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“What Are We Supposed To Do When Our Patients Are Dying?”

“What Are We Supposed To Do When Our Patients Are Dying?”

Author: Morgan Madison, Resident Physician

Date: 2/28/14

During our second COPE session the doctors were asked by Johanna (the external site facilitator from Clinical de Familia) how they can improve their patients’ experiences at Guaymate Hospital.  A heated session began when one doctor asked, “what are we supposed to do when our patients are dying?”
The situation at Guaymate Hospital is a difficult one.  The Operating Room is not functional, there is no electricity during multiple periods of the day, the ambulance doesn’t have a driver (or gas), and they don’t have the appropriate resources to treat their patients.  Most of the doctors at Guaymate were placed there by the government; they aren’t a part of Doctors Without Borders, they didn’t sign up for this extremely difficult low-resource setting.  Everyday they come to work and do what they can to treat their patients, but often this just means holding pressure on bleeding wounds and giving IV fluids and hoping that their patient’s make it to La Romana in time (if they have a way to transport the patient). 
All of these issues are a daily source of stress for everyone in the hospital; thus, it was difficult for the staff who were present to even imagine real solutions.  The beginning of the meeting was essentially the doctors and nurses just venting about the state of the hospital and wondering how they could ever change the current conditions. We quickly adopted their feelings of despair and worried that the concept wouldn’t take.
Miraculously Johanna turned the tide of the session. She let everyone discuss openly about the problems and how frustrated they are – for instance, in response to “what do we even do when the patients are dying?” question, Johanna calmly said “we cannot fix everything right now and maybe some things we cannot ever fix, but we need to focus on what we can fix.”  Johanna launched right into the action plan to discuss the things the staff felt they could fix.  The session soon became very productive, with multiple problem statements and tangible plans compiled.
In the end, it was an incredibly fruitful meeting and that could not have happened without Johanna’s facilitation and the resilience of the physicians, nurses, administration and support staff who were present at the meeting.  While so much work remains, we all left more optimistic than when the session started.
For the next month, the staff at Guaymate Hospital will work on completing some of the tasks on the action plan they created.  This is a multi-disciplinary, collaborative effort including all level of hospital staff.  Our team will continue to work with the leadership of the selected COPE quality improvement committee to help guide this long-term process in improving services at the hospital.
Guaymate Hospital staff participating in COPE Introduction


Guaymate Hospital staff working on Action Plan items


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