First Day at RVTH

Wednesday, March 1st

First day at RVTH.
I worked in the female medical ward this morning. Cuban attending physicians, Gambian med students, Gambian and Nigerian nurses. Nothing happens fast. Little seems to have a system or plan. When you ask a nurse a question she doesn’t pick it up and run with it.
Example: “I need a pair of sterile gloves.”
I get a blank stare. A shrug. “I don’t know where they are.” No attempt to find them, find out where they are, if any are to be had. Nothing.
“Would you please find some.”
“I don’t think there are any.”
It takes several more requests before someone goes up to the “theatres” (surgery) to find some. Meanwhile, I have a patient in severe respiratory distress who needs immediate care. Perhaps they are so used to disease and death that they are lackadaisical about it. I took care of a woman crashing with AIDS and diarrhea; another with a gangrenous diabetic foot that looked like a blackened charcoal stump.



Another patient was a very sweet lady part of whose diabetic foot had simply fallen off (autoamputation), then gone septic. It is healing slowly but still smells awful.
And not a single complaint. They suffer in silence, with a patience and acceptance that is both extraordinary and heartbreaking.
For a real shock work ER in this place! They call it A&E, Accidents and Emergencies. The paint peels. The lights are dim. There’s no privacy. There’s little in the way of equipment.
To get oxygen for an 84-year-old man with a suspected heart attack it takes two men to carry a 5-foot-tall tank from an adjoining room. The oxygen cannula is crusty with use but there is nothing available to clean it. We use it anyway. At least there is oxygen! Patients are accompanied by family members and these “attendants” crowd around as we examine and discuss. They are respectful and don’t interfere but will come forward with questions or requests for the patient. With our lack of staff they are valuable for helping provide care and we enlist them to help move patients and equipment.
A young boy is carried in by relatives. He fell from his bicycle and fractured his right ankle. As they carry him in the bone pokes through the skin and the unsplinted ankle flops about, dripping blood all over the floor. He grimaces in pain but doesn’t cry out.
A 20-year-old woman with pelvic pain and seizures lies at the other end of the room, convulsing.
Along the wall are three beds: a man with a liver the size of New Jersey, one man with a urinary catheter filling a bag with frank blood, and a young woman delirious with cerebral malaria. Two scarred desks line one wall; two more along another; all in a 15 by 20 foot room.
The staff is me, Dr. Rene Rodriguez, a small, handsome, wiry, 35-year-old from Camaguey, Cuba, and 5 or 6 medical students. The students are earnest, intelligent, and hungry to learn. They are terrific.