Week 3 in Review

Week 3 was a good but short week. Since we were gone until Tuesday, I was only in the hospital 3 days this week. We will leave tomorrow (Saturday) morning for Mvuu camp in Liwonde National Park which is in the south of Malawi. We will just spend one night at Mvuu, and hopefully we will see a lot of the Malawi wildlife! It is nice that we are able to get away every weekend, because the pain and suffering that we see each day in the hospital can be very hard and emotionally taxing.

Ok, so I think I will use this week in review blog to highlight more of the differences between this hospital and the hospitals in the US since there are so many and I notice more and more everyday!

On the female ward that I am on there are typically about 78 patients (the "ward" is one large room), and for those 78 patients there are about 4 nurses! Needless to say the job of the nurses is way different here than it is in the US. Here the job of the nurse is mainly to give the patients their medications, to return lab results (which is really funny, because the nurse will just walk through the ward calling out patient's names until the patient responds! Apparently, HIPPA/patient privacy laws have not made their way to Queen Elizabeth's hospital yet!), and hand out food (a 500 ml BAG of milk-twice a day) to the patients. The medical students and interns put in catheters and chest tubes, do all of the blood draws, lumbar punctures (almost everyone that comes in to the ward gets a lumbar puncture...partly because most of the patients are that sick, but also because LPs are a cheap and a relatively easy way to find out what may be causing the decreased consciousness/infection/reason for sepsis...), biopsy lymph nodes, drain bellies that are full of fluid...the list of jobs that the medical students here do (often with no supervision) goes on and on. So different than in the US!
Labs here take forever to get back. A urine analysis takes a few days to return from the lab, and I've never actually seen anyone order a urine culture because that takes weeks. A patient's blood count may be from blood taken 2-3 days ago...so often a patient will be severely anemic and sitting in the ward for days, with no blood transfusion...oh and blood transfusions are few and far between. The other day a 3rd year medical student looked at a patients labs and commented that everything looked normal...when the registrar looked at the labs, she said...while a hemoglobin of 10 may be considered normal in Africa, if you go the US or the UK just remember that we would never look at 10 and think normal! I thought that was pretty funny! One day there was a patient here that had a hemoglobin of 2 and he sat like that for days until they finally got blood from the blood bank. In general, Malawians do not donate blood, so there is a serious blood shortage here.
If a patient needs to have a chest x-ray, the doctor writes an order and the next day the nurse will walk around the ward and tell the patient to walk down to x-ray on their our (or their guardian will help them walk if they are too sick), where he or she will wait in a long line until it is their turn for the x-ray. The chest x-ray will be taken, and then the hard copy of the x-ray will be given to the patient to carry back to the ward. Radiologists do not read the chest x-rays. Instead the attending/resident on service will read the chest x-ray. If it is a particularly tricky x-ray and the attending is not sure what to make of it, the attending will bring it to morning report or the interesting cases noon lecture and all of the medicine attendings will talk about the x-ray and hypothesize on what they think is going on in the x-ray. They may spend 15-20 minutes talking about one x-ray! Then, when the patient is discharged from the hospital the patient is given back the hard copy of the x-ray and it is the patient's responsibility to hold on to the x-ray and bring it back to the hospital the next time they are sick!
Echos on the medicine ward are done on Thursdays. So if someone comes on to the ward on Monday with suspected heart failure or heart valve dysfunction they have to wait until Thursday to have an echo of their heart.

The craziest thing happened to Shant yesterday. We generally all go to lunch at noon, so yesterday I went over to Shant's ward a little before noon to wait for him. He was just finishing up his last note when a woman came up to him and said "something is not right with my husband", Shant looked over at the husband and thought...oh my god, that man looks dead. That man had just been transferred (carried) from a floor bed (literally a bed on the floor) to a real bed because he was too "sick" to be on the floor. Shant went over and touched his hand and it was cold. The brother of the dead man started wailing and crying. The nurse that had just transferred the patient asked Shant what was the matter and he said, I think this man was transferred to this ward dead. Shant tried to listen to the heart, but their was no beat. He tried to look in the patient's eyes but they had rolled back in the patient's head. It was so shocking and sad because while Shant was trying to evaluate the patient his brother was screaming and crying.
Later I asked a medical student what do they normally do if a patient's heart stops beating, or they cannot breath, and the student looked at my very perplexed, and then answered, "well, usually we will hear the guardians start crying and that signals to us that something is wrong." I said, "In the US we do chest compressions, or what is called CPR", and he had no idea what I was talking about. He said, "a doctor has to make sure that that patient is actually dead, but why at that point would we try to bring them back to life?"...it was a very interesting conversation!

By the way, the dress I had made for me by the tailor is finally ready, and it is so cute! It took several alterations, but I cannot wait to wear it when I get home to the US (it is too short to wear here since it is cut above my knees and showing knee is a no-no). And, for all of those that have been wondering, the Malaria prophylaxis is going well so far. I take Malarone daily. The first week here was a little hard on all of our GI tracts, so I cannot blame the Malarone, and I have been fine since then. The tap water here is good and safe to drink.


Well, I should go. I will write again on Monday!