Monday, October 28, 2013

Life Lessons from the Clinic

As our first week in the clinics came to an end, we began to feel more comfortable working with the patients and students in Thailand. We have all gained significant life experiences from working in the rural villages and greatly appreciate all that we have learned in such a short period of time.

As a group, we have collectively noticed an influx of patients who present with multiple different symptoms that all can be traced back to the massive amount of flooding that has occurred in the area. During home visits, we have noticed roughly 6-12 inches of stagnant water under and around some houses. There are many areas where the water level has climbed too high for motor vehicles to safely cross, and even some spots where there are "mini-rapids" where there is even an undertow. We have all encountered children who complain of stomach aches and pains, nausea and vomiting, and other vague symptoms that result from playing/swimming in the contaminated water. Other illness (eg: types of diarrhea and skin disorders, fever) that we rarely see in the United States have presented through some of our patients in the clinic, once again due to the flood waters. These unfamiliar illnesses have been interesting cases for us to work with since we rarely encounter them at home.

Unfortunately, with flooding waters comes the potential for dangerous situations. During the middle of a busy clinic morning, we saw a man driving a motorcycle flying into the clinic. Startled, we made our way toward him and noticed that he was carrying a child over his shoulders, and shouting for help in Thai. We could tell immediately that this was an emergent situation and the child was in dire need of our help. We had learned that child was playing in the flood water and was pulled under and drowned. A group of villagers saw the tragic event happen, and joined together, linked arms to form a line, and starting walking through the rapids to find the missing child.

In a room full of chaos, we, as nurses, did what we do best by immediately reacting to the scene and jumping in head first to help in any way possible. We knew that time was of the essence, and being exposed to similar situations through work and past clinical experiences back home in the states, we were prepared with knowledge and skill to help save a life. Working as a team with members of the clinic, we were able to transport the child through the jungle to meet the ambulance (in a truck shared by the community), and transfer him to the appropriate level of care at the local tertiary care hospital.

The experience was nothing short of traumatic, yet as in all situations, there is something to be learned. When we take a step back and reflect on the situation, a major difference presents with the lack of resources and equipment that were available at our rural clinical site. Inadequate oxygen supply, lack of airway equipment, and no ambulance present for transportation (our clinic only has a single ambulance that was already in use) are a few of the key elements noticed to be missing from the scene in a time of need. We were happy to be informed the next day that the patient made it safely to the hospital and received appropriate care.

We were invited to participate in the discussions with the clinic, local staff and faculty, and community about the event. We reviewed the case and the situation with the clinic and our hosts.  Several things complicated the situation.  Primarily, the clinic was underprepared for an emergent situation.  In retrospect, there is now discussion to have double or triple supplies at the clinic for potential emergencies or other natural disasters.  Next, the clinic is in the process of relocating, further complicating things by supplies being in both locations.  We were able to identify some key resources that should be present in the clinic at all times, as well as discuss with health officers useful resources to have for potential use at the clinic.

Although this was a sad and challenging situation, it alerted us to the reality of the hardships of healthcare in rural and poverty-stricken areas. It reminds us of how we sometimes take for granted that we typically have the necessary resources to provide appropriate and comprehensive care back home. Finally, although this was a difficult situation, it was impressive to see how the community jumped into action and worked together.  While they may not have what we consider to be "necessary" supplies, they have a close knit community network that provides support without being asked.  It is now clear why they refer to each other as grandmother/grandfather/sister/brother.  They are truly family and linked in a way that so much more than the word "community" implies.

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