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To Medevac. To Not Medevac.

Last year we had a trend going on here in Sentani, Papua.  Every time our expatriate doctor stepped away from being “in town”, we (the nurses) ended up with a critical case in our lap.  Every time.  We threated to not  let our Doctor leave EVER again.  But in all reality, this was not realistic or practical or healthy ……  So she went and we learnt.  Fortunately, that trend seems to have been broken. 

However, when our doctor leaves we use the skills and resources that we have, and we proceed to provide care, to the best of our ability.  Fortunately, it doesn’t take a doctor to diagnose “we are in trouble” and “this patient needs hospitalization or a specialist referral”.  Gratefully, we are not an island unto ourselves, as long as the phone and internet are working (one month last year, we had 95% of the time, no internet).  There are doctors with their ears to the ground, and will help give advice.  For this we are indebted and blessed that even though we are alone, we are not alone.  And perhaps by being so far removed, we have access to some of the smartest and best Doctors out there.  Mayo clinic, Doctors in Singapore and more are just a click away.  Clearly, whenever a patient has entered that “critical” window (and usually long before that), we are consulting and seeking advice.  Almost never do we act alone.  In fact, we don’t.  To medevac, is a team decision.

We function in a tight community of expatriates, who are not only co workers ultimately striving for the same goal, but are also like a gigantic (dysfunctional at times:  haha…..so normal) family.  Our children have hundreds of Aunt’s and Uncle’s.  We sweat together.  Occasionally we play together.  Our children go to school together.  We work hard, not all with the same organizations, but together in purpose.  We pray together.  And we form our own opinions all the time of what it going on in this “family” that we care about.  Most of the time, those opinions are from a pure heart, of care and compassion. 

So what can you do (as an expat in Papua or one that has family here)?

Trust.  Trust that insurance, where family is positioned, insurance, advice we are receiving from doctors, insurance, planes available, family choices, medical resources available, and did I mention INSURANCE ?, help us reach that final decision.  To medevac.  To not medevac.  Where to medevac too.  How to medevac.  It looks different every time.

Pray.  Pray that we nurses will have wisdom.  These are the times that we get stretched.  Intellectually.  Emotionally. Time commitment wise. It’s a ginormous responsibility to carry the weight of a human life.  Especially when there is a critical window of time.  We do not take that lightly.  We thrive in patient care, so we are HAPPY to help and it is easy for us to give in this way, because this is where God has gifted us.  Yet, we need prayer and so do our patients, and our own families who are giving up their mothers/wife.

Understand that it is the……

Lack.  Recently, it was the LACK of nursing care and resources that made a medevac a necessity.  A large gash to the knee, that I and another nurse sutured, became badly infected.  Gratefully, an Indonesia doctor serving here in Papua was able to take our patient into surgery, open up the wound, and debride it, placing in an improvised drain, and ordering three different IV antibiotics.  All appropriate treatments.  In the 5 hour post op/general anesthesia window of time that passed, not one set of vital signs was taken. Also there was no assessment of the wound, or ice placed for swelling and pain.  An ampule of pain meds was shot into the whole 500ml of IV fluid, so the entire bottle had to be infused, meanwhile our patient was in much pain.  Hours after the surgery, the only “care” the nurses provided, was to tell us that the patient could not get out of bed to use the bathroom.  Even though she was alert and fully capable and eager to pee.  (When they left the room, we took her to the bathroom, anyhow).  The second dose of antibiotics were never given.  The cultures had to be taken to another hospital 45 minutes away, by one of us, with the results not available for another week.  Finally, after 5 hours, we signed release papers (against hospital advice) and left.  Now we could provide proper pain control, correct timing of intravenous antibiotics, ice, bathroom privileges with assistance and so much more.  This lack was all very obvious.  Sometimes the lack is just the need of a specialist to assess or a test to be run, that cannot be done here.

Ponder these thoughts with me:

Quotes. On a recent medevac to Australia, I was blessed to meet Dr. Shelley.  She is the lead doctor for Australia’s flying doctor program.  Not only did I meet Dr. Shelley, but I also went shopping with her, stayed in her home, ate yummy food with her and saw her incredible work environment and sat at her feet.  She said 3 things that filled my heart with courage on this whole medevac topic.  I wrote them down.

1.  “When in doubt, ship them out.”

2.  “Better to be over safe, than under safe.”

3.  “Its reassuring to know that it is better to over treat some people some of the time.  Because if you are not over moving some of the people, than you are missing people who need to be moved.”

So there you have it.  To medevac or not to medevac. With or without our Doctor by our side it can be a tough decision.  I’m glad that we never make it alone.  We have bold fresh access to the throne of grace, where much wisdom comes from.  Along with that we are honored to serve some of the most generous, big hearted people on the face of this planet. 

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