I've completed my second week at Hospital São João. My team is awesome, they have really make me feel included (even when we are just talking about football!). I will be starting with a different team on Monday, and will be with them for the remainder of my time here.
This week, I met with Dr. Basto just to talk about how things have been going. We talked about me seeing different parts of the hospital and different departments. The hospital is celebrating 50 years, and it is also undergoing renovations. The medicine wards are in the original form of the hospital while some other departments have already been updated.
Dr. Basto took me to the stroke unit where I will be spending some time on Tuesday. I was curious to see the stroke unit because on the internal medicine service we receive many stroke patients. Why do some stroke patients come to internal medicine? Why not to the stroke unit or the neurology service??? Well, I went down the the stroke unit, and that question was answered for me...
First, I met the director and he showed me around. It is a large room with 10 beds and a nursing station in the middle of the room. Everything is brand new. The director explained to me that there are many hospitals in Portugal that have thrombolytic capabilities, and therefore people that suffer stroke are usually able to get thrombolytics within the 3 hour window. This is good right?? Well, yes, but most of these hospitals do not have the facilities to adequately monitor the patients afterwards. They do not have a unit with trained staff that provides 24 hour monitoring specifically for stroke patients, nor do they have the rehabilitation facilities/resources necessary to ensure that these patients reach their full recovery potential. So, many hospitals have the most advanced therapy (thrombolytics), but lack the basic standards (close attention to the patients and rehab).
My understanding is that once the patients leave the stroke unit they either go to the neurology service or the internal medicine service. This is decided in a very arbitrary way: patients below the age of 45 go to neurology, and patients above the age of 45 go to internal medicine. Ok, it doesn't make a lot of sense to me that age is the only deciding factor...Well, it doesn't make sense to the stroke unit director either! The "logic" behind it is that patients older than 45 usually have more comorbidities (Diabetes/HTN/Heart disease, etc) that can be better managed by internal medicine, while patients younger than 45 usually do not have as many comorbidities and therefore are managed by neurology.
This week, I also had the chance to see the Infectious Diseases ward which is also brand new. There are private and semi-private rooms, and all of the rooms have negative pressure ventilation**. In addition, they also have their own unit (ICU) that is fully equipped with ventilators and trained staff. There is a day hospital within the ward where patients can come and get infusions or any other treatments that must be done in the hospital. And they also have their own consultations (outpatient clinic) within the ward that is separate from all of the other services which have their consultations in a particular area of the hospital. Basically, the ID department has their own hospital within the hospital!!!
**Tuberculosis is still a problem in Portugal.
While in the Infectious Disease ward, I was told that the incidence in Portugal is greater than 30 in 100,000, while the average in Western Europe is less than 12 in 100,000. (The incidence in the US is about 4 in 100,000).
In Portugal, it seems that TB is just another occupational hazard for healthcare workers. It is not uncommon for nurses and doctors to become infected. The resident that told me this just finished 6 months of treatment for TB, and the resident's attending has also already had TB. In the medical school, there are about about 3 cases per class per year.
Since I didn't have any relevant pictures for this post, I've attached two pictures of Hospital Geral Santo António which is in the center of town. This is the older part, there are modern facilities behind this building.
...I will have more pictures in the next post!