Update from Bolivia: Northwestern Trauma and Surgical Initiative Expands to Potosi

Northwestern Medicine
Emergency Medicine and Trauma April 25, 2013
 Northwestern Medicine doctor, nurses and graduate in BoliviaIn February, we posted about a Northwestern Medicine group working to improve pre-hospital and trauma care in La Paz, the impoverished capital city of Bolivia. Steven Schuetz, a graduating medical student at Northwestern University Feinberg School of Medicine, arrived in La Paz in February and in March, was joined by Mamta Swaroop, MD, Jennifer Mullen, RN, and Inge LeBlanc, RN, for two weeks. During their time in Bolivia, the group trained more than 230 first responders, physicians, nurses, and medical students in first response/basic trauma care.  They began collecting data for research and laying the groundwork to put a trauma system in place. Schuetz remains in Bolivia and continues to blog* about his experience. In his most recent entry, he discusses expanding the initiative to Potosi, the poorest and least developed of Bolivia’s nine departments. He shares a personal anecdote from an expat family medicine physician from Chicago that illustrates the need for improved trauma care in region:

Many of you may remember Dr. Stephen Hawthorne, an expat family physician from Chicago whom I worked with in rural Potosi during my first trip to Bolivia.  When speaking to him last week about expanding our trauma initiative to the department of Potosi, he provided his strong affirmation through a very telling personal anecdote:  

3 weeks ago, Dr. Hawthorne received a call at his new clinic in the city of Potosi.  The call was from the head physician at the district hospital in Vitichi, a rural municipality about 2.5 hours from the city.  The physician was calling to inform Dr. Hawthorne about a 55-year-old man who was being brought by ambulance from Vitichi to Potosi for further care.   According to this doctor, the patient had fallen out of a tree while harvesting peaches, landed on his feet, and has since been unable to move his leg due to a broken bone.

As the afternoon passed, the patient arrived to Dr. Hawthorne’s outpatient clinic.  Unfortunately, Dr. Hawthorne found the situation to be much graver than previously expected: upon initial evaluation, it was clear that the patient had in fact transected his spinal cord from a vertebral fracture caused by the fall, resulting in paralysis of his lower extremities.  As many of you know, these injuries also affect the nerves going to the bladder, and the patient confirmed that he had not urinated since the accident…5 days prior.  With low blood pressure and a bladder the size of a basketball, Dr. Hawthorne informed the ambulance driver that the patient needed to be transferred to the city’s general hospital after initial stabilization in the clinic.  However, when Dr. Hawthorne had finished caring for the patient’s most pressing needs, the ambulance driver had already left the city for Vitichi and was not responding to any phone calls. Read the full entry.*

For full updates, visit Steven’s blog.*

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