Shortages

Today the interns got paid and came back to work. I met our intern, Dr. Nalwago, who took over some of the blood-drawing responsibilities. She delegated the lab request form filling responsibilities to me. I didn’t mind. It was all part of a doctor’s duties. But I was a little disappointed. I had just gotten good at drawing blood with those oversized gloves. I had my routine down. Tie glove around patient’s arm, find candidate vein, clean with iodine, open syringe pack, attach needle to syringe, put oversized gloves on, remove needle cover, draw blood, remove glove from patient’s arm, remove needle from vein, put cotton on vein, ask patient to put pressure on wound, remove needle from syringe (very carefully), stick needle into patient’s mattress, have assistant open up tubes, distribute blood into tubes, have assistant close tubes, dispose of all used instruments.

I suppose you’ve noticed how there are only the most basic equipment around here. No elastic tourniquets, no special blood drawing syringes with connectors for the test tubes, definitely no butterflies for those hard to find veins. If we can’t get blood because the patient is too edematous (common), too fat (rare), or for whatever other reason, we just go straight for the femoral artery, though we try our best to aim for the femoral vein instead.

Here, practicing medicine is a daily mad struggle for supplies, with each intern trying to amass enough test tubes, lab request forms, clinical notes forms, cotton balls, syringes, sterile gloves, non-sterile gloves, etc., for the whole day. And then we try to hide all the stuff – under charts, in our pockets, wherever else possible – so as not to have them stolen from us by the nurses or other teams.

Today, we didn’t manage to get enough test tubes, so we had to prioritize blood draws for patients who need labs most urgently. And it’s not that the hospital does not have enough test tubes – that’s apparently one thing the hospital is not short on, yet. But there is a special nurse on the floor whose job it is to collect more test tubes from the lab one floor below when we start running low. However, when our intern asked her to collect some test tubes this morning, she told the intern that she was too tired to go downstairs to get them. At 9am in the morning, she was already too tired to do her job. So what exactly was she getting paid for?

Another shortage not only on the floor but throughout the hospital – magnesium. About half of our patients had Cryptococcal meningitis, and were being treated with Amphotericin B, which tends to cause hypokalemia. One such patient was experiencing refractory hypokalemia, probably secondary to her hypomagnesemia. Since there was no IV magnesium sulfate anywhere in the hospital, I was sent to the Obstetrics ward to look for some IM magnesium sulfate. I checked everywhere, at the ObGyn pharmacy, on the antepartum, labor and postpartum wards. They were all out. How could you practice good Obstetrics without magnesium? What about eclampsia prophylaxis for patients with preeclampsia, or neuroprophylaxis for patients with preterm deliveries? And it’s just magnesium for goodness sake, not some crazy expensive patented drug!

After an hour of this wild goose chase, I returned to the ID ward unsuccessful but not yet defeated in spirit. I asked Dr. Wilson if I should check the cardiology floor. They may have some magnesium, right? “No, it’s ok,” he told me. My patient with refractory hypokalemia had already passed away.