Mar 22 2011
By Brett Bechtel, MD
Department of Emergency Medicine
Vanderbilt University Medical Center
I have learned a lot from my time in Guyana. It is amazing to see how long patients will wait patiently to be seen. Crowded onto benches for hours just waiting their turn.
The "asthma room" as it is termed is one of my favorite areas of A&E. Patients magically appear there from the waiting room and are started on breathing treatments. All doctors have heard the term "all that wheezes is not asthma." So daily I would make my way through the group placed in the asthma room searching for the one who didn't have asthma but some other process. I found one elderly lady in heart failure and another baby who had a murmur and heart issue as well. Largely though the asthma room works as it gets those who need breathing treatments quickly the medicine they need. Teaching the residents at GPHC to be cautious about those other kind of wheezers was enjoyable and they will be on the lookout in the future as well.
Sadly I saw a few deaths this month including a few being pediatric. Death is much more accepted, as resources aren't as abundant here like they are in the US. I also saw some patients persevere and do well with diseases and ailments I would never have expected people to survive let alone be functional with. There is a saying here that "God is Guyanese." Essentially these people are looked after by a higher power. One man who was stabbed in the belly made it to the our A&E a full day after his wounds from deep inside the interior of Guyana after a trek through the jungle to a landing strip and then by plane to Georgetown. He remarkably ended up doing ok after surgery to his intestines.
The team working here is amazing. They all are very friendly and dedicated. We had young man come in shot in the abdomen one evening. We quickly had the whole staff helping to resuscitate and care for him. He was taken to the OR in record time but succumbed to his injuries as the bullet had hit the great vessels as well as the liver. He had the best chance to survive due to their quick action and the surgeons being ready as well. Unfortunately where he was shot he wouldn't have lived even at the best US trauma center either.
I did a grand rounds type talk to the Emergency Medicine residents, staff nurses and other doctors on one day. They don't have any Neurologists in the country and I saw many, many seizures of all sorts of etiologies. So after a week of seeing what they had to treat seizures and the kinds that were coming in. I lectured on strategies to manage the seizures using their pharmacological armamentarium. The power of course went out in the room I was lecturing in so it became more of a discussion and me using my computer and its battery as the projector wouldn't work. Overall though it was a great experience and the nurses and doctors were very interactive.
I also did lots of bedside teaching. Many of the doctors in the ED itself are relatively new and have just completed medical school training mostly in either Guyana or Cuba. They are eager to learn and fun to work with. They routinely stop me and ask questions about what I would do with different patient presentations. I would definitely like to return here some day.