnosis.  It is an imperative therefore that the DOH and I/NGOs supporting these facilities train local practitioners.
  5. An air lift, if one is connected and could call up a chopper right away, is not the solution to emergencies.  It’s well-equipped, -stocked, and adequately-manned health centers and hospitals with skilled human resources.  Public hospitals should also explore subsidies for the poor.  Our colleague’s medicines cost PHP70 in all, an insignificant amount to us but beyond reach for the poor.

How can we Filipinos address this perennial problem?  Corruption of people’s monies is a sin against each and every one of us. It is why those who allocate taxes and interest from these for personal use e.g. for purchase of the latest LV bag (vs. one more life nursed to health) deserve the maximum penalty provided by law.  Imprisonment is not something others did to them.  They did it to themselves.  Sadly, even if they were penalized this cannot bring back the many who died as the result of corruption.  The DOH on the other hand need to further step up on it’s role in monitoring and accreditation of public health facilities.

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