I finally got a tour of the hospital. The nursing
officer was only a hour late, I saw this as a good sign. I have started going
everywhere with a book now. You never can count on anyone showing up on time so
you might as well pass the time reading. I have also started carrying toilet
paper with me where ever I go. Although some places actually have flush toilets
chances are they will not have toilet paper. Always good to have a stash with
you at all times. Anyways the chief nursing officer took me around to all the
different wards and introduced me to everyone we saw. Introductions in Zambia
are long and drawn out. To have a proper introduction in Zambia I have found
that are certain criteria you have to meet. First off the greeting has to be at
least 90 seconds long, you need to include the person’s full name, where they
are from, what they are doing here, why they are doing it, and your own person
view of the person. Needless to say the tour took 2 hours and since the
hospital consists of only 4 different wards this was an impressive use of time.
The hospital is composed of a female ward, a male
ward, a labor and delivery ward, and a pediatric ward. Each ward is in a
separate building running parallel to each other. The wards are large open
spaces with beds lining each wall. There are no curtains and no dividers
between each bed. There is one bathroom at the end of the ward with no door.
The bed frames are spaced less than four feet apart from each other; they are
made of steel and have two inch thick body fluid stained mattresses covered
with blankets and sheets that the patients have to provide themselves.
Typically patients cannot afford sheets so they sleep directly on the mattress
with a chitenge covering them for warmth. The air smells faintly of vomit and
urine and bleach. The windows are open with no screens; flies and bugs are free
to come and go as they please. Unusually the flies prefer to stay past their
welcome. There are signs on the doors
promoting the use of mosquito nets; “Do your part in stopping malaria, sleep
under and mosquito net every night!” There are not mosquito nets on any of the
beds. Oh and there is no power. I feel
as though there are too many differences between American hospitals and the Mufumbwe
rural hospital to bother listing them all. I would be been off listing the ways
in which they are alike; there are patients, they are sick, there are doctors
and there are nurses. That about sums it up.
I spent most of my morning in the pediatric ward
doing rounds with the one of two doctors stationed at the hospital. The doctor
would round on each patient, ask the mother a few questions about the child (no
fathers were present), review the vital signs, conduct a maximum of 30 second
assessment and then scribble down a few orders on the medical card which is a
single piece of paper in a yellow folder. For those who are unfamiliar with
vital signs they typically consist of heart rate, blood pressure, temperature,
oxygen saturation, and a pain assessment which are assessed every 2 to 8 hours in
the States. The only vital sign monitored in the pediatric unit was temperature
once every 24 hours if the nurse remembered.
The orders along with the vital sign seemed to be viewed as optional by
some of the nursing staff. There were several orders from the previous day that
were never completed, labs that were never drawn, medications that were never
given, and dressing changes that were not completed appropriately. At this
point I have only observed for a day so I cannot say with any certainty where
the system break down occurred, but it glaringly obvious that the current
system is not functioning effectively. It is also difficult to determine the
long term effects of the failed system since the documentation and record
keeping is relatively nonexistent. One can assume that several patients have
suffered from delayed treatment at best and death at worse. Scary.
The pediatric unit is setup the similarly to the
men and women wards. The beds are a bit smaller, but the mattresses are just as
stained, there are not mosquito nets, and flies are everywhere. There are no
chairs for the mothers to sit in, in fact there is no place for the mothers to
sit, rest, or sleep anywhere on the hospital grounds except for outside. You
can see families cooking outside on small fires, sleeping, and doing laundry.
There was a child in the pediatric unit who suffered
from second degree burns covering 30% of her body. She had knocked a pot of
boiling water off the fire; it spilled down her face, her arms, trunk, genitalia,
and legs. I have never worked in a burn unit but I do recall from school that
burns can cause severe dehydration, and they are at extremely high risk for
infection, and the pain can be unbearable. I know that some other metabolic processes
go on involving electrolytes, capillary permeability, and fluid shifts but I
cannot recall the specifics at this time (sorry Professor Huber). The child was
lying on a stained mattress with a chitenge covering her body, no mosquito net,
and in a room with many other sick and infectious children. I did not observe a
single person wash their hands when moving from one patient to another, in fact
I did not even see a sink or a basin to do so. The dressing changes were
conducted without gloves, without sterile dressings, and without any pain
medication. I am embarrassed to say that I had a hard time staying in the room
while the child wailed and her 9 month pregnant mother tried to smooth her. The
doctor was well aware of the dangers that this child faced, but he said with a
shrug “we can only do what we can do.” Fortunately the child’s wounds appear to
be clean and healing nicely, she is afebrile, and her white blood cell count is
normal; here hoping she stays stable. I am hard time comparing this care with
American standards; it seems horribly unfair that because of the country you
were born in you are deprived safe and effective health care.
I spent the afternoon diagnosing patients with
the other doctor at the walk in clinic. Apparently an American nursing
education qualifies you as a doctor in rural Zambia. I have found that in
Zambia there are three diagnosis favored by physicians; the first is malaria,
then pregnancy, then peptic ulcer disease. If you don’t have one of those then
it might be meningitis, if is not that then you are shit out of luck. Skeptical
about what I will see tomorrow.
