Hospital Musings

 

**Please note, while anyone my read this blog it will be particularly insightful for anyone in the medical world. But really anyone who has experienced American health care will find it interesting, so... continue reading!!**

Working in a hospital, on a ship, in Africa, for free. 

Each part of that sentence is different than anything I was doing a year ago. And each part makes what I do now completely unique in both good and challenging ways. 

For starters, a hospital. While I have worked in hospitals for a few years of my time in physical therapy, most recently I have been in home health. I have driven around to peoples homes hardly seeing any coworkers for the past 5 years. Now working in a hospital again, I have patients on IV poles who are not as medically stable. I check in with nurses, dietitians, hospital physicians, etc before I see a patient. I coordinate my time with them with hospital rounds, shift changes and when they are at CT-scans. On the plus side- coworkers! I love seeing all of those other medical professionals and collaborating with them. 

On a ship. Yes, we are tied up to the dock, but very much on a ship. It doesn't move very much (there are surgeons doing delicate surgery after all!!) but other areas of ship life are very apparent. We have safety drills that call for "abandon ship!" every week. Everything has to be able to be stored and tied down when we are sailing. My cabin, my kids school, my husbands office, the dining room, and where I do my laundry are all just a stairwell away. My commute went from 50-100 miles on my car each work day to going down 4 flights of stairs. 

In Africa. This is the biggest of all of the changes. First of all just being on the other side of the world, away from family and friends. This ship is a community of people from all over the world, so the patients are African but my coworkers are from Australia, New Zealand, the UK, Netherlands, Sweden, and on and on. The patients mostly speak Krio and I use an interpreter for every patient. Our interpreters are "day crew"... local people who are paid by Mercy Ships to be interpreters, housekeepers, cooks, you name it. They are invaluable. 

Being in Africa there is also no health insurance. Staying in the hospital is 100% free for patients so there is no billing portion to my progress notes. I spend however much time a patient needs with them, not based on productivity, MD orders or insurance requirements. If a patient does not meet their goals, we change the goals, we don't discharge the patient. If a patient needs a follow-up x-ray, we go across the hall and get an x-ray with no need to wait for insurance verification. 

Being in Africa also means patients are discharged home to a tin roof hut. Or sometimes a place with no electricity or running water. There is no outpatient physical therapy in their area, or it would cost a months wages to get an AFO. The likelihood of infection is high and education on signs of infection is low. Patients take longer to heal because of poor nutrition. Bones in children take 8-10 MONTHS to heal instead of 8-10 WEEKS. We give them calories and vitamins to take once they are in our care, but it's just not enough after a lifetime of poor nutrition. As a dietician told me this week 'Its like throwing ingredients on top after the cake it already baked". We keep patients for longer in the hospital because followup care is most likely not happening. 

And lastly...For Free. Yep. Not paid. I don't even clock in and out. No W-2 form. I work from 8am-3pm most days without a paycheck. Weird right? Who would do such a thing?!? We joke that everyone on board is a little crazy, and a lot adventurous. But because the ship is run by volunteers (except Day Crew, see above) the people here are fabulous. No one is trying to climb the corporate ladder, get the next promotion or only look out for themselves. Each person believes in something bigger than themselves and wants to be a piece of a larger puzzle. The humility and love onboard is palpable and the patients feel it as well. Chaplins are singing with patients in the hallway, RNs start a dance party with a pediatric patient who is healing all while I am walking patients and giving them new exercises to do. 

Working here is hard. Working here is amazing. Working here is like nothing else I have ever experienced or will experience anywhere in the USA. I'm thankful every time I go downstairs and get to experience the Mercy Ships hospital. 

Questions? Thoughts? Let me know!