By Kim Pruett
The Frist Global Health Leaders (FGHL) program affords young health professional students, residents, and fellows the opportunity to serve and train abroad in underserved communities for up to one semester. In doing so, they will bolster capacity in clinics in need of support as well as offer training to community health workers to promote sustainability upon their departure from these communities. As part of the program, they blog about their experiences here. For more information, visit our program page.
I had no idea what I was getting into. Before I left for Guyana, I knew that our residency was somehow connected to some hospital in Guyana and that many people in our department go there to help out. I wanted to go and help out too. In my mind, that was it. We go there to help. I had no idea what an amazing investment had been made in the people there or how integral Vanderbilt’s involvement was to the working of the Emergency Department of the Georgetown Public Hospital. After I realized the extent of the work that had been done there over many years, I couldn’t believe that no one ever bragged about it. Why had I not heard this story? We should be advertising it from the rooftops as a global health victory. It should be a standard for other programs to strive for. I witnessed first-hand how much there is to brag about.
Vanderbilt Emergency Department has been invested in Georgetown Public Hospital for nearly 8 years. During that time, they have developed and overseen a brand new residency program and are intimately involved in the operation of the emergency department. The same training and educational materials that the emergency medicine (EM) residents at Vanderbilt use are used to train Guyanese resident physicians in the practice of Emergency Medicine. The Guyanese residents are learning practices and principles that are the best the western world has to offer. Essentially this is a sister program to one of the top EM programs in the US. The training is top notch. And during this time, Guyanese residents have graduated that are not only very capable physicians but are also proving to be great leaders. With several classes having graduated now, the Guyanese have begun to run their own department. They are serving as administrators, faculty, mentors, and teachers to the next generation of Guyanese EM residents and medical students. And, oh, by the way, are taking excellent care of patients. It is a wonderful thing to see.
And now that the physicians have proven to be so capable, there is time invested in nursing and in EMS. The first Guyanese EMS service was put into service during my last week here. They have 11 newly minted EMTs (which Vanderbilt helped to train) and 4 brand new ambulances ready to serve the people of Georgetown. It is such an exciting time to be down here. I am so proud to be a witness to this success and play a small part of the all the hard work that preceded my arrival.I hate to feel helpless. We did all the things we were supposed to do. We got his EKG done within ten minutes of coming into the ED complaining of chest pain. We recognized the fact that it was a STEMI (heart attack). We gave him aspirin. We treated his pain. We did an ultrasound of his heart. We got a chest x-ray. We checked his labs. We watched his vital signs and we called cardiology. We did everything right. Then it gets hard. This man had a history of previous heart attack and had previously been given streptokinase to break up the clot. The problem is that you can only get that medicine one time in your life. He was not able to get it again today.
The only other option to save this man from his heart attack would be if a cardiologist and equipment were available to take him to the cath lab and open up the blocked artery using a stent.That option is not available today. The cardiologist came down and said they had nothing to offer. I had never seen anything like this happen before. It was inconceivable to me. But it was happening. We ended up having to watch this man’s heart attack evolve over several hours. Meanwhile more and more heart muscle died from lack of blood flow until his heart was no longer strong enough to pump blood, and fluid began to build up in his lungs. He had to be placed on our BIPAP machine to help him breathe. He became very uncomfortable and eventually developed an unstable cardiac rhythm and died.
I had never seen that happen before. Usually, if we do all the right things and catch it early, people can survive a massive heart attack. It’s not supposed to happen like this if we do our job right. But this time it did. That’s what it’s like in a resource poor environment. That’s just the way life is here. If you don’t have the equipment or medicine that you need, there is nothing you can do but watch and wait.