Eyes forced open

Today I was assigned to work at the county health center.  I showed up at 8am and as is typical here there was no one to greet us for about a half hour.  Turns out they wanted me to take over one of the RNs office and see people all day.  The RNs here see patients order labs and prescribe meds.  If a PA is available the RN does more traditional nursing work but for today we were to take over their place entirely.  One of our staff is a PA from Monrovia so he and I worked together.  He did most of it because 1) he can understand what people are saying and 2) he is used to prescribing for the maladies here.  He had almost everyone tested for malaria.  All but one were negative.  I will have to read up on that.  Was he over testing or is the prevalence that high that testing most is reasonable?  Our RN who was working the pediatric room said almost all of his kids were positive.  All STD suspected patients get a rapid HIV.  Luckily the were all negative.  

The clinic is run like an urgent care- first come first served.  They show up with a paper chart without a cover that miraculously survives several years of use.  They state their complaint and a history is solicited.  No exam is done unless the case is "dire" which is not defined.  The only vital sign done is temperature.  Here is one blood pressure cuff in the clinic and it is not used for fear of transmitting disease.  These rules are the result of ebola and are limitations handed down from the ministry of health.  The labs possible are malaria, HIV, and hemoglobin if the case is "dire."  The panel of meds is limited as well.  One patient treated for gonnorhea could get the penicillin from the pharmacy but had to go to the hospital for the needle and syringe.  

One woman showed up with chest pain, back pain, and numb legs.  She was in her 50's which is no spring chicken around here.  There are no tests available anywhere, so we gave her an aspirin a day and some Tylenol.  It was the best she could get without going to Monrovia.  No exam was done.  Not sure we did no harm.  Another heart breaker was a 12 yo child with an enlarged liver and spleen.  He had been seen 2 weeks previous and referred to the doctor but was never taken.  According to the RN who saw him last he was deteriorating.  His spleen was massive.  We did examine him as the PA decided he was "dire."  He was referred again to the doctor, but who knows what the odds of him getting treatment is.  It was heart breaking.  

If I work there again I plan to disregard the crazy no touch rules and do more.  It just didn't make good sense.  What is clear, though, is that Americans are crazy lucky with the quality of our health care.  Now we need to take a page from Liberia and make it free and available to all.