We decided to take off from the compound a little earlier
this morning so we could make it in time for the rounds that started in the
pediatric unit at 8 am. However, when we took off in the vans the driver
noticed that traffic was at a dead stop so we turned down a gravel road to try
to go around some of the slow traffic. Everywhere we went we eventually hit a
dead end and couldn’t get anywhere, but we had no idea why the traffic was so
bad. The driver, Bernard, eventually called some people around town to see if
anyone knew how to get across the bridge to the hospital and avoid waiting in
the traffic. We were informed that one of the local markets had had a riot and
the police were breaking it up so no traffic was allowed to move around there.
It is generally about a ten minutes drive from the compound to the hospital,
but this morning we spent almost an hour and forty-five minutes in traffic.
 |
| Hindu Temple we drove by while stuck in traffic |
When we finally got to the hospital rounds had already started, but we jumped
in where they were and began to watch. It was a little hard to follow since the
doctors generally speak to the patients in Swahili and then discuss very little
information to the interns in English. Luckily, one of the doctors, named Mona,
is great about turning to us and explaining what disease the child has and what
is being done to treat him or her. Most of the children suffer from malaria,
meningitis, or pneumonia – some worse than others.
There were a few interesting cases,
including a boy about ten years old that had come in with such severe malaria
that he was in a complete coma. Today when they examined him, he had already
been there for five days receiving malaria treatment and just today could he
actually make sounds. The sounds weren’t words, but he could at least cry out
and the doctors said that was a good sign.
Another baby had come in with a
very rare congenital skin condition called lamella echynosis that causes the
skin to appear rubbery and almost like it was severely burned. The infant’s
ears were very underdeveloped and her eyelids were red, swollen, and almost
completely inverted. I tried to Google the illness to show you a picture, but I
haven’t been able to find one yet. It was very hard to look at the baby, but
the doctors said that they have seen it once before and with dedicated parents
who can afford and administer the medication the prognosis is good.
Down the row a ways, we encountered
a very tiny baby that all of us assumed to be no more that a few days old. As
the doctors examined the baby and asked the mother questions we learned that
the baby was born weighing 2.5kg and today was five weeks old and still
weighted 2.5kg. Their diagnosis was vague at best and they guessed that the
baby might be suffering from respiratory illness and clearly from malnutrition.
They prescribed some antibiotics and referred her to a nutritionist.
A new patient had come in the night
before and the doctors had to do a full examination of the little boy to decide
what illness he had. After lots of poking and prodding at the child, the doctor
informed us that because of their lack of technology and lack of money, they
were unable to differentiate between severe malaria and meningitis, so they simply
treat for both illnesses.
The last case I found to be
interesting was a 3 or 4-year-old child who had been suffering from jaundice
from birth. This is rare and makes the doctors assume some type of liver
condition. However, in order to diagnose the child they would have to conduct a
liver biopsy and they don’t have the facility to analyze a liver biopsy here so
they simply have to keep the child comfortable and try to treat symptoms. I
found that kind of sad.
 |
| "do no use bottle" Because they don't have the means to sterilize them properly |
 |
| The hospital halls outside of the children's ward |
After rounds were completed, we
headed down to maternity ward to see what was going on there. The group that
was down there showed us around and explained that natural births are conducted
right there in the ward, but if the mother needs a C-section she is taken up to
an operating room called the Millennium Theatre. There were two women in labor
at the time and both were in a lot of pain. There is no pain medication and no
epidurals at this hospital, so the mothers just lay on a gurney by themselves
until its time for the baby to be delivered. The maternity ward is one of the
nicer areas of the hospital for two reasons: 1) it’s one of the newer wings of
the hospital and 2) it was paid for with private donations and not just the
government money. In this wing there is actually “private” rooms with a curtain
for a door, but at least it gives the mother a little bit of privacy. There had
been two births earlier that day so we stopped in the room where the babies
were being kept. They were just laying on little beds with no monitors, no
nurses, and no incubators. They were just …there.
Before we left for lunch, we
stopped into Minor Theatre and watched a dressing be changed so that we would
be able to do it when we came back that evening at 9pm for some more practice.
 |
| Maternity Ward room |
On
our way back from the hospital, our van broke down. It wasn’t really our day
for fortunate travel. We pulled off to the side of the road and Bernard called
for another van to come pick us up.
We finally made it back, got a bite to eat,
and many of us deiced to take a short nap so that we had energy to go back to
the hospital for an evening shift from about 9pm to 1am.
 |
| Van broken down |
We
got back to the hospital right about 9pm and the first thing we got to do was
stitch and dress a wound. A fourteen-year-old boy had been pushing a tuk-tuk
and slipped and cut up his ankle pretty badly. We cleaned the dirt out and I
assisted Mia in putting two sutures in the deepest cut. We bandaged him up and
he was finished.
This is where the evening gets
pretty depressing. I will do my best to stay as positive as I can, but forgive
me for my frustrations. With not much else happening in Minor, we headed over
to Casualty, which is where everyone is checked into this late at night because
no other wings of the hospital are open. We notice that almost all of the beds
are full and all of the doctors and nurses are behind the desk. With very
little medical training, it was difficult for us to help patients in any other
way but to listen to what they needed then return to the counter and beg for
someone to go assist them. It appeared that very few patients have actually
been helped. One in particular stood out to many of us: a young boy, maybe 4 or
5 was on a bed having significant trouble breathing. Not more than an hour
later, they taped the little boys eyes shut and wrapped him up and carried him
out. He had passed away without even being seen by a doctor. They put the body
in a chair and set it out in a little shower room by the entrance. As upset as
I was I just tried to move on and help other patients.
A woman had come in who had given
birth at home to a baby who was only three months along so the baby didn’t make
it but she was still bleeding badly and needed fluids. A nurse did come set up
an IV of fluids and then hurried off again. About a half hour later her friend
came to find me and showed me that the IV that the nurse had set up was leaking
all over the floor and the patient was not getting any of the fluid. The friend
said she had told a nurse right away but the nurse never came back to fix it. A
few checked it out and found a hole in the tubing for the IV. We just started
digging through supply closets until we found something and we got it fixed and
for her.
A third patient we attended to
showed signs of appendicitis and had been waiting to see a doctor for hours.
Joel went up to the Main Theatre, found a doctor, and he was finally seen. Just
before we left at 1am the man was being wheeled up for surgery. It was
interesting how they diagnosed appendicitis here since they don’t have any sort
of scanning machines or ultrasounds. They use a mnemonic and a point system to
determine if they will take them to surgery. On a scale of 1-10 if the patient
scores over a 7 it is likely that they have appendicitis and they will be taken
up to Main Theatre for surgery.
An older woman came in who spoke
only Swahili and we had to have a bystander come translate for us. She was
having trouble breathing and severe pain in her chest. The casualty ward has
one machine to monitor vitals….that’s it. We took it over to this woman and
attempted to take her blood pressure, but the cuff inflated and never deflated
so we couldn’t get a blood pressure. I immediately said well, I will take it
manually. Where are all the manual cuffs? They don’t have any. I was floored.
My biology class has twenty of them, but there isn’t a single blood pressure
cuff in an Emergency Room here. We checked her Oxygen Saturation, which should
be over 90, and hers read 69. We started digging around through supply closets
again looking for an oxygen mask, but couldn’t find one. We requested one from
a nurse who proceeded to ignore us; we requested again and she asked what her oxygen
saturation was and when we told her she rolled her eyes and went to go find
one. When we finally got a mask we attempted to hook up the oxygen but very few
of the hookups actually work. We had to move her beds so that she could be
close to oxygen. We left before a doctor ever saw her.
While all of this is going on and
Casualty was so busy, we had to go to Minor to look for some supplies. We were
surprised to see that the lights had all been shut off. When we turned them on,
we found a nurse from casualty SLEEPING on one of the tables. Joel yelled at
her to go do something because people were waiting. She responded with, “But
I’m tired”. I was astounded.
Just before we left a
three-month-old baby girl was brought in gasping for breath. Her mouth was white
and dry from breathing so hard. We rushed to get her on oxygen while a nurse
set up a nebulizer. They don’t have the ability to do a nebulizer treatment
with oxygen attached so it was one or the other. We gave her a treatment until
she started to lose consciousness and then she went back on oxygen again. Joel,
the med student from London, explained to us that her respiratory muscles were
very fatigued from trying to help her breathe for so long. The baby remained on
oxygen with very little improvement the whole time we were there. It was so
hard to watch. Joel explained that it was one of the things we had to accept.
We had done everything we could. They don’t have ventilator machines here and
there was no doctor to see her. We left the hospital shortly after and I prayed
that the baby would be in the pediatric unit when I got there the next morning.
She wasn’t.
When we left the hospital it had
started raining so we had to wait for a tuk-tuk in the rain. We got back to
compound we were all exhausted physically and emotionally and all headed to
bed. Although many of us were sure we wouldn’t sleep well with all that we had
seen.
Many of us were upset, frustrated,
disappointed and felt very helpless. Joel was frustrated too, but explained to
us that because we were there tonight: a woman got fluids, a man was sent to
surgery, an elderly woman received oxygen, and a baby received a pneumonia
treatment and oxygen. All which may not have happened, but it still just didn’t
feel like enough.
No comments:
Post a Comment