Taxi transport

Yesterday evening just as we were preparing to go on our walk, the guard came to my house to get me. A taxi had just pulled up with an urgent case. 🚕

In the backseat was an agitated, combative and delirious 40 yr old woman being held by the wrists in a death grip by her brothers. They called it "fitting" but this was like no seizure i've ever seen!

I did a quick exam and even with my limited Wolof i knew she was not making any sense. (BTW, my back and i prefer ox cart as exam tables!) Her brothers told me that she'd had a few days of fevers and that ever since she'd had a seizure the evening before, she'd been awake and constantly talking, yelling or singing. She hadn't eaten anything and barely had anything to drink. 

We couldn't get a pulse oximeter on her finger because of her clenched fists. We could barely get a blood pressure as she was moving too much! Teresa and I were sweating just as much as she was. Reaching inside past the brothers restraining her, I injected a sedative into her deltoid muscle. She was not a fan of this painful stimuli but thankfully her brothers are strong, wiry fellows! i had to go back into the clinic to get supplies to prick her finger and fill a capillary tube for the rapid malaria blood test. 

Hmmm. How exactly would this work? We could not get her to open her clenched fist and our attempts made her even more combative. So i literally had to sit on her lap to be able to prick her thumb which was sticking out just far enough from her fist for me to grasp. Teresa ran the test back inside the lab and i got as much history as i could, including details about the seizure disorder she'd had most of her life but for which she had not been taking any medicine for at least one year. 

By the time they discussed it all to decide if they were going to take her to the hospital and who was going to accompany her, the taxi driver said he had to go because he had pre-paid passengers waiting at a party in their village. So now they wheeled and dealed to see if he would just take her the rest of the 29km to the referral hospital before getting his passengers. And then it was dark. They returned to us to now ask if our ambulance could take her. 

However, the rule is we have to send medical staff along with referrals that go by ambulance and there was no way we were gonna call in someone after the 30 minute family + taxi driver huddle!! Meanwhile, the lady is being held down in the back seat. Still sweaty. Snarling. Singing. And now hoarsely yelling her brother's name over and over as he had her by the arms. (Outsider's Note: The "It takes a village" philosophy is NOT always in the best interest of the patient! Mainly because it takes a LOT of time!) 

I decided that i'd had enough and the patient was stable in that her agitation was not worsening and she was finally showing signs of sedation. So i went back home where i still had clothes drying on the line!! I had to take them down by flashlight and face the insect barrage!

I found out more details later when Teresa and i had dinner--scratch that--a snack at my house. 

Thankfully, they were not upset by the fact that no medical staff person was accompanying her. Remember, they'd only get a written report in this case as our ambulance driver is just that--a farmer turned chauffeur! There are no paramedics or EMTs in this village. And the staff working at the hospital may have personal cellphones but there is no hospital phone to call in order to give report. In fact, we've heard they are sharing one blood pressure cuff amongst five or six nurses in the ward!! And they haven't had x-ray film for months!!

Oh and just like kids who suddenly turn sweet & obedient right before their dads get home, our patient fell asleep just before they got to that town! 

But do ya know what the receiving hospital's staff had the audacity to say?!?!?😡

"You people at NK Health Center never start IVs!" 

Um, excuse me?!? "Never?!?" I could spit nails!! I know for a fact that our last three patients have had IVs. And the most recent one--the lady suffering the miscarriage--had the miracle IV!! 

"Never?!?" Hrmph! I should refer them to my last blog post to clear their addled brains!!

"Never?!?" Man, i'd like to explain that I literally had to sit on this bucking bronco in the back of a tiny taxi to prick her finger!!! But now they have a snoring, sedated patient laid out nicely on a stretcher before them and they have the audacity to whine that we didn't put in an IV?!?! Oh the nerve!! 

I was still steaming mad about their comment this morning when i told our tech what they said. He'd happened to be there last night to buy stock for his pharmacy and so witnessed her significant level of agitation. He replied, "Oh, they only complained because they are no good at putting in IVs!" Hahaha