Kamuzu Central Hospital-week 1

I’ve finished my first week at the hospital; only 3 more to go! It’s been such a wild experience already I hardly know how to put it all in words, but I’ll try to give you an idea.
Day 1: we were supposed to meet with the hospital’s director of nursing at 7:30am. We sat on a wooden bench and waited, and at 9:30 her assistant said, “Perhaps she’s running late”. Yes, perhaps! She arrived just before 10 and we were sent off to different units. I got the surgical ward for my first 2-day assignment. It’s supposed to be a 60-bed unit spread over 3 rooms, but they’ve put beds along both sides of the patio with its half-wall, so they’re now considered an 80-bed unit but often will go up to 120 patients by putting mattresses on the floor. The nurse told me, “The problem is that during the rainy season, the patients out on the patio get rained on, but as long as we can give them a bed and the care they need, the rest is just details.” There are 3 nurses on day shift (7:30am-4pm) and 2 nurses on night shift (4pm-7:30am!). The nurses didn’t believe me when I said my unit in the US limited our patient load to 6 per nurse!

Day 2: The nurses don’t do much physical assessment. They’re responsible for med passing, blood draws, dressing changes, and ‘damp dusting’ the whole unit with a bleach solution each shift. At first I wanted to call what they do irresponsible and lazy nursing, but I’ve come to decide that I can’t put my definition of the role of a nurse on them. They’re not trained nor expected to do what I think of as nursing care, which is a shame, but it’s not their fault. I listened to rounds with a medical teams as we planned for an amputation of a man’s hand burned down to the bones and referral of a man with cancer of the palate with a tumor larger than a baseball sticking out of his mouth. The tumor itself had teeth in it, because it had taken over his upper jaw! We gave another man the news that his father had some sort of abdominal cancer because we pulled out bloody fluid from his belly right there in his bed, but there was no point doing a CT scan to diagnose where the cancer was, because there was nothing that could be done in Malawi to treat it anyway. I also helped with med passing, which consisted of us pushing the med cart to the middle of the room, calling out “medicine”, and waiting for the patients’ guardians to bring us their med slips, collect the meds in their hands, and take the pills back to the patients. See, every patient is required to have a guardian who sleeps on the floor under their bed, cooks for them, feeds and washes them, and empties all the catheters and bags and drains. We assume the real patients got the meds, though we wouldn’t know it. If the guardians were not present at that precise moment and the patients were too ill or were asleep, they didn’t get their meds. When I asked what happened in those cases, I was told “it’s part of our nursing assessment…if the patients were really in pain, they would be here to get their meds.” Interesting philosophy.

Days 3-5: I wore street-clothes and my lab coat because I have no maternity scrubs, and they automatically placed me with the doctor during these 3 days in the Out-patient Department…like an urgent care clinic. It was fine with me—the nurses there only draw blood and check BP, and I kind of get the hang of that! In the course of the 3 days, we saw everything. Malaria is common, but I’ve never seen such severe cases of it. One woman was in a near-comatose, non-responsive state after ‘assault’ (aka rape most likely, though we didn’t do an exam), one man we declared dead on arrival. I saw a woman with advanced AIDS with cancer and severe malnutrition…and an 18-month old baby. She was 29 and looked 80. We diagnosed liver cancer, heart failure, HIV on several unsuspecting individuals, pneumonia, and kidney failure in addition to the basic high BP, diabetes, and asthma cases. We averaged a patient every 5 minutes and still couldn’t keep up with the line of patients going down the hall, some standing, some sprawled on the floor every which way. It makes me wonder what on earth they see in the ER. I guess I’ll find out next week, since that’s where I’m headed!

My overall impressions after the first week? I have many conflicting feelings. In some ways it’s completely depressing to see so much suffering all in one place. At one point I looked down the line of patients, many of whom were young adults or had babies on their backs, and felt a wave of complete shock that any one even survives to middle-age! I can hardly express the feelings of…almost ‘survivors’ guilt’ to think of what an easy life I have, through no merit of my own. What did I do to deserve being a privileged American, and how often have I complained about my doctor running 30 minutes late?

Then I also feel a bit of inspiration at just how strong these people are, to keep on going, to figure out how to make life work in these conditions, and to have joy in the midst of such difficulty. They appreciated even the mediocre care we gave them, and they smiled at us, and the kids played peek-a-boo with me. They’re not wallowing in self-pity or feelings of injustice, they’re just making it one day at a time as best they can, and there’s a beauty in that. Evidence of an inner strength that I doubt many of us would find, were the tables turned.


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