As part of the process to obtain my Guatemalan medical license, I spent one year working for the Guatemalan government. For half of that year, I was assigned to attend patients at a rural government clinic (Emergency Room of that government clinic pictured below).
That clinic was somewhat unusual in that it had 24 hour physician coverage. Myself and other physicians supplied by the Guatemalan government covered daytime hours. The town paid for outside physicians to cover nights and weekends. After one weekend, when I returned to resume my patient care duties, I learned of an unfortunate case. There had been a death at the clinic. A young man from the community presented in anaphylactic shock after being stung by a bee. Epinephrine is first line therapy for anaphylaxis . There had been 24 hour coverage at this government clinic, but sadly there had not been epinephrine. The young man suffered a cardiac arrest and died shortly after his arrival.
A few days ago, a young woman from our community presented to our clinic minutes after being stung by a bee on her lip. She had already developed swelling to her face, lips, and tongue and was quickly becoming hypotensive. She received prompt administration of epinephrine- ultimately requiring two doses- as well as intravenous fluids for hemodynamic support. She was observed for an extended period of time in our resus area. Her symptoms completely resolved. Her vital signs stabilized. She was discharged to home alive and well.
The above two cases with vastly different outcomes emphasize the vital importance of ACCESS to lifesaving healthcare. They serve to underscore the fact that access to healthcare must include not only availability of personnel (i.e. 24 hour physician coverage), but also a robust infrastructure with a reliable supply of high quality medications- particularly the most essential medications, such as epinephrine.
At our center, we continue to actively work toward increasing the access to healthcare that we provide with plans to grow our local team and expand our hours of care. We are blessed to have infrastructure in place to facilitate such growth. Since opening our doors, we have partnered with Direct Relief International and just last week we received the latest shipment of medicine and supplies to our facility (a portion of that delivery pictured below).