The hospital experience

Main signage, hospital layout

Mark here. I decided to hack Sara’s blog to post some shred of evidence that I am actually working while here. My apologies for some medical jargon that may follow, but there may be some folks reading this that are interested in the details…..

The Mangochi district hospital receives local patients as well as referrals from 40 smaller hospitals in the area (25 government, 15 private). For a medical hub, the resources leave quite a bit to be desired. As of writing this post, the hospital is experiencing an antibiotic shortage (oral drugs limited to Ciprofloxacin and Bactrim). They are also out of reagents involved in blood transfusions so many sick children with malaria are stuck with pretty severe anemia. In addition, a major petrol shortage has limited the transport of supplies from other facilities. Pretty rough going but seems to be the norm. Did I mention that electricity works about half time, limiting anesthesia machines and O2 supplies?

The hospital has an outpatient department, an operating theatre, an x-ray department, and clinical wards that provide services for women, men, maternity, pediatrics, nutrition, and male/female tuberculosis patients. I spent my first week on the female ward. This involved general medicine for hospitalized women but also includes going to the operating room for any identified conditions that require such. In one week’s time, I encountered and treated patients with HIV, malaria, sepsis, cirrhosis, congestive heart failure, bowel obstruction, pneumonia, kidney infection, tuberculosis, advanced cervical cancer in the immunosuppressed, and domestic violence-related knife wounds. In addition, I assisted in performing tubal ligations for women who desired sterility and performed quite a few uterine evacuations for women who had miscarriages and retained products of conception. Most patients have advanced disease and may have traveled many hours to get to the hospital. It was a challenging and rewarding clinical week to say the least.

This week, I have been on the pediatric ward and have witnessed a high degree of mortality—more than I had prepared myself for (I personally declared four children dead this week).  Rough estimates show that about 10% of kids under 5 yrs do not leave the hospital alive. This morning I rounded on 3 ward bays, which contain 4 beds each. The math should work out to 12 children, but when I finished, I had seen 62 children, with 4-5 per bed and many on the floors with their mothers. Most of these kids have severe malaria with anemia, interspersed among pneumonias, meningitis, malnutrition, HIV and various other conditions (hydrocephalus, abscesses, kidney disease). Transfusions are limited and IV treatments for malaria and sepsis are not always available, which means doing the best you can and hoping for some luck. Witnessing child death has been a particularly hard experience and it is very different culturally. The process is pronouncement and leave mother for 5-10 minutes. She is left alone and not comforted by hospital staff. After a short time, the child is unhooked from any IVs and the mother wraps the child on her back and there is a procession out of the ward. It is practice to have them buried very quickly.

It has been an incredible two weeks. I have so much appreciation for the health system we have at home and all the things I take for granted while supplying care. I have the pleasure of working with some fantastic colleagues here and I am impressed by the resilience of the Malawian people. There have been many successes among the tragedies mentioned above; I am seeing people get well and leave the hospital; and many of them have a nice smile for the crazy Azungu (white person) who helped take care of them. I’m having a great time.

And on top of all this cool work, I likely will have a chance to see elephants in the wild this weekend. Woo-hoo. 

I hope you are all well.  We are doing great.