It’s almost the end of our first week at Mt Meru and it’s difficult to describe what it’s like here. If you’d like a detailed blow by blow of what our days have been like, Lindsay has been keeping track of our every move and everything we’ve seen in the hospital. However, in general, we’ve already seen a lot of pretty gnarly stuff in a matter of 3 days. We’ve seen an amputation, a packed gynecology ward, mom’s get up and WALK out of the labor ward just minutes after deliver a baby and even repairing a tear, and learned how to do a cervical exam.
Medical care is very different here. Patients are treated more like a machine than a person who has thoughts, feelings and can be hurt by what you’re doing to them. It’s a bit difficult to swallow, especially when they’re teaching us many of the same techniques and we have no way of communicating with the patient to tell them that we’re about to examine their cervix and that we’ll be as gentle as we can. I think that’s been the hardest part for me. We’ve had “talk before touch” pounded into us since day 1 of med school and when you can’t communicate with the patient or it’s through another person it makes it very difficult. So we’re working on our Swahili to learn some key phrases to let them know what we’re doing and to tell them to relax.
And for all of you mothers out there… remember what labor pains felt like? Contractions for hours, pushing sometimes for hours, often resorting to an epidural to ease the pain? Yeah, none of that exists here. The only medications that are given during pregnancy are penicillin if the water has broken, AZT if the patient is HIV positive and that’s pretty much it. If there’s a tear they’ll numb it with lidocaine before stitching it back up, but there’s not much in the way of comfort for a woman in labor. The labor ward is a long room split in two by the “administration area”. One side is for women who are having contractions and are dilated more than 4 cm and the other side is for when they actually give birth. There is no such thing as a birthing suite, no privacy and no husband present to hold your hand or wipe your brow while you push. Fortunately, these babies seem to be quite a bit smaller than what we’re used to. Pushing typically lasts only a few minutes and then it’s over. One woman that we saw give birth yesterday delivered so fast that no one even had time to glove up once we saw the baby crowning. Lindsay has already had the chance to basically deliver a baby herself and both that time and the other one I just mentioned we were standing on the delivery side watching something on one side only to turn around and see a baby’s head crowning and no one supervising.
It really is unbelievable here. Sterile technique seems to be a bit of a foreign concept and it’s somewhat relative given that windows are open and outside air is blowing in during an operation. Today was quite possibly one of the most grotesque injuries I’ve ever seen and may ever see. The Ob/Gyn ward was pretty slow and not much to do for the 3 of us so we wandered over to the operating theater when Dr Lee was to see what was going on. He was just finishing setting a cast on someone when we walked in. After waking up from anesthesia, the patient sat up, they wrapped his blankets back around him and then he WALKED out of the OT barefoot! I’m not even sure whether or not they opened up his arm, it may have just been setting it, but that ground in there is absolutely filthy!!
(This is the grotesque part so those with uneasy stomachs beware!!)
So then they put a new sheet over the operating table and wheeled in the next patient. As they transferred her to the operating table, her bandaged leg flopped around like gumby. When Dr Lee cut through and unwrapped the bandage, her entire shin was practically exposed and the tibia fractured all the way through. As Dr Lee tried to examine the foot, bone and muscle, the woman screamed in pain at every movement. They finally gave her some anesthetic (ketamine) and Dr Lee went to work chipped away at some of the bone to see what was still viable. After awhile, it became quite apparent that the entire lower portion of the tibia was dead and unsalvageable. Her options? Amputation, which would be the most sterile, or somehow using the fibula to become the main support of the leg. Although I’m not sure either option would ever allow her to walk again.
More than anything, the last few days have made me very grateful for what services we have in the states. It’s difficult for me to make a judgement about the way that they do things here even if I do think it is often not exactly sterile or seemingly barbaric. It’s really like taking a step back in time and I know that they do the best that they can with what they have. I’ve noticed that patients are responsible for purchasing a lot of their own materials. Women are required to bring in a couple pairs of surgical gloves and cotton gauze for their examinations. They have to purchase their own bandages. In some ways, it makes sense, but on the other hand, it’s very possible that a woman could be ready to give birth and there are no sterile gloves around if they’re out and the woman forgot to bring her own.
A lot of the supplies that we brought are disposable, such as suction bulbs to clear out the newborns’ mouths when they are born and sometimes that’s not a whole lot of use to them. The things that they need are things that can be sterilized and re-used.
When you step back and think about it, it’s heartbreaking to walk around and see what happens in the hospital every day. But regardless, these are patients that desperately need care and they do the best they can with what’s available.
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