BGUH

Today we went to the Beirut Governmental University Hospital, or BGUH (also known as the Rafik Hariri University Hospital). Built in 2005, the hospital is large and modern and, in contrast to AUB medical center, cares primarily for the uninsured. The hospital is primarily affiliated with L’Université Libanaise but AUB residents also rotate here. Ola, an AUB intern, describes how they must rely heavily on their history and exam skills because lab tests and imaging are not necessarily available.

The medical team is composed of three students, one PharmD, one junior resident and one senior resident. The students, perhaps nervous by our presence, endearingly stumble through one-liners after which we walk-round. The entire team sees patients together: while the senior resident directs the encounter, medical students are expected to interview and carefully examine the patient. Family members are present and get to ask questions. Although I cannot understand the language, for the most part they appear humble and grateful for their relatives' care.

But despite the team’s clear dedication and efficiency, rounds occur amidst the disorganization and chaos of a perpetually underfunded hospital. Nosocomial infections are rampant and big-gun antibiotics (meropenem, tigecycline, polymyxin) are used aggressively. While affected patients are theoretically on contact isolation, gowns are uniformly unavailable. The PharmD on the team, however, does point out that now at least there are signs on the doors to indicate that patients are supposedly on isolation.

The team cares for a man with a gun-shot wound to the face and an elderly woman status post colectomy. When I voice surprise that these patients are not on surgical teams, one of the residents simply replies, “well, you know how surgeons are”. We also see a man who has been intubated on the floor for three days because ICU beds are unavailable. Chucks are used to restrain his wrists and his FiO2 is permanently at 100% because the vents are missing a valve necessary to decrease the oxygen.

Rounds illustrate the striking discrepancy between what patient care should ideally be and what doctors actually do given their limited resources. Although we grumble at Milstein when things don’t happen the way we wanted them to, it is sobering to see a hospital where every second of patient care is governed by this principle.