After being taken in fighting in northeastern South Sudan whenever the clinic he was in need to be evacuated because of approaching gunfire Thouk Reath, 19, was recovering from a leg amputation.

Patients and doctors in the clinic at the town of Maiwut risked being caught up in an army offensive closed in on the nearby opposition-stronghold Pagak.

The United Nations said last week that approximately 5,000 people had fled to neighbouring Ethiopia to escape the fighting, also rebel spokesman Lam Paul Gabriel told.

“I was shot along with my leg has been amputated in Maiwut Hospital where I was regaining until we had been advised to flee,” said Thouk, lying beneath a blue sheet.

“It was a challenging journey. We were first driven to Pagak, subsequently flown to Old Fangak and then taken to the hospital across the river from boat.”

Old Fangak is a little, spread-out town of mud huts on both banks of the White Nile, approximately 300 kilometres (190 miles) in Maiwut. By boat, the way to receive visitors is without the access to the region by main streets.

Thouk was in Maiwut, about 25 kilometres from Pagak after being homeless a very first time when his village came under attack. He thinks they might be dead and hasn’t seen his parents because.

A South Sudanese whose leg was amputated Due to a gunshot wound, Thouk Reath, hasn’t seen his parents because his village came under assault

ALBERT GONZALEZ FARRAN, AFP

Approximately 20 individuals and Thouk’s arrival has witnessed the Old Fangak hospital extended into treatment rooms lined with metallic beds and blankets that were warm by one tent, all coated with rainproof tarpaulins.

Operating theatre nurse Robbie Gray, trying to find the International Committee of the Red Cross (ICRC), recalls being advised to “prevent mid-surgery” to flee the Maiwut clinic.

“I was assisting an operation when we suddenly heard about gunshots out Maiwut. We had been advised to immediately evacuate,” he told AFP.

In Old Fangak, Gray, with a group of employees and nine other ICRC doctors, has been treat patients who fled Maiwut, most of them suffering gunshot wounds.

In a different part of the treatment facility Nyachan Makuach with a gunshot wound to her abdomen. Lying in woollen blankets, she succeeds in and out of consciousness. Her eyes are drips from her forehead that is little.

In accordance with hospital staff she’s traumatised from the memory of watching her father.

“She recalls all,” said that the ICRC’s surgical group leader Louise Humphreys.

Makuach’s uncle, who came to Old Fangak, is dropping months’ worth of work.

“But now we are glad to receive treatment here,” he said.

– ‘Fighting will last’ –

When President Salva Kiir detained of plotting a coup, his former deputy, Riek Machar South Sudan’s civil war erupted in December 2013.

Fighting between government and opposition forces in South Sudan has driven tens of thousands from their homes

ALBERT GONZALEZ FARRAN, AFP

Tens of thousands have been killed and countless made from their homes in the years because a series of peace deals have been abandoned. The newest statistics say half of of the population — approximately six million people — will require emergency food aid this month.

With combating with continuing around Pagak, the Old Fangak clinic has scaled-up its team numbers, flying in other doctors and nurses.

“The past months have seen tens of thousands of people being homeless,” the rebel spokesman Lam told AFP.

“If the military progresses, the fighting will last.”

Pagak’s loss could be a major defeat to the already weakened opposition.

David Shearer, head of the UN Mission in South Sudan (UNMISS), stated last week that he was “seriously concerned” by the situation and called for both parties to stop the fighting.

StephanieFired

I talked about the fact that I had become interested in this event during my struggle to get the health care I needed because of my cancer diagnosis. I discovered that people from my section were studying it now. Some stated I was courageous, others, well, others don’t appreciate such outspokenness. A few told me to not participate in the solidarity event. What are they afraid of? I speak out because I dream of a future where residents and students could live without the fear of bullying, harassment, and retaliation. I want physicians to be able to care for others as well as themselves.

I documented the hurdles that I faced in residency in order that I could suggest alternatives to incorporate into a doctor wellness program. I expect that residents who require care such as therapy, in addition to ill residents, can use this app later on. In describing the difficulties that I faced, I quoted the words spoken to me by my attending physician on the day that I was diagnosed with cancer, “You first want to choose whether you are a physician or a patient.”

My program had been punishing me and accusing me of being “unprofessional” for attending appointments despite my telling them beforehand and providing doctor’s notes. On the web page now launched, I stated it was also hard for us to acquire mental health therapy. During my study into this is the case, I discovered cases of other people that have experienced negative consequences following revealing their need. It disturbed me stigma is so widespread in this field. Everyone needs help sometimes, and physicians can get sick. I am not sure folks are conscious of the hurdles doctors face when trying to care for themselves physically and mentally. We can do some thing to stop it when the issue is realized.

Standing up for this is going to be tough. As soon as I started standing up into lifesaving care for my fundamental right, I was repeatedly retaliated against. This retaliation happened after I pointed out the fact had I not received the treatment they punished me for that my physician stated, I would not likely be alive now. Actually did not appear to register with my superiors. I then went into the dean’s office, then to the ombudsman, afterward to the institution’s president. It was a game of hot potato. It was a difficulty passed around the establishment so quickly that no one held on long enough to burn off their hands. It was as if they believed that, when they ignored me, I would go away. I made the decision to go outside of the institution. Later visiting the government that definitely got their focus as not. They stopped blowing me.

I had documentation of everything I had been through because my diagnosis and evidence that my performance was at or above average. Despite major operation, tubes, drains, fainting, vomiting that is constant, and panic attacks I was nevertheless able to be a fantastic physician. I always place my patients’ security and that I really don’t believe there is anybody not even those that voted for my termination. I was both a patient and a physician and even though pressure from previously I received excellent evaluations in my attendings. So did they have excuse to shoot me? I had expected that the dean’s office will look at the facts. They did not. They chose to terminate my job right after the National Day of Solidarity to avoid Physician Suicide volunteer web page went live.

I’m not sure what to do in this stage. Next week I’m advised to have an MRI, and I don’t know whether I will have a paycheck or maybe health insurance to cover it. I know you’ve helped so many physicians, and you are truly an inspiration for me. I trust all that I have been through will jumpstart a change in the culture that is medical that is present. I need physicians to not be made to choose between being a physician or a patient.

Outraged that a physician would be fired by a hospital for having cancer? Appalled that a psychiatric resident would be fired by a hospital for helping physicians? Show your support by attending a vigil.

Image credit: Pamela Wible

Long ago, before our clinic changed over to a virtually complete hospitalist version, the faculty at our internal drug clinic functioned as the attending of record for every one of our own patients, in addition to the patients of the inhabitants we supervised, when those patients were admitted to the inpatient services throughout the road.

When we would arrive in the morning, we would examine the entry list, note that one or 2 of our patients had been admitted, and possibly a couple of a number of our taxpayers’ patients, and knew that our day could have the accession of rounding on those patients in addition to our entire schedule of inpatient responsibilities.

As the hospital transitioned over to a hospitalist version, they requested that we relinquish this duty, give up the care of our inpatients. It had been less of a request and much more of the FYI. Among the primary problems was that on any given housestaff inpatient group, the inhabitants would frequently have around a dozen attendings they needed to explore their patients with through morning rounds and through the day. This enhances.

As those of us in the outpatient world gave upon the vast majority of our inpatient responsibilities (except the occasional social visit to our patients that are admitted), the perishable skills of inpatient care jumped away from most of the faculty who focus their lifetimes in the inpatient setting. We are outpatientists, not hospitalists.

The 1 thing that has persisted has been our coverage of weekends about the service. Some of our coworkers continue to staff the medication service inpatient company, covering the weekends, and service has been completed by us as a practice to the hospital. In order that many attendings cover just 2 weekends a year we’ve divided them up.

Since we have a huge practice not much 2 weekends from the year isn’t much in any respect, created more manageable.

But with this portion of their responsibilities, as we’ve moved further and farther away from being doctors, more and more of our faculty have expressed dissatisfaction over the last few decades.

When you only do it 2 weekends from the year, so there are usually many months involving the times you really even log onto the inpatient electronic health record (different from our inpatient EHR) — let alone take care of septic patients having metastatic cancer anticipating brain biopsies about Monday morning.

We’re highly proficient at handling outpatients, but when we are asked to cover the very ill patients that are lying about the inpatient provider, a number of my faculty are open and honest in expressing their lack of confidence in their skills and ability to safely choose the very best care of those patients.

We finally realized we had reached a breaking point, as the voices requesting to be eliminated from this task grew more rapid and more varied, and also increasingly more and more of our faculty told me that they were not comfortable caring for the population of individuals anymore.

So we have a proposal set up to relinquish this duty, and occupy a new one, something that I am sure were great at, and now the challenge is trying to determine how to build this new version to offer the very best service to our patients, to our practice, and also to our clinic.

We’ve developed a business plan to offer our services up to make access for individuals on the weekends, even a time when access to care has historically been quite limited.

At the moment, our practice closes at 5 pm on Fridays, our telephones roll over to the answering service, along with attending and an on-call resident manage requests and telephone calls from individuals phoning up the weekend.

Many of them are regular clinical conditions, easily handled with a prescription or a few medical advice. But often times these are items that call for a visit to the physician, the auscultating and probing along with laying on of hands that we do. And much more intensive interventions.

At this time, the alternatives for patients out of the providers would be to go to a local care centre, or to the emergency area.

Long waits. That do not know them. Separate EHR’s. Overtesting. Overtreating.

Doing exactly what works — and also what we adore

Could not it be much better if we can send these kinds of scenarios, those patients, to an inpatient setting that is appropriate, the continuity-of-care location our patients love and know, and also where we are comfortable practicing?

The emergency area is inundated with that which we call “primary care-responsive experiences” Minor injuries, Upper respiratory tract infections, UTI’s, migraines, and the range of conditions that pose to our office Mondays through Fridays.

Patients that arrive with conditions in the emergency department are currently being routed to their telehealth program, where a provider goes over their issue by means of a video connection. If they had the ability to simply turn those patients and ship them to our workplace across the road, how much better would it be?

We may now be able offer rapid discharge visits the next day. If no one could get them into a consultation with their physician for close follow-up in the next 24 to 48 hours patients are often held in the clinic over the weekend.

Would not it be nice if rather than holding those individuals lying there in a hospital bed all weekend, preventing another individual from coming up from the overcrowded emergency area, that we could send them home from the hospital on Friday afternoon, and possess our provider see them in the office the next day if necessary?

My college is excited by this new concept, this new version of care, and we expect our patients will likely be. Instead of being routed to the emergency area if they have got strep throat, to figure out, I could see them.

And a few patients may even want to schedule an annual physical or a visit on a day when they do not need to take off work to visit their physician.

I am not suggesting that we all begin to work 6- and 7-day work weeks, but we are certainly happy to exchange the inpatient weekend service coverage that we do now (and largely despise), using something that we are great at, using something our patients actually need.

There will be hiccups, issues with putting up this and getting it figured out. Days with no patients, days with way. Trauma and play, incorrect patients in the perfect place, right patients in the incorrect place. Finding the coverage system that is perfect, the resources to look after these patients, the mixture of individuals, and simply spreading the word that this can be obtained, all will be challenges.

I am aware of many specialist and subspecialist coworkers that do a few weekend hours, and receiving buy from them that we could send an urgent ophthalmologic individual across to ophthalmology clinic rather than to the emergency room might continue to boost care and get our patients what they need with no long, long wait in the emergency section to be observed by a specialist.

We are currently working to ensure that we have access to laboratory services and radiology services, and even reaching out to our insurers to make certain we could get consent for CT scans over the weekends.

I am convinced this will be a wonderful new version of care, along with my faculty is definitely enthusiastic about offering this service to our patients and to our clinic, and they are all more than happy at the chance to end up covering a project they do not like performing, trading it in for something that they love.

Fred N. Pelzman is an associate professor of Medicine, New York Presbyterian Hospital and associate manager, Weill Cornell Internal Medicine Associates, New York City, NY. He blogs in MedPage Today’s Building the Patient-Centered Medical Home.

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