Series on Pakistan: Triage??

Note to readers:  This entry is Part 3 of a 5 part series.  If you have just begun to read please feel free to reference Part 1: Orientation.  Thank you for your interest!

This entry is authored by Carol Brown.  Carol is a Registered Nurse and worked in Pakistan for 2 years at the hospital mentioned.  She met her husband Dan while working there.  Carol currently works as a community health nurse and whenever she is given the opportunity boards a plane to encourage, work, and build relationships.

 tri·age –

  • the rationing of patient treatment efficiently when resources are insufficient
  • to treat all immediately; the process of sorting victims, as of a battle or disaster, to determine medical priority in order to increase the number of survivors

Following our morning clinic in a remote village where we had dispensed medicine in a rough lean-to, bumping our heads more often than I care to recount, we were headed to a nearby village for an unexpected, unplanned short clinic.   We were tired, hot and thirsty.  The set-up would be fast.  We would see as many as we could in forty minutes.  The decision had not been well met by some of us, anxious to call it a day, with the heat, dust and challenges having taken their toll.  Our team leaders had determined that for the sake of relationship, of high value here, we would need to do the clinic now and come back for a longer visit and survey of these families’ needs.   The short distance on the dusty, rough road was not long enough for the van’s AC to make a dent in the 105 degree heat.  We clambered out of the van – five of us, three foreigners and two Pakistanis – with our depleted nine-box portable dispensary.

“Carol, can you do triage?” asked Dr. Wendel.

My internal response:  “Yes, I can do triage.  I can prioritize well.”   Looking into the sea of Sindhi faces in the crowded courtyard, babies crying in their mothers arms, all of them sick and anxious for a hearing with the Doctor, I quickly realized my limitations.

“No,”  I answered, “Rahanna needs to do triage.”

I felt a sense of personal failure.  I’m an experienced nurse and I travelled ten thousand miles to help.   But our time is short, our resources are limited, we’ve given out most of the malaria drugs we have.   All of these people are sick.  I don’t want to miss the details of their stories, and mistakenly treat the baby with worms and a fever over the one with meningitis because I misunderstand a word or phrase.

Rehanna is a gifted, young Pakistani health worker.  She has served at Shikarpur Christian Hospital in numerous roles.   She has the discernment and skill to take in all the details and to prioritize appropriately.  Her patience and compassion are felt by the women.  I watched as she effortlessly took over and organized the crowd.

To realize our limitations is humbling.  This scenario played out repeatedly over the course of our two weeks.   We needed each other.  The experience of teamwork was a gift.   We could not function without the help of our Pakistani co-workers.  Neither could they accomplish the work without us.   It was exhilarating to participate.

Here’s the problem.

Those nine boxes were inventoried and packed on our last day, ready for use by the next team.  There hasn’t been a next team. The boxes remain in storage, the medications expiring and gathering dust.  The staff on the ground continue to work, but they don’t have the human resources to keep a hospital functioning and run mobile health clinics with the staff they have.

In early December I received an email.   Was there any way we could send more money to buy blankets for refugees facing the frigid, forty degree desert nights?   Funding had run dry.   From our small community in Western Massachusetts, we sent another 1000 dollars.  It will buy blankets, but then what?

Update- Pakistan has experienced yet another tragedy in the death of Salman Taseer – governor of the Punjab.  Taseer was a strong and outspoken leader,  recently working to change the blasphemy laws in Pakistan. See story here:

http://www.nytimes.com/2011/01/05/world/asia/05pakistan.html?_r=1&nl=todaysheadlines&emc=tha2  

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