Hospital Pablo Arturo Suárez

What a busy two weeks this has been for me! I have mostly been working at the hospital, and I can't even describe how much I love it. I am more sure than ever that medicine is what I'm meant to do! I am learning so much from the doctors and interns and I am so grateful for this experience. My biggest struggle so far has been the language. I am thrown off by the medical terminology, which I know in English but not in Spanish. Fortunately, though, a lot of the terms have the same latin root so I am able to deduce a lot of the words. I work Monday through Friday from 8am to 4pm. This means that I have to get up at 6am so that I can leave by 7am. That has certainly been an adjustment but it's not too bad. At 8am I go on rotations with Dr. Mario Pancho and the rest of the doctors and interns, and we go to each patient in the Cuarto Critico (ICU) and Observacion to discuss their case and make a plan for the day on how we can continue their treatment. For the rest of the day I accompany the doctors and interns as they perform patient exams, and assist them in any treatments. For example, I have helped with multiple sutures, wound cleanings, and the like. I think that next week they are actually going to teach me how to suture!

I have never worked in a hospital before, let alone a public hospital, meaning it is funded by the government. They have very little resources to work with, but I think they do a good job. They have talented doctors and bright students. The ER consists of three exam rooms, two observation rooms (one for men and one for women, but usually there are patients of both genders in the same room), and the cuarto critico, or ICU, which as two beds. It's a very small space, especially when there are a lot of people. When a patient arrives, they check in at a small window and fill out a form with basic information. After that, they are admitted into the ER and the doctors and interns examine them. Ideally each patient would be examined in one of the exam rooms for privacy reasons, but the rooms are usually full, so they do the exam wherever they can, including on the waiting bench. It's also common to have two patients in one room. Each exam room consists of a bed, IV stands, a tray for the doctors to use, and a supply cart, which contains 4 bottles of solution used for cleaning wounds, gauze, tongue depressors, and a bottle of anesthesia. Notice that it does not include hand sanitizer or gloves. There is one box of gloves in the nurse’s station, and hand sanitizer (apart from the travel-sized bottle that I carry with me) is non-existent. It was obvious from the beginning that this hospital does not use the same standards of hygiene that we use in the United States.

Another thing worth noting is that for the first twenty days of April, the operating room in the hospital is closed for remodeling. This has a big impact on the ER because we can examine and diagnose a patient, but if they need an operation of any sort we have to transfer them elsewhere. For this reason, we have seen a drop in the number of patients that come in. My first week the ER was absolutely full, but for the last couple of days we have had about 50% of our beds free.
The hospital is not free, as I had previously thought, but it is much cheaper than a private hospital. Generally once a patient has been examined, the doctor gives a prescription to the patient's family members with a list of supplies, medications, and orders for lab tests, x-rays, etc. that need to be done so that they can treat the patient. If the medication can be found in the hospital's pharmacy, it is free of charge. If not, there are at least six pharmacies directly across the street where they can buy it. The patients that come in to our hospital are generally of the lower class. I think this makes sense, not only because of financial reasons, but also because people of the lower class tend to be more at-risk. This could be because they don't take good care of their health, because they have more dangerous jobs, or any number of things.

Now on to the exciting part...cases! As you could expect, we get a huge variety of cases that come in. Interestingly enough, about 50% of the patients come in reporting abdominal pain. It usually turns out to be appendicitis or gastroenteritis. We also have people come in reporting chest pain, headaches, and other things of that sort. And of course, we get trauma patients. Here are a few memorable cases that I’ve had so far:

- I helped a doctor suture up the head of a guy who had been shot by a robber that entered his home. The skin on the top of his head was ripped open all the way down to the skull, but fortunately it didn’t go into the bone. It took us three hours to stitch him up.

-We had a 16 year-old patient with tuberculosis and HIV. The doc told me that he probably won’t live for more than 6 months.

-Multiple patients have fallen from heights of one or two stories, mostly construction workers. Their injuries include broken hands and fingers, swelling of the brain, and more.

-This week we had two patients brought in (within 24 hours of each other) by airport police for trafficking drugs. I was there for one of them. He had swallowed about one kilo of cocaine in capsules. He was ok, but they had x-rays done and everything. This guy was from Amsterdam and doesn’t speak Spanish, but he spoke English, so I helped translate for the doctors, and later for the police.

-The other day there were two burn victims in the ER at the same time. One had been burned by fire at work, and the other had been electrocuted. Obviously both were in a lot of pain, but I think the electric burn was probably worse because it’s on the inside.

-One day I came in and all the doctors were in one room crowded around a patient that was unconscious. They were using a hand-held breathing device to breathe for him. We have ventilators, but only in the ICU and both of the beds were already full. So I took over for one of the doctors and started breathing for this guy, who had an aneurysm. As I was standing there, just me and him, it occurred to me that I was the only reason this guy was still alive, and that scared me. But, I did my job and he was put on a ventilator shortly after that.

These are just a few of the cases that I thought you would find interesting. I’m sure that in the coming weeks I will have a lot more to tell you!