Saturday, June 29, 2013

The Hospital at Aweil

So far I have only been into the wards of the hospital that are staffed by MSF. Maybe I will get to see the others later. These are the typical Florence Nightingale arrangements, namely long, even very long rooms with beds side by side along both sides and doors at each end, and lining the corridors to and from. I would be surprised if even in Florence Nightingales time there were so many people crammed into the in-patient wards, children and babies and their caregiver families crowding the beds and the narrow spaces between them, the heat and smells, the noise, the dust and dirt, a feeling that the place must be on the edge of collapsing into complete chaos such is the apparent confusion of noise and crying and talking and push and shove. The MSF doctors that work here work incredibly hard all the time – their patients are all kids and babies, and unlike maternity which also gets chaotic and mad, but gets quiet sometimes with a little lull in the floods of women coming in to give birth – there is an unending flood of kids with disease, and injuries and worried parents and complicated problems to unravel.  And they have to do this with almost none of the resources we are all used to back “home”, things like comprehensive laboratory services, radiology, microbiology and pathology services, not to mention the hierarchy of colleagues in other sub branches of medicine with expertise in dermatology or rheumatology, cardiology,  and endocrinology, people we are all used to having on hand to get second opinions from.  In our ward we have a tiny portable gadget that gives a rough estimate of a persons hemoglobin concentration – in other words it tells us if they are anaemic or not and by how much, but the device is very basic.  We can send blood to the lab for a result which I took to be obtained from a more sophisticated machine but found out today their machine is the same as our one! The medical doctors are always last in for lunch and dinner.

The maternity service here delivers more than three thousand babies annually, so its very busy. There are several tiers of worker, from Medical Assistants to midwives, nurses and nurses assistants. Almost all of them are men. On our ward round the other morning I discovered we also have an Interpreter – he  explained this to me after I asked him to discuss the clinical state of the patient in the bed in front of us, much to everyones amusement. Some of the staff can be identified by the colour of their work clothes, which makes it easier for me, because they all seem very eager to help out, but some are well trained medical assistants while others barely trained at all. At least three are called Joseph, just to add to the confusion, and they are supposed to wear name badges to help me out but most often they don’t.

The long maternity ward itself has 10 beds for pregnant women at one end with problems like miscarrriages and malaria, then a small area for Triage where women sent in from elsewhere are assessed and then either admitted or sent home depending on what the problem is, then  further along still there are 5 Intensive Care beds, and on the other side of them ten beds for women who have given birth, and then beyond them and through a door another ten beds for women in labour. When their babies are about to come out they transfer into an adjacent birthing room where there are four birthing tables in a line against the wall. There is absolutely no provision made in almost the entire place for the sort of privacy we are used to in the west. You may be naked and giving birth on one bed while another woman arrives or is bleeding and being resuscitated beside you or also giving birth or having a miscarriage in the adjacent one on the other side. There arent even curtains. 

A word about the intensive care beds : to us westerners, “Intensive Care” conjures up vision of hi tech beds that cost more than a car, banks of machines and instruments with figures flashing on screens, oxygen outlets and suction hoses and monitors – well you can forget about all that – Intensive care beds here are just ordinary clapped out old beds like the others, theres no space age technology, no flashing light alarms or oxygen monitors, nothing. Its just that the really sick or potentially really sick patients get put in this little group of beds together to make it easier to keep an eye on them – so its intensive observation more than anything else.

This whole ward is usually also packed to the rafters with patients and their families, so is noisy and busy.  At times I am told they will run out of beds and people will sleep on the floor. Fortunately once the babies are born the mothers only stay a few hours before going home, so the postnatal beds  empty out often but then steadily refill. It is quite a wonderful place to pass through, as many of the women and their visitors, now smiling and relieved are dressed in exquisitely coloured flowing clothes and often have colourful scarves around their tall heads. The local women are Dinka, a race of very tall men and women who are often more than 6 feet tall and tower over me. They are never overweight, indeed most are probably underweight, but they are slender and strong with high cheek bones, very black smooth skin and are often remarkably elegant. There are also women from other Sudanese regions as well as Uganda and even Ethiopia.

These are our patients. Like women everywhere, they are phenomenal.

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