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Divergent Practices

Divergent Practices

MCN Healthcare staff give back in a variety of ways during the year.  One of our clinical staff recently travelled to Madagascar through the Lutheran Church Missouri Synod. This group sends short term medical teams into a variety of countries to provide much needed care to rural, under-served areas.  Each team is made up of 14 members from all over the US; pastors, nurses, pharmacists, and other medical and lay persons.  This is the last blog entry..

Divergent Practices

Andranomadio is the Lutheran Hospital in Antsirabe, Madagascar. The people that receive care here pay in cash for their services. Those that are too poor to pay are treated at the hospital’s expense.

This is not a criticism of practice but an observation of two extremes.  Andranomadio operates on a very limited budget, the patients are stoic, narcotics are rarely used, and follow up is not necessarily done – other than returning to the hospital; I am not sure where the patients from Andranomadio would go for follow up care. Primary care does not appear to exist. Pain is managed with acetaminophen or ibuprofen. There are limited IV antibiotics; one of the cefazolin family and flagyl. Length of stay is very short, maybe 2 days. In addition, local healer’s and traditional practices remain in some areas.

Last week we watched a mastectomy for a tumor the approximate size of a walnut. There it was, just growing through the skin. How long had it been there?  We surmised a long time. The patient was sedated, intubated, and her right breast removed. The edges of her skin were pulled together to close the wound left by the breast removal. There was not reconstruction or prosthetic fitting, and I am going to guess that there is no counseling.  Chemotherapy is available but I did not look into the types or who can get the drugs.

We observed an abdominal cyst removal. It took a very long time for the doctor to remove the cyst. Well, it was a dermoid cyst and resembled a mass of sawdust and pale peanut butter and did not come out cleanly (in one piece). These are usually benign but will go to the lab in Antananarivo (Tana) for analysis along with breast tumor. Did I tell you that someone from the hospital has to make the 3 ½ hour drive to Tana to take the specimens to the lab? Remember the roads? Although, the road to Tana is not as bad – we saw some repair work being done.

A woman came in with second degree burns to her hands and face. Her story was that her house was on fire so she ran back in to save some things. Curious burn pattern; face to her hairline and along the jaw. Her eyes were not burned and her eyelashes were intact. Only the back of her hands to just past her wrists and the outside edges of her palms were burned. Her neck and chest were clear as were her feet and legs. Joanna and I discussed her burn pattern and did not think it followed her story. It looked like she covered her eyes with her hands while she was being burned but this does not explain the lack of burning to the rest of her body if she was indeed in a house fire. Also, the fire was stated to have happened recently and the patient went to a local healer. She had swelling in her hands, eschar in areas, and some tissue healing. Maybe the fire was 2 weeks ago or longer? Hard to say, the patient’s story did not waver. We watched the debridement. The doctor was able to find silvadene cream and Vaseline gauze. We were with the patient in the OR when she started to wake – no narcotics. Ouch.

Molly and Samantha watched a birth the same time Joanna and I were watching the debridement. No epidural and no drugs. The mom was coached, in pain and delivered a healthy, beautiful baby.

We watched the care delivery of multiple patients and Joanne, Nurse Practitioner, showed pictures of many surgeries that she had witnessed in the 10 weeks she had been at Andranomadio. The hospital staff are skilled and deliver the best possible care within their means. And guess what, the patients survive and infection rates are low. We saw a couple of the patients from Joanna’s pictures for a checkup – one young man with spiral tib-fib fractures to both legs – also treated by a local healer before coming to the hospital. Another man had been attacked by an ax wielder and required draining of a subdural hematoma – cool surgery but I have never seen so much blood evacuated from the brain cavity. Gives me a headache to think of the amount of pressure that was on his brain.

Incredible, incredible medicine. Dr. Harison and the staff at the hospital have my deepest respect. Maybe, we can learn some lessons in the United States and be a little more moderate with what we do for the patients. It probably will not happen but the week in the hospital reminded me so much that God created our bodies and all their complexities to be resilient and to heal as much as possible for our own survival. The dayshift begins with chapel in the Pharmacy waiting area. We prayed at the start of the surgeries I witnessed. We prayed a lot, treatment and therapies are performed and patients endure.

2015-10-22 OR (1)


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