Home visits have an immense value in the refugee population to increase patient education and compliance with treatment and allow providers to assess and overcome barriers to care that result from lack of resources in the home.
The A&E. I have enormous appreciation for the staff, nurses, residents, and attendings I met during my time in Guyana. In a short time, they have welcomed me into their emergency department, helped sharpen my clinical skills, and become a second family far from home. What’s more, there are actually some elements of Guyanese health care that I wish for after returning home, such as universal health care and access to primary care. There were many times I could send a patient from the A&E directly to a specialty clinic the same day. I prescribed medications knowing that patients could fill them for free from the hospital pharmacy. Time and again, I was shown ways in which low resource did not equate to low quality 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.
The statistics were just numbers to me until my first few weeks at Georgetown Public Hospital, where suicide attempt is a routine chief complaint and deaths from poisoning and hanging are common in our emergency department. These are just the patients that survive to get to the emergency department. In the US, I had seen plenty of suicidal patients, usually with a minimal gesture like taking 5 tabs of Tylenol in order to buy an admission to a psychiatric ward. In Guyana, suicidal patients mean it, and they are usually successful the first time.
Working on the ground in a global health field position is a special chance to observe the collisions of world views, and Georgetown, Guyana is one of the most spectacular melting pots to do so. I am fortunate to work with resident physicians, nurses and students who are supremely passionate about providing the best emergency care for everyone who comes through our doors. We have great and powerful motivations from our faiths, families, friends and life stories. But as is always the case, an army of do-gooders cannot meet the needs of a whole population. How do we move from the cottage industry of global health into a world of systemic change?
Global health itself is worth every penny in global peacemaking. If we could tweet out the cross-cultural bridges built during every patient-provider interaction in hospitals like ours, we would dwarf the Olympics in size. Recent articles have described how global health should be situated prominently in the foreign policy plans of governments. The far more difficult and important challenge is to discover how global health efforts can change the hearts and minds of more people and become bridges of peace every day.
My last night in Guyana arrived sooner than expected. I worked my last shift and then went out to dinner with the A&E residents. It has been an incredible and rewarding experience spending a month in Guyana teaching emergency medicine and learning about the healthcare system in a developing country. I have told the emergency medicine residents and doctors here that their job is much harder than mine - and that they are doing incredible work. The local doctors are learning not only how to practice medicine, but also how to advocate for continued change and improvement in the healthcare system. I only hope that I have made an impact here by sharing my training and experience.
This week there have been two holidays to celebrate, giving me a few days off work and the chance to experience some of the local culture. The first holiday was the Hindu holiday of Phagwah, which is observed in March and celebrates the triumph of good over evil as well as the arrival of spring. The celebration involves music, dancing, and lots of color! Each person wears white, and then colored chalk is used to make each person into a canvas.