The Daily Round

Every morning we have a meeting immediately after flag break at 7.30.  If the Director is away it is usually brief.  If he is present it could last half an hour or more.  At the start of today’s meeting, while we awaited the Hospital Director’s arrival, I checked with Dr Poly about our sick lady and discovered that she had died on Friday the day after her third operation.  That’s the second maternal death since I arrived in the hospital but I doubt if she will feature in the National Data as this is not directly attributed to pregnancy complications.  Nevertheless demise from the complications of induced abortion is undoubtedly a maternal death.  Another avoidable tragedy.

On a lighter note, and in case you wonder what is discussed during our daily meeting, I jotted down the topics from today:

Preparing the Daily Report

Firstly the list of admissions of the past 24 hours is read department by department.  There were only two admissions to maternity, both in labour.  Two patients admitted to surgery with gastrointestinal bleeding had been operated on.  One had stopped bleeding but the other had not – he is in his late 20s.

There are currently 24 patients in the 14 bed intensive care unit and the Director made a plea for as many as possible to be transferred out to medical and surgical wards.  We need to prepare for admissions of patients wounded in the fighting on the Thai border as ours is the nearest level 3 hospital.  At the last count there were 11 killed and 43 wounded but we have seen none here yet.  The wounded are probably all soldiers and they will be looked after by the military.

A woman admitted with snake bite is very lucky as the fangs only grazed her skin.  It was a poisonous snake but not a cobra.  She vomited but that was her only problem.  An application for supplies of anti-serum sent to the Provincial Health Department 2 months ago in readiness for the rainy season has not yet been acknowledged and we have no stock in the hospital.  Snake bite is much more common in the rainy season as the snakes emerge from their flooded holes and often enter houses.  Last year a 6 foot snake was found in the office I’m working in now.  The man who came to catch it took it home for dinner (he didn’t feed it dinner, he ate it).

Clinical Waste in the grounds today

There was an exhortation to greater care of the hospital environment as many patients and relatives litter and defaecate in the grounds.  If a patient will not desist from throwing litter then send him home!  The suggestion of putting up security lights to illuminate the grounds and discourage defaecation was dismissed as people will just throw stones and break them.  There was laughter as the Director said the barangs are shy about discussing toilets and everyone looked in our direction.  Not so.  In Battambang hospital on Friday I attempted to clear a blocked toilet which was solid with faeces and still being used.  It filled up to the brim with water and still would not flow.  The pipes are not big enough for the job and the fact that they don’t flush is partly because there is not enough water being poured down the toilet to carry solid waste away and they are likely to be blocked along the full length of the pipe-work.

Further amusement at the plight of the hospital gardener who was admitted with diarrhoea after spraying the grounds with insecticide without adequate protection or washing his hands after wards.  He cannot read Khmai so the warnings written on the bottle were no help to him.  It is entertaining to us to see what causes amusement during the meetings.  The gardener was found fast asleep in the flowerbeds at lunchtime last week.  He had fallen asleep on the job.  The staff in the wards sleep at lunchtime too.  It is expected that lunch will last from 11.30 until 2pm so siesta is normal.

A woman patient with HIV is often seen around the hospital.  The Director has decided to employ her and keep her here so that she can receive her regular treatment for HIV under supervision whilst her deaf and dumb daughter of about 10 years can stay and help her mother pick up litter.  That’s the kind of compassionate person our Director is.

Motos parked at the market

Motorbike drivers have been parking and standing around on the precious grass near the front entrance spoiling the beautiful lawn.  That is to be deplored and must stop.  The guard must see to it that they move.  The gardens are the Director’s pride and joy.

On Saturday the water and power went off and the guard failed to inform the Director of the problem.  One of the students had phoned him and he arranged for power to come back on.  I have no idea who the Director telephones or how he has the power to have the electricity supply restored.  The hospital must go on and when Dr Witchouk is around, it does!

He also advised the young nurses and students not to go out after dark, and especially to avoid the discos and night clubs.  We don’t have such places in Mongkul Borei as far as I know but there are some in Sisophon town 9km away.  There have been fights, fuelled by alcohol and the jealousy over girls; some stabbings and shootings are reported but from Phnom Penh rather than round here.

The Economic and Finance Ministry is to start checking up on doctors who don’t show up at night when they are supposed to be on duty.  They should come when they are called.  So beware!  The Ministry estimates that it has lost over 100 million Real ($25,000) each year because of this problem but I am unsure how money is lost in this eventuality.  Something lost in translation I fear.

Money is a constant issue especially the finances to run the hospital.  It was announced that in future, students from the private International University in Phnom Penh will be charge for the privilege of learning in the hospital.  We have medical students all the time here.  The students from the State University will not have to pay however.  New sources of funding are constantly being sought.

So those are the items for today!  Now let’s get down to work …

P.S. Blog done in my lunch break when I ought to be asleep!  In fact I ought to go and get some lunch, it’s already 1.30 and lunch break started 2 hours ago!



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5 responses to “The Daily Round

  1. helen

    Please don’t go anywhere near snakes! Don’t like that the antiserum is so far away. Difference in national debt problems is crazy. The discussions I have at work at the moment is the £millions that are being wasted that we can save by ‘doing the right things the right way’ or something. Well I’m about to sit down to some roasted veg for dinner. Hope you found something satisfying too. Love u xxxx

  2. Teddy

    Oh dear. I do hope the toilets get unblocked soon – I guess they don’t have plumbers on hand if a doctor is required to do the job! Hope you get some breakfast and down time tomorrow 🙂

  3. Leonora

    Hi Adrian, I have enjoyed reading your blogg and catching up on your journey. Your director sounds like a great bloke and I hope mother and daughter are doing well in health and her employment at the hospital. Think it might be hard moving all those bikers, I don’t hold out much hope for the lawns survival. Keep well and avoid the snakes.

  4. Hi there, I found this page from mixx. It’s not something I would regularly read, but I liked your perspective on it. Thanks for making a blog post worth reading!

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