Monday, 5 January 2009

Every day starts with morning report at 7am. Usually, it’s a member of the night staff from each ward who reports briefly on any new admissions, difficult cases or deaths. Sometimes, one of the staff do a presentation or discuss any outstanding issues. This morning it seemed like the hospital was falling apart as the generator ran out of fuel (the power goes off quite often as it’s the rainy season-a c section was delayed because of the power cut and unfortunately the baby died), the incinerator has broken again so back to the same problem as before of sharps being strewn everywhere at the back of the hospital, there are still no prescription charts, lab forms, discharge forms as something’s gone wrong with the admin department and they’re out of paper, they have no BP cuff in paediatrics, no stethoscope, no latex gloves (they keep running out everywhere as all the hospital cleaners are using latex gloves instead of their heavy duty cleaning ones which means they put themselves at risk of needle sticks while cleaning and lots of money wasted on these gloves) and finally I think the last issue raised was a problem with getting in contact with the people on call at night and at weekends. There’s no landline phones in the main hospital which work so people use their own mobile phones but people don’t often have credit on their phones so it’s left to the watchmen or messenger to physically go to the clinical officer or doctors house when they’re needed in the hospital. Unfortunately, there seems to be some confusion over whose duty it is to go to the house of whoever is on call and a patient died over the weekend after being left for 5 hours while bleeding after giving birth before anyone called the lab assistant to cross-match her for blood. It turns out there is a messenger who is supposed to go to the clinician’s house but there seems to be some problem with their rota leaving them with no days off and I guess they’re rightly unhappy and so have started to refuse to relay information. Some sort of telephone system would be very useful and in this women’s case, potentially life saving.

So after all that I was surprised anything was working and that the whole place hadn’t just come to a standstill. There were still 80 odd patients in paediatrics so no rest for the wicked as they say. Luckily there were lots of well children so lots of discharges but they reckon that admissions will be up in the 100’s by the end of the week. It’s a bit chaotic. I need to keep reminding myself to plot weights on the growths charts in the health passport books each child is supposed to have and check vaccinations too-apparently, 1 in 2 children are malnourished and often it’s hard to believe the age of a child when you look at them. It’s easy to forget how a well nourished child should look. There was another death this morning too. He was admitted with a haemoglbobin of 1g/dL (normal is >12g/dl). That’s the lowest I’ve seen so far, most are about 4-6g/dL. And I’m told it just gets worse until the harvest comes in March. The price of maize is already rising at 500-600K a kilo. Expensive enough if you only earn 3000-4000K a month and impossible if you are a subsistence farmer. So you don’t eat. Adults might just get by but the children are really pushed to the limit. The current president has apparently created much better food stability with maize reserves for famine but it looks like they’ll have to rely on more food aid as they wait for the next harvest.

Yesterday, I went walking up a hill close to Nkhoma with a couple of the other Dutch students (everyone is Dutch here now so I’m pretty outnumbered!). The views were amazing and the sky so clear. It just reminded me how beautiful it is here. I haven’t quite made it up in time for the sunrise yet mind you. Maybe one day before January. 4.30am is kinda of stretching it a bit!