Before going into the outpatient department, I wanted to share that due to some family issues, I have come back to Tokyo. I’m unsure when I will be able to go back to Luang Prabang but I would love to one day, hopefully soon! In the meantime, I wanted to share my observations of the Outpatient Department at Lao Friends Hospital for Children.
To give you a general overview, on an average day, the LFHC sees around 40–60 outpatients. It’s especially crowded on Mondays and after national holidays so you’ll see patients and their families wandering around. The outpatient department opens at 8:00am till 5:00pm and during closed hours, patients can come in through the emergency room.
LFHC has quickly become the go-to children’s hospital in Luang Prabang, so most families with young children in LP have visited the hospital. Many of the patients are from town, however we also have patients who travel for hours from far away villages to receive treatment. Often times the patients who have traveled the furthest are the most sick and impoverished. (More about that later.)
Registration and Triage
When a patient and their family first arrive at the hospital, they must register with registration/triage with their pink booklet. In Laos, all major hospitals provide a little booklet for each where doctors record symptoms, diagnosis and treatments for each visit. Each hospital has a different colored booklet and LFHC happens to be pink!
While patients keep track of their visits through the booklet, LFHC has an newly implemented and electronic medical record (EMR) system of record all patients’ history . LFHC is the only hospital with an EMR system in all of Luang Prabang, so that’s pretty exciting!
Once the patient is registered, they go through triage where a nurse checks their temperature, weight, height and symptoms. And just like at any other hospital, if they are in critical condition, they are taken directly to the inpatient department and if not, they are asked to wait, usually for about two to three hours. Two to three hours is a long time but it’s because there are only 3 outpatient doctors on call at a time. Some Lao doctors are still in training, so it takes time for the expat doctors to diagnose the patient while simultaneously train the Lao doctors.
Our indoor outpatient waiting area is quite small so a lot of the times, families wait in the outdoor waiting area. Families usually take a nap, read (from our children’s library) or watch the hygiene and nutrition video that’s broadcasted in the waiting area. I thought it would be nice to have toys out but I was told that we have to be careful of which toys to have out since infectious diseases can spread if the toys are not properly cleaned each time. Makes sense.
One day when I was shadowing the outpatient doctors, I saw two very different cases of patients which I think shows a wide spectrum of the patients’ backgrounds and financial standings.
The first patient was a 3 year old girl who came in curled up in her father’s arms as if she was trying to control a tummy ache. Her shirt was a little torn with dirt on her feet and you could tell the family had traveled a long way to get to LFHC. The family was Hmong, which is one of the ethnic minority groups in Lao whose language is completely different from Lao, so our doctor had a difficult time communicating with them. We immediately asked one of our Hmong doctors to help translate and found that the girl had fallen on some bamboo and had severe pain in her abdomen. You couldn’t tell from her facial expressions that she was in pain but she looked very timid and gave out a sharp shriek when the doctors lightly touched her abdomen.
The parents kept pointing at her abdomen and mentioning that she had fallen but didn’t elaborate further, I still don’t know why they didn’t give us the full story the first time. Maybe they did not think it was important to understand how the girl was hurt or maybe they were embarrassed. The doctors eventually got to the bottom of it and found that she had fallen on a pile of bamboos which had caused sharp pain in her abdomen. And after further questioning, the father nonchalantly mentioned that his daughter had had a fever for the past 6 months! They lived very far away from the hospital and did not have the money to travel for to just treat a fever, but after she could no longer withstand the abdominal pain, they decided to bring her to Luang Prabang. Her ultrasound results showed that there was internal bleeding and she was immediately taken into the impatient ward for treatment. Her fever and abdomen were treated and she was discharged within a few days! It’s crazy to think that she was not treated for her fever for half a year but also amazing that she was able to get better in such a short amount of time. It’s sometimes it’s the simplest medications and care that can help make some of these children healthy again, they just need to receive it in time.
Our other patients were siblings, a 5 year old boy and a 3 year old girl who both had the same symptoms, a slight cough and stomach ache. They were frequent visitors of the hospital and had both visited a month earlier for similar symptoms. When they walked in, I noticed that the children were wearing clean clothes and the father spoke very good English. From that observation and their frequent visits for minor symptoms, it was clear that this family was financially better off than our previous patient.
The father told us he was a tour guide in Laos and Thailand, so he was often traveling back and forth and rarely at home. The girl had been getting stomachaches lately and kept asking her father to rub to her tummy. Our doctors found no obvious problems and we explained to the father that kids sometimes get sick, it’s part of being a kid :) He seemed unconvinced and asked for medication but the doctors just smiled and said, “They’ll be fine. Just make sure you spend time with your children when you’re home. I think they might just want your attention ;)”
As LFHC sees a wide range of patients from different financial standings, living conditions and levels of education. However, regardless of their backgrounds, all patients receive the same level of treatment and care. Some families who live close by may take advantage of the free healthcare but we cannot deny anyone treatment regardless of how minor their symptoms may be. If the parents are worried about their child, LFHC will respect their concern and make sure to provide the most appropriate care for each patient. Just like one of Friends Without a Border’s mission statement, “Treat every patient as if it’s your own child.”