5th day... GSW, MVA & assualts

Today was filled with a plethora of patients with GSW (gun shot wounds), MVA (motor vehicle accidents) and severe assaults… to name a few

Examples; GSW to Jaw (gross comunited fracture of the mandible) with bullet going into neck C2 shattering the bones and causing false aneurysm of the artery requiring embolisation via cath lab then removal of bullet in surgery

Numerous pelvis fractures on patients- 2 being pregnant secondary to MVA

GSW to the tibia causing gross comunited fracture

Stabbing to the tongue and into the mouth

Patients were still there from 24 hrs ago waiting for beds. Today I had time to reflect more on the care, some aspects of nursing care is very good, it seems acute initial assessment is excellent ie trauma team and roles but some aspects less so on longer care of patients. Although I expect some aspects of compassion is a cultural mix and difference.

The nurses have excellent education by all accounts but are under paid and over worked with low numbers on duty and pressures from the nursing management. Low morale and burn out is a classic combination for SA nursing. But there is good and not so good practice everywhere in the world.

Huge influence is resources, equipment is old and they have little of it. An apron with no blood on it will stay on all day. On the wards and in emergency some patients if necessary are tied to beds as they will harm themselves.
Although GSH is known to be the best  government hospital in the province and has an abundance of resources compared to others. CT scans, diagnostics, advanced surgery, cardiac surgery specialties are impressive. Some of the equipment might be old ie CVP monitoring, thomas splints, cardiac monitors... but it works.

I guess I will see an huge difference in a private unit compared to a government run- the government puts in 11% of the funding but 80% of the population attends as there is a huge deficient of poverty in the country.

Paradoxically the medicine they practice is clinically based with only necessary  diagnostics as they do not have access to a whole hosts of blood tests for example. (We tend to over investigate which is not indicated unless it would change management)

They practice with fewer resources but use the most out of that, more emphasis is also on imaging even watch and wait. The crush injury  protocol is an interesting example (no LFTS or CKs as they will be raised- just U&Es, urinalysis and fluids/CVP)- pure medicine and treatment with no unnecessary bloods excellent clinical medicine, back to basics in the nursing too. Also the surgery and speciality is excellent.

Again the staff from the nurses and doctors have been so welcoming and helpful I feel so part of the team and really enjoying working at GSH- big thanks to them all. So another great day and experiences, I have learnt so much  – so much more to come…. J