The huge Mater Dei Hospital

Having gotten my feet wet in the small rural hospital of Santo, Vanuatu it was time to turn to the opposite end of the spectrum. Mater Dei is a huge 900 bed Hospital located in the main city of Malta, Msida. I applied here because I wanted to contrast what I was seeing in my two rural hospital placements and see a large range of patient presentations in the time I had available. And what an experience it was!

During my placement I was awed by how well run the Emergency Department was despite averaging 250-300 presentations per day. The ED was split into areas for the different triage categories with around 20 beds for each of category 1 to 3. Lower priority patients were seen in a ‘minors clinic’ which seemed to run in a similar fashion to GPs in NZ. There was also a separate Paediatric ED, three full resus rooms and an imaging suite with two CT scanners. Although this was a busy ED it never seemed chaotic. I put this down to the organisation of the department and they way the staff were split into teams (or firms as they were called here) each looking after a different triage category but supporting each other as necessary. Some of the Doctors, including my supervising consultant, were pre-hospital accredited. This meant that while covering category one they could also go out in the first response vehicle and attend emergency call outs alongside the ambulance personal. Interestingly the ED nurses were the main staff members on the ambulance and they seemed to work pre-ED and in ED in the same shift. The uniforms were hi vis heavy duty scrubs that made them easily recognisable.

Nursing uniform with hi vis for visibility while working on ambulance call outs

The patient complaints varied widely, with the usual heart disease, type II diabetes, falls, fractures and COPD taking the majority. But there were also a number of cases which were very different to New Zealand. One major group was work accidents. There is no strict health and safety compliance in Malta and therefore many work injuries. Each week saw labourers that had fallen from scaffolding while at work due to not being harnessed. I assisted in resus with one worker who had broken his femur in a second story fall onto pavement. He was also not wearing a helmet and very narrowly avoided a traumatic brain injury.

There was also a smattering of domestic violence cases. One women came in with multiple stab wounds to the face and acid burns. I had heard about the prevalence of acid attacks in the UK but had never seen one in person. We were later told this was the first presentation Mater Dei had seen.

Motorcycle accidents were also starting to become a big chuck of the ED work, with dozens of presentations each week and often fatalities. The ED doctors put this down to issues with people racing their bikes on the roads around the coast of the island. One accident I saw however was due to water on the road. The interesting thing about this accident was the huge difference in outcomes between the two motorcyclists involved. One was an experienced rider in his 50s wearing Kevlar riding gear and used evasive manoeuvres to escape massive injury and this resulted in only a fractured medial malleolus. The other rider was younger, wearing jeans and appeared to have been thrown from his bike onto the concrete medium barrier. This helmet was spilt in two and had multiple internal injuries including pulmonary contusion and splenic rupture. He was intubated in ICU while the other rider was discharged.

Category 1 bays at Mater Dei Hospital

One of the great things about Mater Dei is working alongside elective students from around the world. The programme here is very popular and teams usually had 3 or 4 elective students. In this way I also got to learn a bit about common presentations and how the hospital system works in their home countries.

Malta is a beautiful country with a very efficient and well run hospital systems. I was very lucky to have been placed here and experience all the island had to offer. The much sort after down time allowed me to learn more about the history of the islands and explore buildings and ruins far older than anything I’d seen before.