Showing posts with label LBJ. Show all posts
Showing posts with label LBJ. Show all posts

Thursday, January 8, 2015

Friday January 2, 2015

Friday was next 24 hour call shift (now q6 since one of the other doctors returned from off-island).  There were 2-3 c-sections and two admissions (plus multiple phone calls and consults).

The most interesting patient I had admitted was a 13 year old girl coming in with DKA.  I had managed DKA in adults several times on our inpatient service, but this was the first time managing a child. It was also interesting because I needed to physically write out all the protocols (insulin drips, hypoglycemia, etc) by hand - I had gotten so used to simply opening the DKA orderset in EPIC back home and click-click-click... move on.  Looking back, I think having to write out the orders really tests your knowledge of the etiology and management of the disease.  There are also limited computers and no wifi, so you have to rely on *books* and other sources to look up information.  I actually felt like I was doing real medicine.

Another strong learning point was in the interpretation of Xrays.  There is no on-call radiologist to read your films - you are it.  The films are read several days later, but by that time you hopefully have treated whatever the patient had.

LBJ Tropical Medical Center - American Samoa

Here are some various photos taken around the ground of LBJ Tropical Medical Center:

This first photo is the main sign at the entrance to the main parking lot.  The hospital's main bus stop is situated behind.



The hospital is laid out in wings, with two main hallways joined by cross hallways.  The US and American Samoan flag fly out front.  It is not uncommon to see dogs sleeping on the sign (see my previous post).


One of the several open air pavilions at the hospital that acts as a waiting area.  Due to the heat, much of the hospital is open-air. 


Another view of the open-air courtyard. There is a picnic area in the middle, to the immediate left of the camera is the women's axillary snack shop, where you can buy egg sandwiches, tuna sandwiches, and various drinks.  Tuna is a staple here due to the starkist factory in Pago Pago.


There are almost as many chickens running around as there are people.



Here is the drive-up to the Emergency department.  There are usually 4 physicians or NP/PAs working in the ED per shift.  Two trauma bays, around 10 separate bays with curtains.  They do not have any advanced imaging - no MRI, CT, or even ultrasound.  They have XR and use the PACS system that we use at HCMC to view films - though the monitors are standard definition. The ambulance parking is on the right side of the building in the photo (not pictured), and patients are loaded through a side door that is guarded.  Most pediatric procedures are performed by the Peds on call - LP, catheterizations, lines, etc.  The staff in the ER are a friendly bunch, and do a great job with the resources they have available.

(I think this would be an awesome place for HCMC's EM program to rotate - they could really help out with their ultrasound and trauma skills, and the hospital could really use their help)




One of the main hallways of the hospital.  The pipes above are exposed, which adds a neat dynamic to the building. In general, the hospital is very clean and well-maintained. 


There is a very affordable cafeteria here with good portion sizes.  You can usually get a good meal for around $4-$5.


 As you can see, the placement of the wards and departments are fairly random. I got lost for the first two days any time I needed to go somewhere.  I especially like the fact that the "spare parts" are located next to the morgue. Hmmm....


The doorway to the ICU.  I did not take a photo inside for patient privacy reasons.  It is basically two rows of beds facing each other and separated by curtains.  There is one isolation room in the back.  The ICU has a reputation on the island as the place nobody leaves alive.  (I had to admit a kid for DKA to the ICU and had to talk mom out of hysteria because she thought her kid was going to die simply because she was in the ICU)... again, this reputation is a testament to the struggle that the amazing doctors here face on a daily basis.


The wards were recently renovated (I think using stimulus money). Here is the pediatric ward.  Very bright and colorful - well, apart from the seasick pooh bear on the wall.  The nurses here are very nice.   


In the corner of the outside courtyard (across from the ER) lies the Pediatric Clinic, the place where I spend most of my time when I am not on call or in the Nursery/NICU.  There are two benches outside and generally it is packed with people waiting to be seen.


The waiting area of the clinic.  This photo was taken at the end of the day. Usually this place is completely packed with patients waiting to be seen.


At the back of the clinic is where bicillin shots, albuterol nebs, and other medications are administered.  The nursing staff in the clinic are super friendly.


Here is one of the patient rooms.  It is equipped with pretty much everything you need.  The one downside is that there is not enough ear pieces to go around - so we save them for cleaning and reuse at the end of the day.  We use CPRS for our Electronic health record (same system as the VA), which is adequate to get the job done, but not as complete or easy to use as the EPIC system we use at Hennepin.  There is also a very large written component to the documentation (a fact that I kept forgetting the first few days).


For the animal lovers out there, here is my furry companion.  She sleeps right outside my door at night and is always there to greet me in the morning.  The hospital has "adopted" her, and she is the only dog I have seen around that actually wears a collar. All the other locums and families throw her scraps of meat, so she is fat and happy.