An African Hospital

 I live near a hospital, just across the bumpy dirt road from my house. The same bumpy dirt road that the pikipikis (motorbikes) use to transport patients. Imagine being in labor and traveling down a road that's horrible for a car, and then even worse on two wheels. But this is the way here, and without the pikipikis some folks would never get here at all.

 

Men's Ward at Berega Hospital
 

 This is a hospital with problems, like all hospitals, and like all hospitals everywhere, we have healthcare issues. But our problems are different. Sometimes there is not enough medicine, or not the medicine required. We have machines in our lab, but we don't always have the reagents to run the tests. Maybe if they had been able to zero in on Jackie's problem, he could have been helped. Maybe.

 Sion, a doctor from the UK, has been here for seven months, and has done incredible work, but it is taking a toll on him. This is not a preventive society. Prevention is a western idea, and a luxury here. So this man is trying to prevent in a place that knows only to react, and it's frustrating. I've been here a long time, so I know all about this, and my skin is thicker. But he gets up every day and soldiers on, and I have immense respect for him.

Nursing station

 We also had David and Anne visiting. They come here every year to help out. David is a pediatrician in his sixties, so he has a mountain of experience, and Sion is getting all he can from him. So that's my intro.

 Very early one morning they got a call from the orphanage to come immediately, one of the babies was in trouble. Triplets had been born ten days prior, and the mother died, so the girls went to the orphanage. This orphanage does a very good thing; babies come after a mom dies in childbirth, and Ute, the manager, keeps the them for two or three years, with family to help and visit. After those years, the babe goes home. Here in the villages, if a mom dies, it's a very real possibility that the child will also. So she keeps them 'til they are strong enough to live in this hard, hard place.

 Two of the girls were fine, eating and growing and lying there looking cute. The third was only one kilo, with some genitourinary issues I don't need to go into at this point. But she was looking bad, and not gaining weight. As I was going into Morogoro anyway, they asked if we could transport her and her caregiver Vienna to the hospital in Morogoro, to see a specialist. Hamna shida. I decided to stay until the baby was seen, as sometimes a very sick person can wait a long time to be evaluated.

 We arrived at the hospital, which looked ok to me: relatively clean, and happily not crowded. There were only about three of us in the under five waiting area, so we sat and waited.

Labor room at a local clinic near Berega

 Around this time an ambulance pulled up. So who has been to the circus? Remember how the tiny car drives into the ring and 9,000 clowns get out? Well, an ambulance arrived, a couple of guys jumped to the ground, dragging out a very ill man and threw him onto a gurney; limp, dirty and moaning. Then more men got out and dragged out yet another man, also unconscious, and threw him onto another gurney. Then a third. Vienna and I just looked at each other and wondered how many clowns were actually going to emerge from this ambulance. One more, as it turned out. Unfortunately there were no more gurneys so they just dragged him into the center of the ER and plopped him down. Then the clowns who could walk jumped into the ambulance and left.

 These guys were truly a mess. I was only able to get part of the story, as it was in Kiswahili, so I found an English speaker and she told me that these men had been put into a closed metal crate to be smuggled from Somalia to possibly South Africa. Apparently this is common. They go for work. But as it's illegal, they are transported this long way in a closed container. If there are problems on the road, or any delays, which are bound to happen here, they stay in the hot crate and suffocate, starve, dehydrate, or a combination thereof. This happens in America as well, but the Somalis are Mexicans, and the results are frequently the same. I asked what would happen to them. She said they would be treated, and those that lived would be sent back to Somalia, to try again. Somalia is a rough place; I wouldn't want to live there either.

Pharmacy and Cashier

 It was our turn to see the doctor/nurse; I wasn't sure which as no one introduced themselves or explained anything. This is typical in here, a patient sees a provider, they get medicine, and leave without knowing any more than they did when they came in. The baby had a temp, so I removed her wraps, which is not usually done here. Babies are wrapped here and the sicker they are, the more wraps they use. The intake nurse didn't try to stop me, to her credit, but the next nurse who came by told me to cover her, which I did not.

Dental clinic in Magubike

 To have a baby exposed to the air is a sign of bad mothering here, and I have to say, as a mom and an RN with many years experience, I felt the pressure to cover her. Strange that I can live in a culture long enough to feel like a bad mother for doing exactly what I am supposed to do.

 We made it into the ward, and there ensued a lengthy argument over the correct feeding schedule and amount to be fed. She is tube fed, and the doctor seemed to feel that the problem was that the feeding schedule was wrong, and the abdominal distention was due to gas. Personally, I was more concerned with her ragged breathing, her gray color, and her fever. She looked very bad. I've seen that look on many people; generally they are dying. It was also a concern that the doctor was doing the feeding calculations by counting on her fingers.

Dental tools

 The specialist arrived, and I left the hospital to do some business. I came back about an hour later and she was in a little crib in the same room as the baby warmers so it was very hot. She was on oxygen, but even grayer, with dark rings around her eyes, taking a gasping breath about every ten seconds. They had failed to insert an IV for fluids and meds, but that's no surprise, there wasn't much to her. They gave her antibiotics IM.

 Remember that she was pretty fresh from the womb, tightly packed in there with her sisters, and now lying naked in a crib with nobody near. It's been proven that any attention is better than none, and as a nurse I know an unconscious person can still hear and respond. So I leaned in and started to talk to her, mostly about nothing, and she did respond. Her breathing quickened, she moved her little chicken arms and legs. I did promise her that if she lived, I would pay her school fees, which could get expensive as there are three of them.

 Vienna had gone to get a soda, and when she returned I told her I was leaving and asked her to talk to the baby. She looked at me like I was crazy, but I explained and she agreed. That was Saturday, and on Sunday she was still alive. We hoped the meds would take hold and she could be stabilized. Her genitourinary issues would be dealt with when she was not so fragile.

 Her name was Emalie, and she died on Monday.

 Two more babies died over the next few days, here in Berega. If you consider that most hospitals are understaffed, poorly equipped, and too few to be readily available, then multiply that by the thousands of villages in this country, and in most countries in Africa, possibly you can see the depth of the problem. It's truly staggering, and depressing.


Clean water mural at Berega Hospital

 Sometimes what I write is depressing, but then, sometimes this place is depressing. But good things happen, right now some very good things. About two months ago, we painted part of the pediatrics ward and turned it into a play area for the kids who are well enough to use it. Then just a few weeks ago a volunteer arrived, named Ann, and she commissioned John to paint the hospital walls with information for the patients to read while they wait. One wall is about clean water, two are about nutrition, and currently the maternity wing is being painted with pictures of fetal development. So much of what happens here could be prevented if people just knew some simple facts. It's all very basic information, but that's where we are here. Basic.

Nutrition wall at Berega Hospital