Edendale

So now that we've been working for the past week, I'll attempt to begin to put into words what we've experienced here. A word of warning, none of what you are about to read is uplifting....

First the facts: we're working at Edendale Hospital, which is a 900 bed facility that caters to the surrounding regional community of about 1 million.... everything from trauma to medicine to ARV clinic. It was traditionally the "black hospital" pre-end of apartheid era, and so the facilities are not as robust as the nearby Grey's Hospital (the "white hospital"). If a patient needs an MRI or echocardiogram, they have to be transferred to Grey's for the study, usually weeks to months later (assuming they are still alive). 90% of the patients we see have HIV/AIDS, many of who are also co-infected with tuberculosis, and sometimes MDR-Tb (multi-drug resistant Tb) and XDR (extensively-drug resistance Tb). Tuberculosis and HIV are so common here that patients are assumed to have HIV or a complication of HIV until proven otherwise and N95 masks are required at all times. Even the hospital elevator is commonly referred to as the “XDR express.”

As expected, we've spent a good part of the week both frustrated and saddened - while we've encountered loads of wonderful, hardworking doctors who genuinely care, lack of resources is profound. 3 ICU beds. Only the recent introduction of a statin on formulary. Bloodwork that returns the next day...or never. Missing paperwork and incomplete histories. However, I think what we have been most struck by, is that the lack of resources also includes people. There simply aren’t enough of those hardworking doctors to go around, and so only some patients get seen by an attending each day. There are no handoffs and continuity of care is rare. And when someone dies overnight, it's difficult to find out why, because no one seems to know. We came in today to find that the majority of patients hadn't had their temperature taken over the weekend (I'm still not sure if it was because there weren't enough nurses or because the thermometer was broken).

Needless to say, we've already seen many deaths.... the 17 year old with HIV related cardiomyopathy who needs a milrinone drip but gets morphine, the 22 year-old with altered mental status and not so normal CT Brain who dies before the neurologist sees her the following day, the 55 year old with sepsis and DKA. Le sigh. Despite all this, we've also been struck by the incredible amount of dedication from the attendings here, who choose to work at Edendale everyday to manage the best they can with the resources given. More on this in the next posting...

-N