Jesse Raiten, MD (Faculty, Anesthesia and Critical Care Medicine) - Blog Post 1
I am teaching critical care at Central University Teaching Hospital in Kigali, Rwanda, on a grant from USAID and the Clinton Health Access Initiative. It's a massive hospital with extremely limited resources and an incredibly sick patient population. The ICU is small, packed with patients, and the mortality equals the survival rate. Young and healthy patients die every day from complications that could have easily been prevented.
Bed 8 is a young man that's been a real challenge this week. He's 38, a refugee from Congo. Unfortunately he developed appendicitis that went misdiagnosed leading to ruptured appendix and septic shock. He arrived in our ICU in the middle of the night. Our abilities to treat him were limited not only by the usual lack of resources (no ABG, minimal labs, minimal antibiotics, etc), but also by his refugee status. Until his family got his UNHCR (certifying his refugee status) papers, we could provide minimal care after his surgery. We got the hospital to agree to life saving therapy for now. We started him on dopamine and adrenaline, because those were in stock this week. Without infusion pumps we just dripped them in until his BP improved. We have him on some basic antibiotics but he can't afford the ones he needs and even if he had insurance, the Rwandan health insurance only pays for antibiotics if blood cultures come back positive. We did get one set of labs and his potassium was > 6. I hope it goes down because, although dialysis does exist, his family won't be able to afford it. And since we can't check any more labs, his first presentation of actually needing HD will probably be cardiac arrest (like his neighbor, similar story, died from yesterday). The mortality rate from septic shock in this ICU is 89% with all available treatment.