To care or not to care, that is the question…

IMG_0067Week 2 at Queens in Blantyre

This week I am working on an adult medical ward. I arrived at 7.30 to what I can only describe as a cacophony of noise and chaos. It quickly became apparent that there had been 2 deaths that morning and the grieving families were at the height of their distress. I duly followed the nurses onto the main ward, the night staff had already put one body onto a trolley (which remained in the middle of the ward) but the second was still lying in his bed. Hospitals here offer little or no privacy and minimal dignity whether for the living or the dead, there are no curtains to shield the rest of the ward from the sight of this young man being unceremoniously hoisted by three nurses onto a trolley. The two dead young men (one 29 the other 34) were then wheeled into the sluice (see the photo) to be ‘laid out’.  Following this we were off to the mortuary. This for me was a moving experience as all along the way people stopped and bowed their heads in respect, the family following behind in open and very vocal grief. I don’t think I will describe the mortuary here but I think in a country where death happens on a daily basis your attitude and behavior must inevitably adapt to cope. I on the other hand felt quite traumatized by the whole episode and was very glad of my friends and a glass of vodka when I got home!!!

Unlike the UK there are no bed managers here saying the ward is full, if a patient needs to be admitted you just put another mattress on the floor and off you go! Prisoners are simply chained to the nearest bed with the prison guards visiting twice a day to take then to the toilet and give them a drink. Hmmm, I don’t think this will catch on in the NHS.

Here in Malawi the ‘guardians’ care for the patients, they wash, feed collect medication, empty catheter bags, you name it they do it. With the nurse patient ratio as it is this is a system put in place out of necessity. However, sometimes the guardians need help and nurses here seem reluctant to offer that help, whether they feel it is just not their job I don’t know. Being a UK trained nurse where basic care is very definitely the domain of the nursing staff I was straight in there. Most nurses I know will describe the satisfaction of the transformation brought about to a patient following a bed bath and some TLC!! Just doing these simple things was quickly recognized by the guardians and patients who called me the ‘caring nurse’ and the ‘good mother’ both terms bringing a tear to my eye.

There are obviously some draw backs with the guardian programme here in Malawi but it also has huge benefits, some of which our struggling NHS might do well to take note of. It is commonplace in paediatrics for mothers to stay and care for their children I can clearly see the benefits of extending this to other areas such as elderly care for instance.

I spent the week working in the HDU part of the ward; this would be unrecognizable back in the UK. Resources are in such short supply that oxygen is shared between the patients. Being able to monitor your patient brings about its own challenges, with no ‘sats’ probe and no way of getting blood gasses analyzed how do you know if your patient is hypoxic?? With broken or no blood glucose monitoring equipment how do you know if your patient is hypoglycaemic?? Assessing renal function, well you can only do that if the family can pay!

The tenacity, dedication and sheer hard work of those working under these circumstances is amazing. Instead of losing heart it is a driver for creative thinking and I absolutely love it here.

Work aside Jo Vicky and myself were introduced to the joy that is DAPP. This is a huge second had clothes shop here in Blantyre, rummaging through the rails we found designer label skirts, blouses trousers shorts, each of us ending up with a carrier bag of clothes for MK900 (£1.20). How could I say no to Abercrombie and Fitch shorts for 20p!!! To top it all DAPP is a charitable organization and the money goes to good causes here in Malawi.

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Orientation or disorientation

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Paediatric A & E

Paediatric A & E

 

Theatre in paediatric A & E

Theatre in paediatric A & E

Orientation or disorientation

On arrival at Queens hospital Blantyre Jo, Vicky and myself waited nervously outside matron’s office for our month long timetable. Once in hand we were off to our respective departments. Vicky and I found ourselves in paediatric A & E. An enormous room with several smaller rooms off it. The sister gave us a brief tour and we were off. First stop triage, this is where the parents, predominantly mothers, brought their children to be assessed by a couple of nurses. The first thing that strikes you is the sheer number of children being brought in, the second is the quiet compliance. Not a single word of complaint from patient or parent. This all seemed a little ad hoc and Vicky and I found ourselves pointing out children that we felt a little concerned about. One of whom was nearly 3 and weighed less that 5.7 kg!! Malnutrition is a real problem and leads to many deaths. The nurses are trying to pick all these children up and they have quite a good screening programme.

Later that day we found ourselves in resus with a very poorly 2 day old. Very shortly after arrival the baby stopped breathing and I found myself assisting with resuscitation. He clearly needed to be ventilated but there were no beds and no equipment. It all seemed a little hopeless but to all of our surprise the baby was still alive the following morning. I was delighted that my A & E experience didn’t let me down but I have to be honest it is far removed from my work as a specialist nurse.

The following days have been spent on the paediatric unit and in particular in high dependency. On arrival Vicky and I just stood open mouthed and clearly in shock – nothing could have prepared us for what we saw. I have included some photos because whatever I say will not fully explain the chaos that confronted us. This large room was full of ‘cots’, wooden with only  4 inch sides, they had a mattress, no linen and up to 3 plus babies per cot. There were other mattresses on the floor where larger children were sleeping. All the families were with the children, including siblings which all added to the sense of chaos. Shortly after we arrived a woman in a uniform was barking instructions to the parents and they duly left the ward with sick children on their backs. Not a murmur of complaint! Two cleaners then came in and mopped the floor and wiped over the mattresses. Sounds good and this was done twice a day. However, the water was filthy and so was everything else in the ward. The cockroaches were running wild. It is very distressing seeing flies and cockroaches crawling all over sick babies in HDU!!

On our first day we saw two avoidable deaths of little children. It costs a lot of money for the children to go to the mortuary so the hospital lets the parents take the children home. The dead baby is strapped to the mothers back and off they set to catch the bus home!!! Bus drivers are not very happy about this and will kick the mothers off the bus if they find them so they try carefully to wrap the child up so as not to be noticed. Shocking barely covers it……

The Journey to Blantyre

 The day started at 5.30, quick shower and out the door – or so one would hope….. as Jo and I (we were sharing a room at the hotel) tried to open the door the handle fell off, no panic, call reception and they will let us out… the phone was dead, ok now time to panic!! With a stroke of luck, our neighbor and friend was just leaving her room hoping to catch us before we left. After a few shouts of ‘help’ the door was opened and our journey could begin.

 The coach was pure luxury, comfy seats, refreshments and a loo, something one of our colleague was delighted by, some of our ‘tummies’ were starting to struggle (enough said).

 It is a 4 to 5 hour journey from Lilongue to Blantrye, you cant get lost Malawi only has one road – the M1. The journey takes you through some pretty special scenery – mountain ranges, panoramic views, I am sure you can imagine. But the sights that remain with you long after the journey has finished are those of the poverty. Just at the roadside markets are set up, hundreds of people selling vegetable, repairing bicycles, sitting aimlessly or tending cattle it all sounds rather romantic but it isn’t, this is all carried out in complete squalor. The clothing is filthy and in shreds. It was very hard sitting in our lovely air-conditioned bus looking out on this.

 Once in Blantyre we found a great lodge to stay in. Jo, Vicky and myself (all three of us will be working as nurse or midwife trainers at various places in Malawi) all have separate rooms with our own loo and shower!! Another great thing about this place is good internet connection. Something I must make the most of! The photos are of my room at the lodge and the view from my room!Image

On the way!

ImageFinal packing done, last goodbyes said and I am on my way! Arriving at Heathrow airport I was met by three of the boys – Calum appeared to have organized everything including a journal with messages from my dear friends and all the boys, together with plenty of photos! He was wise enough not to present this to me until the last minute because it got the anticipated reaction – tears, lots of them!!

 

Two other volunteers that I had previously met at a VSO training session and already considered friends, were also at the airport and we managed to secure sitting together on the plane which made a long and rather tedious journey much more fun. The only thing mentioning about the flight was the woman sat at the back of the plane. She was being deported and had eight rows and two security guards all to herself! As it turns out no amount of space or security was going to help us as she proceeded to scream at the top of her lungs for 3 solid hours! Fellow passengers decided to help the fraught security guards to no avail in the end exhaustion won the day and she slept.

 

Arriving in Malawi we were greeted by VSO and taken to a hotel, the base for our week long in country training. With no time to even catch our breath sessions started followed by a party hosted by volunteers already in the country. It was great to meet everyone but after one beer I was to be found sound asleep on a sofa.

 

The week passed with some fun lectures and some not so. But health checks now done, bank accounts opened, registration with NMC started and essentials purchased. For me one of the most important aspects was the friendships that have already been made. These people together with volunteers already here are going to be my lifeline. Knowing you are not alone and that you have some support when times are tough is going to be vital.