Day 33 Dalaguete, Philippines #DPC CPR, IV Insertion

Typhoon Pablo made landfall in Dalaguete today. Luckily, the news reported that it had lost a lot of momentum once it came in contact with land. It was rainy and windy all day and around 5:00PM the hospital and all of Dalaguete experienced a brownout.

The ER was busy today because actual emergencies (instead of OPD or checkups) occurred. What made it even harder was the brownout. It gets dark here around 5:00PM and around 4:30PM our first ER patient came in. He was a construction worker and had somehow had his arm caught and twisted in an excavator. His left arm was dislocated and fractured at the forearm. The doctor order an IV line and gave him an anesthetic (I can't recall what the drug was), then order an X-ray to confirm the break. Because this is a primary hospital, it's not set up for long term casting, so during the X-ray the doctor order the nurses to construct a splint out of whatever they could find. The ended up using cardboard and neotape and immobilized the patients arm so that he could be referred to the city. However, the patient ended up being admitted because the weather was too severe to be transported to the city.

The second patient was brought into the ER by her family because her NGT was dislodged and needed reinsertion. By this time it was already dark and we had to work by candlelight and flashlights. The hospital has a generator here but it isn't hooked up because they're still waiting for the fire department to process the paperwork. From what I've heard, they've been waiting a few years now. Anyway, the nurse removed the old NGT and the doctor inserted a newer one. However, there was a problem. After the doctor confirmed the correct placement by listening to the stomach (use a stethoscope, push in a little air via plunger, and listen for a gurgling sound), the water he used to flush the new NGT wasn't traveling down the tube freely. If an NGT is placed correctly, water flows fairly quickly through the tubing. This wasn't the case. The doctor reinserted it but placed it a little shallower, reconfirmed the placement, then tried flushing again. This time, there was backflow from the tubing. After a third attempt, a third conformation of placement, and a third failure of correct flow, the family then told the doctor that she hadn't had a bowel movement for 5-6 days. The doctor told the nursing staff to administer a suppository because it was likely that there was an obstruction. Even after the patient was given the suppository, she still didn't have a bowel movement. The doctor told them they should refer to the city in order to get an emergency scan of her stomach and colon since it was likely that she had an obstruction of some sort. The family decided to wait until the next day due to the weather.

The next patient that came in had a deep laceration on her leg exposing part of the Gastrocnemius muscle. Apparently a tin roof had come flying off a house and hit her on the leg. The doctor said, luckily, it was a clean linear laceration so stitching it would be simpler. I've worked with cadavers before, but they were prepared down to the muscle, so this was the first time I'd seen the hypodermis stripped away from the underlying muscle. The nursing staff cleaned the wound, the doctor injected a local anesthetic, stitched the wound, and the nursing staff dressed it. All of this was done using flashlights because of the power outage.

Here is some footage from the ER during PM shift. WARNING, this video shows a minor surgical procedure (the deep laceration). I've grey-scaled any footage that shows blood, but if you don't like looking at wounds or dislocated arms, do not watch this video. Again, I am grateful for the ability to capture these moments on film and will do my best to maintain anonymity and  dignity for those filmed.

I ended up spending the night at the hospital because of the weather, so I also experienced my first night shift. Around 12:00AM a patient was brought in because she had suffered a heart attack. The nurse on duty at the ER started CPR while I used the BVM to give rescue breaths. I'm CPR certified, but that was the first time I had ever seen CPR administered on a real person. I'm definitely glad I got to see how actual CPR looks because it requires a lot more effort than any dummy or training can accurately portray. Sadly, the patient was DOA and we were unable to revive her.

The last thing I want to talk about is IV insertion. Last night one of the nurses here let me try inserting an IV in her. It took me three tries to get it right, and she was totally ok with it. Back in the US, you have to take classes and practice and all that – but here you just have to learn to do it. Most of the nurses here have never taken an official class for IV insertions. Their training was the doctor (or another nurse that already knows how to insert IV's) telling them to insert an IV on a patient while they watch. Their “graduation” from IV school is the second after they insert an IV correctly. The hospital here is understaffed and IV's play a huge role in primary care, so it's important the the nurses all know how to insert IV's. What impresses me the most about this place is the youth. It's the youth giving first care response. Giving CPR. Applying pressure to wounds. It's the youth passing medication. Doing intravenous injections. Intramuscular injections. It's a whole bunch of early to mid twenty-something year olds literally saving lives by reviving. By stabilizing. It boggles my mind how much responsibility is shoulder by the youth and how well they perform given the immense pressure and expectations. The overall health of Dalaguete relies on the ability and dedication of its youth.