It was finally the end of the month, and we had got through without any major issues. I was completing clinic duties when I received a call to attend to an emergency case in the Emergency Department (ED). I rushed over, where both the Emergency and Anaesthetic teams were stabilising the patient—a trauma case requiring urgent surgery. We immediately planned to take the patient in as soon as possible.
It was finally the end of the month, and we had got through without any major issues. I was completing clinic duties when I received a call to attend to an emergency case in the Emergency Department (ED). I rushed over, where both the Emergency and Anaesthetic teams were stabilising the patient—a trauma case requiring urgent surgery. We immediately planned to take the patient in as soon as possible.
It was six months into the year, and still there was no sign of another medical officer joining the team. The workload was overwhelming and exhausting, but what could we do? We were the only hope for the critically ill and helpless in the province. We had to continue providing our services despite the many challenges: manpower shortages, shortages of drugs, power outages and, of course, burnout.
My team comprised two Specialist Medical Officers (Surgeons), one experienced Clinical Health Extension Officer (HEO), and resident medical officers who rotated through. I was the only Surgical Registrar. Most of the responsibility was given to the registrar, as this is part of specialist training. Clinics, ward rounds, consultations, Continuing Medical Education, and most operations took up much of my time.
Milne Bay, a maritime province with an estimated population of over 300,000, has only one referral hospital. It has four districts: Alotau, Samarai-Murua, Esa’ala, and Kiriwina-Goodenough. The furthest islands are more than 400 km from Alotau, the capital and home to the referral hospital. Patients referred from the outer islands struggle to access specialist medical care. There are no doctors on these islands—only Nursing Officers, HEOs, and Community Health Workers. Due to poor management and lack of leadership doctors have left the province leaving district hospitals such as Misima, Losuia and Esa’ala without medical officers. This has left Alotau with the only specialist capable hospital in the province. A huge responsibility.
The Emergency Department was packed most days, with patients waiting for hours. The staff, already overrun, simply could not cope. With the wards also full, it was like a traffic jam. Patients could not be admitted to the wards because there was no bed space, and some waited in ED for days. Surgeries were performed almost every day. Even scaling down elective procedures wasn’t enough. Emergencies from the surrounding islands kept flooding in.
It was the critically ill patients who required the entire team to work continuously. Just one patient in ICU involved the anaesthetist, internal medicine team, obstetrics and gynaecology team, and surgical team—not to mention the nursing staff and supporting staff such as laboratory, radiology, and physiotherapy. Most days started at 8 a.m. and ended after 6 p.m. We still had to return to the wards to review current patients and admit more. The fatigue was obvious on all our faces. But we had to turn up. Patient turnover was fast and often forced, as we had to create bed space for new admissions. We began to see cracks in the system. Staff were struggling under pressure, and we knew something would eventually give. As a surgical team, we trialled a twelve-hour shift for our nursing staff to ensure more nurses were in the ward to manage the workload. But this was a solution for the nurses—not the doctors or HEOs. We were there every day with no breaks.
Returning to the story—while I was preparing to admit the trauma patient, another call came from the ward. Another patient had suddenly deteriorated, and the team was attempting resuscitation. I had no choice but to leave the patient in ED with the emergency team and run to the ward. Again, the same anaesthetic and surgical teams were involved. Despite our efforts, it was too late—the patient succumbed. The first blow of the day.
We had no time to recover or regain our composure, as the trauma case in ED still needed us. After completing the paperwork in the ward, I rushed back to ED and prepared the patient for emergency surgery. Within hours, the patient was in the operating theatre. It was another exhausting and challenging case, made worse by the fact that there was not enough blood in the blood bank. The patient eventually succumbed to massive blood loss—the second death of the day.
At 6 p.m., as I sat down to complete another set of notes, my resident updated me about another case in the ward: an advanced cancer patient on palliative care had arrested and passed away a few minutes earlier. The third death. We all remained silent and continued with our tasks. None of us could think clearly, and I was still on call that night. I could see that the team was also exhausted. Our bosses ordered us to go home, eat, rest, and return if there were any other issues.
Before leaving, I walked back to ED to check if there were more patients to review. Sure enough, a list was waiting. I reviewed them with my resident and HEO, and finally left for home around 8 p.m. My back ached, my legs felt ready to buckle, and my head was heavy. All I could think about was my warm, comfortable bed, where I could rest and try to forget what had happened. What a horrific day. What a way to end the month. But we never forget. We never truly recover. We just learn, adapt and continue with our duty and responsibility. Because we must, because no one will come to help us.
Burnout is a huge problem in every hospital. In PNG, most of our hospitals do not have the manpower or resources to manage large numbers of patients. It is left to the team leaders and managers to work with what they have, to provide the best care possible.
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