By Dr Gideon Rukundo Rugari –
People are dying like engege fished out of the waters.
Many families have lost their loved ones out of negligence.
There is little manpower. Any patient needs constant and vigorous monitoring both through history taking and physical examination, observation of the different monitors, Laboratory tests and imaging. Each of the above is heavy duty work for the relevant people.
They need timely medications which align with biochemical changes: ie, there must be enough people to do tests at the time they are needed and bring results IMMEDIATELY so that changes in medication can be instituted IMMEDIATELY.
Any dissonance will lead into patient death. Don’t delay to understand that the patient’s Sodium needs to be checked because if you delay, the abnormal sodium will cause other three or four biochemical substances to get abnormal and you notice when there is no time to save the patient.
If you take blood into the laboratory, it should come back IMMEDIATELY. If it delays by 24 hours, the results are useless because they tell of the patient’s condition the previous day.
I saw this happen in private Hospitals, imagine public hospitals. This means the patient may get discharged or die without the physician ever knowing the “current status” of a patient to make a life changing decision.
A patient needs vigorous feeding or they will get a secondary ailment of hunger which may lead to death. Our nurses have never been trained to feed patients and even if they have the orientation, they are thin on the ground. I heard a story today that patients spend days without tasting food.
And what food are government hospitals supplying to COVID19 patients?
They need turning frequently for lung drainage etc.
They need complicated charts construction to easily determine little changes in patterns of different parameters: pressure, temperature, respiration, heart rate, urine output, O2, CO2, GCS, etc… the list is endless. This needs clerks.
General coverage and manning, how many patients is a nurse responsible for?
If they are more than 2 patients, expect the nurse to do only 1/3 of the above, if she is hard working.
In our systems, a nurse is responsible for nearly 5 patients and more.
This is worse in the HDU, yet these patients develop equally difficult to manage complications.
Presence of relevant drugs. Usually relatives are asked to run to a private pharmacy to buy X, Y and Z drugs ASAP or else! Who buys for our patients at public ICU?
I could really go on…..
COVID19 is a very complicated disease.
Finally, the global mortality rate of patients with COVID19 is about 35 to 40%
It tends towards 100% in our places.