Journey from Port Moresby General Hospital to Madang
In Madang in 1998, I turned up at my workplace Operating Theatre and my team was already there in full swing at 0730 hours, they were called early at 6 am for an emergency operation to help an expatriate mother deliver her baby.
The baby came out completely flat (can’t breathe), so our team started trying to revive the baby without luck, the baby died. All the efforts were in vain, mother had undergone Emergency operation to save the baby!
So sad, everyone responsible turned around and there was ONLY ONE PERSON RESPONSIBLE!
The Community Health Worker that was monitoring the mother and baby in the INTERMEDIATE ward of the Hospital.
She got ALL the blame for NOT calling for EXPERT help earlier (on time) for the rescue mission.
She was crying, and I went to her, and comforted her after doing a quick audit of the case.
My quick audit findings:
1. That particular CHW was not a trained midwife. She did not know the normal and abnormal foetal heart rates. She recorded foetal heart from 150 starting her shift at 10 pm, and finally arrived at 40 at 6 am. That’s when she knew that heart rate below 60 is bradycardia (adult normal range), so called for help, that was 4 hours too late. The foetal HR was 120 b/m at 2 am, that was the correct time to call for help, however, the poor CHW was not given that knowledge, so what do you expect?
2. The intermediate ward is like a hotel, a private ward with no disturbance. That is Not a Critical Care Monitoring Unit, where we monitor patients hourly, a very busy ward.
Therefore, this was a management problem, SYSTEM ERROR!
To put this Critical patient in the Intermediate ward and secondly assigning an inappropriate night shift officer to monitor this patient.
I defended the CHW, and she was so happy. Case closed, no further action.
My family and I left for Nonga Base Hospital in 1999, as the Deputy Chief Anaesthetist for New Guinea Islands region (from 1999 to February 2006).
We started Critical Care Medicine in Nonga during this time.
After a month of my arrival in Nonga in 1999, we had a mother who collapsed in the post-natal ward after bilateral tubal ligation (a relatively minor procedure with little to no complications).
Patient was in a critical state requiring respiratory assessment, so I was asked to help. With the interest, knowledge, skills, and understanding of Critical Care Medicine, I used these on this patient.
According to my assessment, this patient developed internal haemorrhage post bilateral tubal ligation, so required Emergency operation to try and save the mother.
However, according to medical standard protocol, I can only offer advice, it is up to the Speciality Physician to authorize the emergency lifesaving operation.
The Speciality Physician depended on the advice from the Speciality Registrar (trainee doctor), who lacks the knowledge and understanding of Critical Care Medicine.
The excuse that was given was that this patient developed disseminated intravascular coagulation, and not internal abdominal haemorrhage. Basically, lack of knowledge!
What would have been the cause of disseminated intravascular coagulation?
And why did the patient develop intravascular coagulation?
We didn’t do anything further, and the poor mother died, I was devastated, because I knew the problem, and I knew, we could have saved the mother, BUT the Medical system was unhelpful.
A system error!
So, I waited for the new fresh graduate Resident Medical Officers the following year 2000. As soon as they arrived in the hospital, we set a strong Continued Medical Education (CME) program, and used this vehicle to teach Critical Care Medicine subspecialty.
Start of formal training in Critical Care Medicine in Papua New Gunea.
The well-known Resident Medical Officers of 2000 from Nonga Base Referral Hospital were: Dr. Julius Plinduo (Emergency Physician) and late Dr. Kapeo. Later Dr. Arnold Waine and his lovely wife Dr. Shalon Waine, Dr. Perista Mamadi and Dr. Ruben Kamus joined us as Service Registrars.
The journey continues with next batch of Resident Medical Officers who are now very prominent and powerful Specialists (Super Specialists), in their own fields of interest.
Ones that come to mind easily are, Dr. Alex Maha, Dr. Kilalang (paediatric cardiologist), Dr. Apuahe (Neurosurgeon), Dr. Charles Benny, Dr. Beryl Vetuna and Dr. Wandi.
We built the Critical Care Medical Team using the Anaesthetic team capability.
So, our Critical Care Team consisted of Anaesthetic Technical Officers on call, who would take care of the Respiratory system assessment and management (experts) and the Speciality Registrar responsible for Circulation assessment and management and specific management of the patient.
Critical Care Medicine in Papua New Guinea. Part 3
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