let me preface this again with saying that this is in no way meant to criticize health care in south africa or pass judgment on what they do here. i've said it before and i'll say it again...they are doing the best they can with what they have. but because they have so little resources compared to what we have in the US, the resulting treatment approaches can be somewhat humorous...especially when we put it into the context of a US hospital and imagine what people would think if they saw some of this stuff happening in US health care. so some of these stories are somewhat comical when taken out of the context of south african health care...but i hope they are also eye-opening.
story #1: i walk into one of the wards and see someone laying in bed with a contraption that looks like this (see picture below). my first thought was, "what the hell is going on?" sorry for the language, but if you walked in and saw some of this stuff, i'm sure you would have the same response. i mean, i walked out of a healthsouth hospital on a wednesday (which corporate health south means they have so much equipment and technology that they don't know what to do with it) and walked into this on the following tuesday. it was quite a culture shock. so i ask the therapist that i'm with what is going on there. she looks at me like she doesn't understand why i don't know what that thing is. i explain that we don't use those in the US; she looks baffled but provides some explanation. i learned that it is called "cones calipers". and yes what you see there is actually what it is...there are screws into the side of a person's skull and they cable attaches them to the bed. it is providing cervical traction and they use them after a neck fracture if it is unstable or if they are waiting for surgery. the patient is unable to get out of bed, sit-up, lie on their side, turn their head, move their arms above 90 degrees...they're basically stuck lying flat on their back 24/7 until either the fracture heals or they end up having surgery...which could be months. CAN YOU IMAGINE? it makes me incredibly claustraphobic to even think about it. so after the therapist answers my questions, she asks me how we don't use them in the US, she is perplexed. i told her the main reason is that we don't have patients lying around for months waiting for surgery...if they need spinal surgery they would get it immediately. here they just don't have the availability of doctors for that to be possible. so lots of the patients i've seen are simply sitting in the hospital until a surgeon is available...they have no idea how long they will be waiting there, alot of times they aren't even sure of what surgery they are waiting to have! point of the story: they need more doctors.
story #2: i started by rotation in trauma by 3rd week here so by that time some of the initial shock had worn off. however, a day still doesn't go by that i'm not shocked by something i see here. and my first day in trauma was certainly no exception. i walk into the trauma ward and see probably over half the patients there with huge incision straight down the middle of their abdomen. and again, my reaction is "what is going on?!" so i ask one of the other therapists and again i feel like she is surprised that i've never seen this before. she tells me that its called a laporatomy aka laps. she said that after a patient is in some sort of trauma (car wreck, assault, etc) alot of times the doctors just do this procedure to "check" and see if anything is wrong in the abdominal cavity. i'll admit i found some humor in this concept....i feel like it's like 2nd graders practicing medicine...and they're like hmmm i wonder if everything is ok in the abdominal cavity, how am i going to find out?...oh i have an idea i'll just slice all the way down the middle of their stomach, open it up, and see what's going on in there. i would love to introduce this concept to a US doctor and see their reaction. but on the serious side, it is really all they can do here. thankfully in the US we have imaging machines available to see what's going on internally, here they literally have to cut someone open. i think they have one CT scanner at the hospital but last i heard it wasn't working. point of the story: they need more equipment.
story #3: i just started my neuro rotation last week. my first morning in the gym, i see another therapists literally strapping slabs of wood to the back of a patient's legs with an ace bandage. they wanted to get the patient to stand and their quads were too weak so they just strapped some wood onto their legs! hahaha i can't stop laughing when i picture me walking into my first day of work when i get back to the US and bringing in a couple slabs of wood to put on patient's legs. the US equivalent of slabs of wood would be a knee extension brace, but even that i've rarely used and when i did it was only on one leg. here they use it on both legs at the same time. and if you can imagine trying to sit back down when both your legs our strapped straight...not so easy. in the US we tend to approach things in a different order. if a patient didn't have a quad strength to stand at all, i would start with quad exercises like crazy to gain some strength. here they never know when a patient is going to be discharged so they start trying functional tasks even when the patient doesn't have the basic requirements to complete them. in the US, we would never send a patient home if they couldn't transfer from a chair to a bed, walk or use wheelchair. on friday, i had a stroke patient get discharged to home and he had never even stood up and he had no wheelchair to take home with him (too expensive). point of the story: their treatment approach here is VERY different.
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