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.