By Vivian Lei
Two weeks working alongside the Guyanese residents, nurses, and staff at the Georgetown Public Hospital Accident and Emergency (A&E) Department has been an incredible reminder of why I chose emergency medicine and how unique this specialty can be. We truly care for anyone, anytime, anywhere.
Here, I am confronted with the same emergency conditions that are so common back home: terrible fractures, gaping lacerations, sepsis, myocardial infarction, stroke, or severe asthma exacerbations. However, the acuity feels much higher. A 2 day old baby girl born at home may be carried in at the same time as a family’s 92 year old patriarch, both struggling to breathe. It is remarkable to see the resident physicians and nurses work to care for these sick patients, many of whom have traveled many hours from the Guyanese interior to seek medical attention. Resources may be limited but everyone strives to provide a high standard of care.
Personally, working in the A&E has challenged me in surprising ways. There are not nearly enough nurses and staff available to start IVs, draw blood, hang IV fluids, administer medications, or reassess patients. Much of that responsibility is left to the physician, and it’s awkward to admit I’ve placed more IVs in 2 weeks than I have in all of residency. Lab results can take half a day to return and a CT scan is often out of the question. While it is actually refreshing to rely on my physical exam, technical skills, and clinical intuition to take care of patients, I feel the weight of each decision I make much more.
Meeting the emergency medicine residents of GPHC has been a highlight of the trip. The emergency medicine residency program in Guyana was created by Vanderbilt and was one of the first residency programs at GPHC. There have only been a handful of graduates from the program, but those I have met are unbelievably well trained, efficient, thoughtful, and impressive emergency physicians. Part of my role has been to oversee residents and other trainees in the emergency department but I am constantly humbled by their knowledge of diseases I have only read about in textbooks. They certainly have a great deal to teach me in the next 2 weeks.