Vital Times 2022 - 70

a national health care system, like Guyana has. The wait
times that are imposed on a patient for elective surgery
in such a system amount to a form of rationing, which
tends to make us Americans very uncomfortable. Yet,
everyone has access to health care, which of course we
struggle with in the USA.
Dr. Paluy noticed that a pre-eclamptic woman in the
PACU on obstetrics did not get her blood pressure of
170/110 treated expeditiously or efficaciously. She
received one dose of hydralazine, which was clearly
not enough. Having to manage with a system in which
resources of equipment, medications and even staff are
not reliably available, can create what may be called
learned helplessness because one's expectations adjust
to that unpredictable environment. He also noticed that
at all levels the trainees were hungry for knowledge and
sought our input into their practices.
In pursuit of a sloth sighting along the Essequibo River
central lines, which have only recently been available
in Guyana due to material constraints. Residents and
CRNAs frequently chose to do entire cases with a mask
anesthetic to develop and maintain their mask airway
management skills, something that Joelle had never
experienced at UCSD.
Michael Paluy, CA-3, is from Israel, and his only
experience of health care outside the U.S. was from
being a medic in the Israeli Defense Force (IDF). Being
from a rural area of Israel he had first-hand knowledge
of the sorts of challenges one also sees in rural Guyana,
that of transport to the tertiary care medical center
where a sick patient can be taken care of. He also had an
understanding of what it is like to work in a country with
Drs. Takahashi and Paluy found themselves well utilized
in teaching medical students. Guyana now has six
medical schools, the one public (University of Guyana)
and the rest private. The private schools tend to receive
medical students from all around the globe. We met
medical students there from Guyana of course, but
also from India and Nigeria. As is true with medical
students most places they were largely observers in
" theatre " (the operating room), and therefore did not
receive much formal education. My residents did a
capital job of teaching them pharmacology, airway
management, cardiac and respiratory physiology, and
the fundamentals of administering anesthesia.
Guyana, with its newly flowing oil reserves, appears to
be at an inflection point in its development. Compared to
three years ago there is much more evidence of foreign
investment and of foreign trade. More cars have come
into the country, resulting in impressive traffic jams
on the streets of the capital city, Georgetown. Guyana
has always had a large diaspora. It has been said that
there are more Guyanese living abroad than there are
in Guyana. Members of this diaspora are now returning,
70 | CSA Vital Times
Vital Times 2022

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