Limited resources

This patient presented from Burma after not being able to move the right side of her body OR speak for one week. She'd been hospitalized in Burma for 5 days, recieving who knows what for treatment, when they decided to refer her to our tiny little satellite clinic on the Burmese border today. From there, Dr. Mark sent her to KRCH for a head CT, which revealed the obvious hemorrhage in the above image. It's amazing she is even alive. Unfortunately her family is very poor, but they have agreed to transfer her to a higher level of care for neurosurgical evaluation and treatment. 

She was overall stable while here with intermittent bradycardia and borderline hypertension (likely Cushing reflex). We emergently stabilized her starting her on mannitol and transferred her to Sangkhla Buri hospital. 

This is an amazing example of how lucky we are in the United States to have access to medical care in emergency situations. Yes, it's true that we have a convoluted and expensive medical system that is not accessible to most people for primary care, however had this patient presented to ANY medical facility in the US, she would have received the appropriate care emergently. Granted she likely would be in medical debt for the rest of her life, but at least in the US, in the most dire of circumstances, we can get the emergency care we need. Here in rural Thailand and especially in Burma, access to adequate healthcare is very limited, especially for the poor. 

While having to consider a patient's finances and ethnic background while managing their medical illness has forced me to be creative and become more clinically savvy, I am looking forward to getting back home where I am able to treat everyone who walks through the door equally regardless of their ethnic or financial bacground.