By Brett Bechtel, MD, Department of Emergency Medicine
Vanderbilt University Medical Center 
Georgetown, Guyana

Georgetown Public Hospital Corporation (GPHC), is the central hospital for the country’s public health system. The A&E (Accident and Emergency) functions as the essentially Level 1 Trauma Center and the Emergency Department for the country. Referrals come in from all over the country from outlying health clinics and hospitals if more specialized care is needed. Georgetown is also the population center of the country and so most patients arrive to be seen first here with acute complaints. There are multiple clinics ranging from diabetic foot clinic to eye clinic to pediatric and surgery clinic that see and refer patient to the A&E for admission or further treatment as well.
The A&E has about 15 beds in addition to multiple treatment chairs and an asthma room.  It is divided into a trauma and medical section just like many US EDs. It’s air-conditioned and there aren’t any mosquitoes so it makes for a comfortable work environment. Crowds fill the waiting room and along the outside wall waiting patiently for their names to be called. Attendants carrying stretchers haul unconscious patients with hypoglycemia, seizures or bad trauma right in to a bed past the less acute crowd waiting to be seen. Multiple doctors sit at desks seeing the “non urgent” triaged complaints as other doctors tend to the sicker patients who are “urgent” and in a bed. When ready for the next patient, the doctor rings a bell and calls for staff to bring back the next patient. It all seems to flow nicely.
The pathology is diverse - everything from malaria to acute myocardial infarctions. In just a few hours I had seen array of trauma like femur fracture, 60% burns, mandible fracture. Medical issues like rigid abdomen with free air under the diaphragm, typhoid, multiple asthma patients and pediatric patient complaints.
The sea of patients in the waiting room seems endless, but sometime during the evening it beings to thin out. The medical officers keep moving patients through. Sick ones get reviewed by medicine or surgery and are admitted. Most are discharged to home with clinic follow up and maybe a prescription for a medication. A visit to A&E is free and so are the prescriptions written by the MDs, the variety of medications is limited, but there is a drug for most everything. Only pregnancy tests and CT scans cost money, the rest of the work up is covered.
The staff are very friendly and welcoming. Many MDs have trained in Cuba. A few of the hospital surgeons have been to Canada for extra training in their specific trade.
Off to a good start. Am enjoying doing bedside teaching and reviewing cases with the general medical officers and the residents in the Emergency Medicine program here. More to come on some specific cases.