“Where are the American Doctors?”

Gia and I had just finished rounding on the male inpatient ward on our first clinical day at Martha Tubman Memorial Hospital (MTMH), a 70-bed government hospital that houses male, female, and pediatric inpatient wards; one operating theatre; an emergency room; and an outpatient department with 4 consultation rooms in Zwedru. As we were about to start rounds on the pediatrics ward, a physician assistant hurried down the hall and asked, “Where are the American Doctors?”

We were quickly taken to the Emergency Room, which consists of a small 10 x 10 room with two stretchers and a sheet to compartmentalize the room. On a stretcher, a 46 year old male lay, breathing fast and deep and unresponsive to pain or sternal rub. The wife explained in Liberian English that her husband had fallen from a tall tree and hit his head 24 hours ago. He was referred from his community health center to MTMH for evaluation and management.

In the United States, this man would have been quickly evaluated by ED physicians and trauma surgeons. He would have already been in a cervical collar, hooked up to vital sign monitoring, and an endless array of X-rays and a head CT would have been performed within an hour – if not minutes – after he arrived for medical evaluation. In Liberia, Gia and I, two resident physicians in Internal Medicine, were now asked to become the ED physician and the trauma surgeon. We used purely physical diagnosis skills to note that he had left sided hyperreflexia, a clavicle fracture, and bilateral pneumothoraces. He also likely had a brain hemorrhage although no CT can be obtained. We consulted the general surgeon at MTMH, who came quickly, to assist in the evaluation.

This sad case illustrates what I know Gia and I will continue to struggle with while we are seeing patients here in Liberia, and that is the lack of resources and infrastructure to be able to care for patients the best we possibly can. Knowing that this same patient, if he had presented to a US Hospital, would most likely be in the trauma ICU with continuous vital sign monitoring, one nurse caring for him 24 hours a day, radiology and laboratory capabilities, and trauma surgery expertise, but is instead in the medical male ward in Liberia with no continuous monitoring, one nurse who is caring for not only him but 10 other patients, and no radiology and limited labs, is frustrating and unjust. It is these feelings that I believe will continue to make both of us pause, reflect, and consider how we can make this wide divide in health care narrower.