A Hospital Experience

Not as bad as I expected!

Sono was working on his boat at his house.  Suddenly he came driving furiously up the drive way yelling, “Come!  Come!”  His left forearm was wrapped in his shirt and dripping blood.  Off we flew to the hospital/health centre.  Luckily he knew what to do because the process was out of my experience.  There was simply no one there to receive in coming patients. However, we were quickly seen in a little messy room with several other injured men.  A Cuban doctor came by and gave a cursory glance at the gaping wound and pronounced, “Only muscle”. A huge, silent, clumsy nurse stitched it together.  I estimate about 15 stitches, dressed it, took his name, handed him a prescription for an antibiotic and told him to go home.  He spent a very bad night. 

We went back this morning.  The dressing needed to be changed and he was having a reaction to the antibiotic.  We arrived at 10:30 and were seen at 1PM.  Not that unusual I guess, but it was eerily quiet.  We sat on a bench by what was once a fountain and is now a pit with plastic bags, card board boxes and other unidentifiable bits and pieces in it.  Nothing was happening, no medical personnel in sight, only the ambulance driver and the orderly walking in and out.  Other clusters of patients were waiting.  It seems that when someone needs to go to the health centre, the entire family goes.   I thought we were about 10^th in line, but actually we were 4^th.  Later 4 or 5 policemen arrived to question the family of a man who was beaten up last night.  When we arrived, the man was passed out on the bench by the fountain in the foyer.  We got the dressing and the prescription changed.

NOTES and IMPRESSIONS:

• The hospital itself is at the top of a long steep hill.  The halt and the lame, the sick and the injured walk up
• The confidentiality cult has not hit Dominica.  Everything is conducted in the open corridors.  But, why not? Everyone knows everyone and/or they are related.  You know the concept of 6 degrees of separation?  Well, here it is 1 degree! 
• Sterilization hysteria is also not a part of the ethos in the Portsmouth Hospital!  It is dirty, run down, chipped paint and lifted floor tiles, bucket and mop propped up in the corner of the treatment room, cardboard boxes on broken chairs.
• The ‘reading’ material is a WHO booklet on Control and Surveillance of African Trypanosomiasis, the Dominica Chief Medical Officer’s report of 1996, and several pamphlets advertising the North Eastern Funeral Association.
• People will not help each other.  An old lady, in a red sequined cap, couldn’t push her even older husband in his wheelchair up over a bump in the floor.  No one helped her.  However, when they loaded the beaten up man into the ambulance, everyone was up and out the door to watch.  Whenever a door opened or someone came by, all heads would swing around and gawp.
• Prescribed drugs are cheap. 28 erythromycin cost about $5.00 Canadian. 
• The health system is 2 tiered.  You pay to go to a doctor in his/her office, and you pay for the medicine OR you go to the local Health Centre and see a non-local doctor (usually Cuban),  and free drugs, if the hospital pharmacy is open. 
• The institution does not keep records.  Each individual has “a book” which is an ordinary school exercise book and keeps it for themselves and their children.  When you seek medical help, either at the doctor’s office or the health centre, you are expected to produce ‘the book’.  “Where’s your book?” is the first question asked. The doctor or nurse transcribes what the complaint and treatment was and what drugs were given.

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