Emergency Room Progress

Our Medical Coordinator, Dr Emily Spry, is writing for the BMJ about her experiences at the hospital...

http://blogs.bmj.com/bmj/category/emily-spry/


Emily Spry on ER in the Pikin Hospital

Pikin HospitalI am happy and exhausted at the end of the first week of the new Triage system and Emergency Room at the Children’s Hospital. Around 80 children present to the hospital each day and Triage nurses now briefly assess them and rush those with Emergency signs to the new 3-bedded ER. There they are assessed and given emergency treatment by a team of specially-trained nurses and the Medical Officer on call.

After 4 days of training last week, the nurses are showing great enthusiasm. I have seen several cases where their prompt intervention bought the child crucial time, allowing a happy outcome instead of a tragic one. This is particularly the case with the hypoglycaemia associated with malaria and malnutrition. It is hard to describe the buzz you get when a grey, clammy, barely-breathing child wakes up after their dextrose infusion and starts screaming. The nurses had most of the skills and knowledge before, but the ER seems to allow everyone to focus their attention on the sickest children for the crucial first half hour or so after they arrive.

That’s not to say it’s all been plain sailing. It quickly emerged that, despite recent payments to the hospital electricians to renovate the room, none of the plugs in the ER work. Our brand new oxygen concentrator tubing now stretches across from another bay and is trampled on every few minutes. The concentrator also has a two-pin plug; the nurses do a hair-raising trick with a pair of scissors to jam it into the three-pin sockets.

There is no precise system for sharps collection or disposal. Although this part of Africa has a relatively low HIV prevalence, this is clearly still breath-takingly dangerous for all involved. As far as I have been able to ascertain, the standard method of waste disposal in Freetown is to chuck it over the nearest wall, which doesn’t give me great confidence about where our lovely mixed clinical waste is going.

But it’s one day at a time… this weekend I’m buying some plastic buckets so that water for hand-washing can be fetched when the taps go off. Maybe I’ll buy an extension cable and a plug adapter too. At some point in the next few months, I’ll spend a day following the cleaners and pondering how to make a sharps bin that has no resale value (else it will undoubtedly be emptied and recycled somewhere along the chain).

Staffing the new ER was in its first week was complicated somewhat by it coinciding with the Sierra Leone Medical and Dental Association annual conference, in which several of our Medical Officers played a role.

Amazingly for a country of 6 million people, there is only one fully-trained Paediatrician in Government Service in Sierra Leone, Dr David Baion, who is the Acting Medical Director of the Children’s Hospital. The Ministry also allocates 10 other doctors, including 5 newly-graduated doctors on three month placements. The five Medical Officers, two of whom work part-time elsewhere, are the more experienced and mostly hope to stay in Paediatrics, although there is as yet no formal Postgraduate Training available to doctors in Sierra Leone. The Medical Officers graduated between 1 and 5 years ago and some have special roles in treating TB and HIV.

One of the Medical Officers, Dr Freddie Coker, is on permanent night shifts. If you can imagine it, this means that Freddie works every night of the year, except when he can get a colleague to cover for him. What would the European Union have to say about that? With Freddie on nights, that leaves two full-time and two part-time doctors to cover the ER, Wards and Outpatients by day, with the help of the House Officers. When I collapse in a heap after a morning in the ER, I do wonder how they do it.

Emily Spry is a doctor from London who has taken a year out of her General Practice Specialty Training Programme to live and work in Sierra Leone, West Africa. She is working for the Welbodi Partnership, a charity which supports the main government Children’s Hospital in a country where more than one quarter of children die before their fifth birthday.