It is good to be back in Guyana. It has been a week since my arrival and there is a feeling of returning home. Although I left this country when I was very young, the culture, the food, the sayings, even the hot humid climate and cooling ocean breeze are all so familiar and welcomed.
I have been working in A&E at Georgetown Public Hospital, the country’s tertiary care center, for the last 5 days. I am amazed at the broad spectrum of pathology that we see in any given day - some of these have included cerebral malaria, snake bites, herbicide poisoning, tetanus, advanced HIV, acute myocardial infarction, infected diabetic foot ulcers, and strokes. What is most impressive to me is how many complications I have seen from poorly controlled chronic medical conditions, many of the same disease processes that we deal with in the US. As an internal medicine resident, I think about my own panel of patients back home and how aggressively we are taught to manage diseases such as hypertension, diabetes, and coronary disease. Unfortunately, this is not possible in Guyana in large part due to lack of a trained physicians to take care of these people and poor medical records (surprisingly, many of the first line drugs that we use to manage chronic illness are available here). Guyana, like so many developing countries, continues to struggle with “brain drain” as more and more trained professionals migrate in search of a more economically secure way of life. In the medical profession, those who are left behind do the best they can, but are often overworked and undertrained.
Working in a developing country with so limited resources certainly requires that I adjust the way I think about and approach a disease process; this is easier said than done. The emergency medicine residents do the best that they can to be aggressive in the resuscitation of very sick patients - unfortunately, often with so few ICU beds, ventilators, equipment for monitoring, it is difficult to sustain a high level of care for the critically ill and many do not survive.
There is just so much that we take for granted in the U.S. I met a 17 year old girl who was brought in to A&E by her parents with 6 months of a progressive motor weakness and spasms that left her wheelchair bound and in significant pain. She had been in and out of the hospital, with essentially negative work up including lumbar puncture, plain films and CT head. She had seen a private neurologist and needed a MRI. Due to the cost she has not yet gotten the test and even with her consultant advocating her case to the ministry of health, the outcome is still pending. Getting such a simple test that is so easily accessible to us in the U.S. seems an almost insurmountable hurdle to overcome in the work up of her disease.
It is humbling experience to be here and is a great reminder of what a privilege it is to be able to practice medicine and to serve those who need the most help. I am constantly being reminded to how much I don’t know and how much I can learn from my patients.