This week I spent most of my time at the ICU. The Doctors and the Nurses are great. Although they are allocated to different patients they seem to work together at all times and they help each other. I find this very good when someone has doubts or when they just need some more help. The family is still a resource when the patients need to change position or be feed.
However, something really horrible happened this week. I was at the ICU when I saw the family coming with a stretcher and standing by the bedside of a patient who was intubated. Intubation is done when patients cannot breath by themselves. So, a tube is put inside their lungs and a machine inserts a determinate quantity of oxygen and air to the lungs. I asked one of the Nurses what was happening and she told me that the family had decided to take the patient home. I could not believe it!!. I told her that they could not take the patient home because the patient could not breath on its own, and would die if disconnected from the machine. The Nurse said that it happened all the time and that the called it LAMA (Leaving Against Medical Advice). I tried to find a doctor who could talk to the family and make them understand the severity of their decision but there was no-one, and I don't speak Nepali. In less than one minute the family had the patient in the stretcher and out of the door. The only thing I could do at the time was to teach one family members how to give breaths to the patient (with my non-existent Nepali, and only universal sign language), and to ensure the oxygen tank was well connected, had enough oxygen, and that the patient was not losing consciousness. However, I am not sure what happened after they left.
I asked one of the doctors what had happened. The answer was that the family wanted to take the patient out of the ventilator, but the doctors realized that the patient could not breath on its own. So, the Doctors said they would not disconnect the patient because she would die. But, the family couldn't longer afford the expenses of the hospital, so they decided to go "LAMA". At least one more week in the ICU was needed for recovery, but it was possible. The ICU is very costly for the patients, and they cannot afford it. Even if this is one of the cheapest hospitals in the city. The government hospitals are very basic and do not have the facilities for the treatment of patients with higher needs. The doctors mentioned that LAMA was something that happened in the daily bases. That maybe he could pay for one or two of the patients but that was about it. Unfortunately it is something that everyone at the hospital has seen way too many times, and they are sort of used to it. A single day at the ICU can be equivalent to a moth salary for a family. Sometimes families have to sell their land, and their animals, and be left without a way to sustains themselves.
I also went to buy a syringe at the pharmacy and it was $130 rupees, which was too expensive considering that my lunch was $180 rupees. It was just a little tiny syringe!!. I can't imagine the cost for the families who have to pay for each medicine, each syringe, every lab test. :(((. The worst part is that some of the nurses at the hospital don't even get paid. One of the best nurses I met told me that she is working 12 hours shifts/6 days a week, because she need the experience before she can apply to a Bachelors of Nursing. :O.
So, I haven't written because I am trying to process this on my mind. I still cannot understand. I dont see how my presence changes anything. I wish there was a way out. I wish I could speak Nepali to talk to the families and figure out ways to help them. This trip has confirmed by extreme hate towards private health care :(.
