Nurses

The interns here work 365 days a year -- not a single day off! So its hard to blame them when things don't get done efficiently. Especially because one of the most striking faults about the clinical care here is the lack of nursing care. Take one patient admitted last night -- she is 28 years old, is failing second line HAART for AIDS, is severely, severely wasted, refuses to speak or feed, and her temperature was 33.4 and BP 65/45. Her initial IV line infiltrated and despite attempts by the medical students and frequent reminders to the night intern, a new line was never established overnight. It was not until 1pm this afternoon that she was finally able to receive her fluids and medications to treat presumed septic shock. There is no one person to blame for this inadequate patient care -- it is an overburdened system with many intelligent, well-trained personnel but not enough time and support to provide the needed care.

Being on the wards here has shown me how enormously important nurses are to the functioning of hospitals and to patient outcomes. While doctors may examine, diagnose, and prescribe medications for patients, it is through the nurses that the medications, fluids, monitoring of vitals, food, and hygiene actually get to the patients in order to make them well.