Emergencies In Paradise: Weekend Trip to Lautoka

This weekend we ventured to Lautoka - which should be like driving to Austin from Houston, about 3 hours, but because of the roads - takes more like 6 hours. Doesn't matter because you drive along the coast for all 6 hours, better than driving across most parts of Texas!

But first, some pictures from the day before...

This is the main entrance into the CWM Hospital - leading into the A/E department

This is their directory for the hospital - with my sense of direction, its a good thing you walk right into the A/E department if you head straight back!

Dr. Miller and I had to get a picture of the way the EKG's were done. Takes you back to the basics for sure! The only adaptation we had was reading the long strip that was produced instead of the layout we are used to in the USA. Easily fixed with spare paper and scissors - if needed.

Our curiosity lead us to this doorway - where there are 2 separate rooms for the ICU patients, separated only secondary to space limitations. We also came to check on an 18 y/o M that had come in the night prior with symptoms consistent with Leptospirosis - yeah, that took us way back to medical school days! There are 2 main forms for Lepto here - one manifesting mainly in the lungs and one manifesting as a hepatorenal syndrome. This young man had the pulmonary form - walked in, acutely decompensated while in the ED - stabilized and sent to ICU, where he died that night. Absolutely unfair. He had been mismanaged by his PCP and even with his symptoms and heightened suspicion for Lepto after the recent floods - he was sent home with an NSAID. No antibiotics. We knew something wasn't right when he looked at me and suddenly said he couldn't breathe as well - a red flag to any of us!

Mika, one of the residents preforming a paracentesis on a known renal patient with moderate ascites and pleural effusion brought in by his daughter because he wasn't as responsive as he normally was. Dialysis isn't a given here - in fact - it is only for "the rich." There isn't compassionate dialysis either like at LBJ. Here they just manage. So, after he was tapped in the EC, he was sent to the hospital ward. The next day we saw his daughter who reported that he was awake, talking again, and enjoying his lunch. I wouldn't have guessed that outcome, but was thrilled to hear it.

Before we headed out on the road, we went for morning checkout in the ED - which is somewhat new to the residents here. Before a few months ago, the physicians would just come and go without much accountability or transition of care. Now they are getting there as long as nothing acute comes in that takes priority, of course!

Which...leads me to the next picture. We walked into the Resus bay to find a brand new patient on the bed with chest compressions being done. Good morning. So, CPR was continued, patient was initially asystole - compression continued- epi was given. Next pulse check - pulses present, SVT on the monitor - epi drip started, ultrasound visualization of heart rhythm - with diminshed septal movement. Patient intubated - however, there is no vent to place the patient - any patient - on in the EC. So we bagged, and bagged for the next hour or 2 until the patient received a bed in the ICU. EKG was done - STEMI called - streptokinase ordered, and actually given. Within 30 minutes - patient began having spontaneous respirations and his pupils went from bilaterally dilated, non reactive to some constriction and reactive. Positive signs, so we left for Lautoka as the patient left for the ICU.

Pt's ABG.

Pt's EKG.

Bagging patient...

Still bagging patient...

On the road to Lautoka - we stopped off at a resort for a break. Gorgeous - wouldn't have minded staying for the rest of the weekend! This was the Warwick Resort.

On the way, we stopped to pick up another resident at Siguatoka and toured their A/E. I have pictures from there and will upload them tomorrow as this took over 2 hours to download these pictures! Not the fastest connection...

Anyways, we move on to Lautoka.

Random, but these were the largest tadpoles I think I have ever seen! Easily 6 inches long-I think the grown up version could eat my little Max and Jax!

There really isn't a bad view anywhere here. This was along the sidewalk on our morning walk prior to heading to the medical school and hospital.

Still walking...

Gentleman fishing

After my second lecture to the medical students - we came and found Dr. Miller working with the residents here with the ultrasound - again they were mesmerized with something we sometimes take for granted!

Looking for healed fractures on one of the residents

The entrance to the Lautoka A/E

The asthma hallway - set up very similarly to the one in Suva - very little physician interaction. Luckily this one was adjacent to the EC - so if a patient became ill, the physicians are more likely to be aware.

A gentleman stopping in for his treatment. Close to no one is on a breathing regimen at home - if they are, they are using improper technique for the inhaler.

The wards here were beautifully painted- all named after local flowers and painted accordingly.

I loved this one - the children's ward decorated with very familiar characters.

Putting a local twist on a very familiar room.

This little boy was not a happy camper! He was sitting down for a breathing treatment - and was screaming, screaming, screaming. We told his mom to give him a slight break - this was the face I got instead...at least there weren't tears!

The resuscitation bay in Lautoka. This is the airway cart.

Another view of the resus bay.

The A/E.

An ambulance dropping off a patient.

After meeting with the residents to give them more time with the ultrasound, Dr. Miller and I went to lunch at a local hotel. This was called First Landing - story is this was where the first people landed when they arrived at the Fijian Islands. Named accordingly.

Can't get fresher coconut water than this!

My camera decided to ruin this picture - which was such a cute picture! Obviously it was not the photographer's fault! Glad the coconut is in focus, though.

The beach once we were walking around after lunch. It is unreal the difference after leaving the A/E and coming here - there is just an absolute disconnect from the real world when you step into these resorts!