Through the Wards

Today I got to sleep in since it is Saturday and we did not go to the hospital until later. It is the first time that I have really gone through the wards and seen the patients who are staying at the hospital (before I had mostly been doing clinics, watching surgeries and seeing outpatients with Dr. Kajese). I went on rounds with Dr. Kabonzi (still can't spell but I'm guessing). I was really hit today by the fact that I am in rural Zimbabwe. The wards are divided by male, female, pedi, labor and delivery, postpartum and a NICU of sorts. We started in the NICU which really isn't a NICU, just a place where premature babies stay with their mothers. I have never seen a baby so small in my entire life. Then again in the States they would not let nursing students in where the premies were. The room was quite cold because they really have no way to keep it warm. The babies are wrapped up under lots of blankets to try and keep them warm enough. They are supposed to be fed every 2 hours but there is no clock in the room and the woman have no way to tell time and the nurses are often too busy to remind them so the babies are often not fed as frequently as they should be.

The pediatrics ward was heart-wrenching. This entire trip is life changing but I think one of those life changing moments happened in the pedi ward today. There were 12 beds and then more mattresses on the floor inbetween. Mothers are in bed with their children, most of whom are very small (<3 years old). There were 2 older children with terrible burns on their legs from hot water (accidental). Apparently that is very common. There were also a few who were malnourished and many who were dehydrated from gastroenteritis (also common here). All of these patients are in the same room, bed next to bed. Seeing young children with AIDS was so sad (that does not even begin to describe it). A boy had AIDS and TB which is a common combination here. They try and keep the TB patients separate from the other patients but it is nothing like in the U.S. There are no negative pressure rooms here, they simply try and keep the doors open for fresh air. (Even when we see patients in the exam room, patient privacy is compensated because the door must stay open for the protection of the doctor). When you walk in a room, there is no bottle of purell, no boxes of gloves in every size, sinks with soap in every room, face masks. There is nothing. Nurses do not feed their patients and wash them, it is up to the family members to take care of them in this way. Hospitals in the U.S. are really 5 star hotels compared to this.

In the mens ward there was a patient with a CD4 count of <1. A normal CD4 count in a healthy person is over 1,000. Patients here are treated for HIV/AIDS when their CD4 count is <350. With the medication, it is hoped to keep them around 500. I did not even know that it was possible to have a CD4 count so low. I had to ask the doctor, "you mean just the number 1?!" He said yes. I have also seen a few people with CD4 counts under 40 since I have been here.

All HIV/AIDS medication (ART treatment) and TB treatment are free here (the government pays for them, and they get many donations from global funds). Many of the patients do not want to be tested so by the time that they come in, their CD4 counts are very low, meaning they basically have no immunity. They often will need anti-TB meds first and ART cannot be started while they have active TB. The TB meds take 6 months and then ART will be started. If the patient is already on ART when they get TB then they will have to change their ART regimen because TB and the TB meds mess it up.

Many of the patients need xrays for different things such as injuries from carts crashing (I'm not sure what exactly they are called, unfortunately I still miss a lot of what is said because of accents and people are very soft spoken here.) and also they need xrays for TB. Xrays here cost $20 which is very expensive and most of these people cannot pay it. On a side note, U.S. money is used here because the Zimbabwean currency is worth nothing now. There are a lot of $2 bills here which is interesting (I remember thinking how cool finding one at home was when I was little). It really makes me think about all of the things I have wasted $20 on in my life.

We are done for the hospital for today but Dr. Kabonzi told the nurses to send someone to get me if there is a delivery and he told them that I am supposed to do the entire thing and even suture them up if needed. I laughed like ya right and he said you have to get your hands dirty while you are in Africa.