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| Dr. Willie greets us outside the hospital |
As we spent the day with
Dr. Willie at La Esquintla public hospital we learned about several health
problems that are common for patients in the hospital and surrounding
Guatemalan communities. According to Dr. Willie, head of the hospital, chickungunya,
dengue fever and nosocomial infections are all serious concerns not only
effecting hospital patients but those living in the community.
Both dengue fever and chickungunya, according to the WHO, are viruses spread by mosquito bites. Both tend to present similarly with general symptoms such as: headache, fever, rash and joint aches. The difference between the two is that dengue unlike chikungunya can progress to severe dengue which is marked by hemorrhagic fevers meaning the body loses its ability to clot blood and control it's blood supply, thus bleeding out and wreaking havoc on surrounding organs. Therefore dengue fever, in rare cases, can become fatal whereas those who have contracted chinkungunya may have lingering joint pain for weeks, months or years but most patients fully recover.
Apart from these two viruses, another type of infection has been spreading in not only La Esquintla Hospital but in all hospitals around the world. This type of infection is called a nosocomial infection, or an infection contracted from within the hospital itself. Many people hear about catching things like pneumonia and C-Diff while being hospitalized but Dr. Willie informs us that there has been another infection plaguing the patients at the Esquintla Hospital. These infections were caused by the infamous bacteria: Achromobacter xylosoxidans. According to Dr. Willie this is a very rare bacteria that is resistant to many common antibiotics meaning it has been very difficult to treat. He had to consult with doctors in Costa Rica as the bacteria was spreading through the hospital causing much devastation. It turns out this bacterial infection required up to five different antibiotics at a time to treat. In a place where resources are so low, this had devastating effects. The infections from the Achromobacter xylosoxidans bacteria turned out to be one of the most costly and deadly patterns of nosocomial infections Dr. Willy has ever experienced in the hospital.
Even though patients continue to be at risk of catching these diseases the hospital has been implementing changes in the community and the hospital itself to decrease the risk of contracting these diseases and to decrease the spread of infection within the hospital.
As far as preventing dengue and chinkungunya the basis is simple, avoid exposure to mosquitos. The doctors and nurses continue to educate the public on the importance of wearing insect repellant. The hospital itself does not have a central air conditioning system which in an area that temperatures often reach 120 degrees Ferenheit this is a must. Therefore the hospital often is extremely overheated and all windows are left open. The problem is that most if not all windows lack protective screens. This obviously allows insects to enter the patients' quarters and puts them at risk for contracting dengue and chikungunya. Little by little the hospital is installing individual air conditioners in patient care areas to cool the area down but also to help prevent exposure to the outside elements.
Both dengue fever and chickungunya, according to the WHO, are viruses spread by mosquito bites. Both tend to present similarly with general symptoms such as: headache, fever, rash and joint aches. The difference between the two is that dengue unlike chikungunya can progress to severe dengue which is marked by hemorrhagic fevers meaning the body loses its ability to clot blood and control it's blood supply, thus bleeding out and wreaking havoc on surrounding organs. Therefore dengue fever, in rare cases, can become fatal whereas those who have contracted chinkungunya may have lingering joint pain for weeks, months or years but most patients fully recover.
Apart from these two viruses, another type of infection has been spreading in not only La Esquintla Hospital but in all hospitals around the world. This type of infection is called a nosocomial infection, or an infection contracted from within the hospital itself. Many people hear about catching things like pneumonia and C-Diff while being hospitalized but Dr. Willie informs us that there has been another infection plaguing the patients at the Esquintla Hospital. These infections were caused by the infamous bacteria: Achromobacter xylosoxidans. According to Dr. Willie this is a very rare bacteria that is resistant to many common antibiotics meaning it has been very difficult to treat. He had to consult with doctors in Costa Rica as the bacteria was spreading through the hospital causing much devastation. It turns out this bacterial infection required up to five different antibiotics at a time to treat. In a place where resources are so low, this had devastating effects. The infections from the Achromobacter xylosoxidans bacteria turned out to be one of the most costly and deadly patterns of nosocomial infections Dr. Willy has ever experienced in the hospital.
Even though patients continue to be at risk of catching these diseases the hospital has been implementing changes in the community and the hospital itself to decrease the risk of contracting these diseases and to decrease the spread of infection within the hospital.
As far as preventing dengue and chinkungunya the basis is simple, avoid exposure to mosquitos. The doctors and nurses continue to educate the public on the importance of wearing insect repellant. The hospital itself does not have a central air conditioning system which in an area that temperatures often reach 120 degrees Ferenheit this is a must. Therefore the hospital often is extremely overheated and all windows are left open. The problem is that most if not all windows lack protective screens. This obviously allows insects to enter the patients' quarters and puts them at risk for contracting dengue and chikungunya. Little by little the hospital is installing individual air conditioners in patient care areas to cool the area down but also to help prevent exposure to the outside elements.
There has been some recent
changes in the hospital that affect the risk of spreading nosocomial
infections. Parents are now allowed and even encouraged into the hospital to
help their children bedside. Previously it was a rare occasion to see parents
in the neonatal and pediatric intensive care units, but now more and more
parents are seen bedside. On one hand, Dr. Willie acknowledges parents are able
to participate more in the care of their children and are much more aware of
the care that the doctors and nurses are providing their children. On the other
hand this is yet another potential source of infection for the patients as the
parents are bringing in all the microbes and pathogens from not only the other
parents of the hospital but also the outside community. In order to help
decrease this risk, Dr. Willie and his staff require visiting parents to wash their
hands every 30 minutes.
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| Solitary neonatal ICU crash cart |
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| Parents tending to their children in the pediatric ICU |
Unfortunately the water
supply at the hospital, as with many other parts of Guatemala, is quite
dubious. Dr. Willie informs us that the hospital only has running water two
hours a day. After those two hours the city cuts off the supply. To make do the
hospital has created a makeshift irrigation system which roughly consists of a large
container of water on the roof of the building that is connected by plastics
pipes and uses gravity to run to only the areas which are considered the
highest need: the neonatal and pediatric ICUs. This leaves the rest of the 250
bed hospital without running the majority of the day. Dr. Willie has plans to
bring in an engineer to help build a well to give the hospital the most
essential element to infection control, running water in order to wash ones’
hands. So for more hours of the day, staff, visitors and patients have to make
do with the occasional pump of disinfectant foam or gel found in limited areas
of the hospital.
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| Nursing assistants documenting |
Although the hospital
faces an immense amount of obstacles in preventing infection in its patients
and surrounding community, it is obvious that there are improvements that have
and are continuing to be implemented throughout the hospital. It is quite evident
that Dr. Willie is dedicated in improving the hospital’s conditions in order to
provide his patients and community with safe and quality care. We look forward
to helping support Dr. Willie’s vision and to see these improvements next year.
-Nikki Stevens, RN
Allina Urgent Care
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