Our days in the hospital

It has been a good week. Roman and Canadian nurse , Sharmilla continue to be the extraordinary wound team at Kilema Hospital. They feel guilty now when they need to take a day off to go to town. The hospital we are working in functions reasonably well for minor ailments and women in labor but does not deal well with severely ill patients, especially children. We have no blood bank (families need to donate blood on theh spot for their loved one)and we cannot check kidney function, electrolytes or blood cultures. Writing an order on the chart and seeing it carried out can take hours even if a child is dying. I guess that is just the way things have always happened here. Human life is improtant but not seen in the same precious way that we see it in North America or in Western society in general but we are realizing that it is very difficult to change things with any significant speed. There is a definite resistance to trying new techniques and 'changing old ways'. It may be due to years (more like decades) of having only basic medicine and equipment available. Now that newer drugs are available (provided either by the Tanzanian health care system or by donations from various organizations), there is a reluctance to institute changes in care. I am not entirely sure why, there is certainly the feeling that we need to save things for a rainy day even if it means treating a burned child with inferior medicine or life threatening techniques (minus any pain control). I haven't quite grasped the whole situation yet but I am trying hard to understand it and make slow changes where I think they will take hold. There is a new computer here with satellite internet that is finally working but it needs to be locked up tight with only one of the nuns holding the key for fear it will get stolen. That will make my plan to teach the docs and clinical officers how to do a pubmed search somewhat difficult. I am trying to find a way to work around it. You often need to take the time to convince the powers that be that it was 'their' idea and then you can start to make new changes. The most iverwhelming issue we have in our hospital right now 9although the doctors assure me it is not new) is an epidemic of TB. The male medical ward has 8 out of 13 patients with TB and 4 of them have co-infection with HIV. Two of them are dying because they have stopped their antiretrovirals and chosen to be cured by a witch doctor. It hasn't worked. They have infected wives as well and several have infected children. We have a government funded 'TB coordinator' who I have not managed to meet or find yet. I asked this week how tracing of infected family members is done and they said it isn't as she is too busy with patients who come to be seen at the hospital clinic each weekday. The WHO advises that contact tracing be carried out for all potential contacts...this does not happen in our region. We just wait for them to appear at the hospital. HIV and its down stream effects seem to have taken over how i practice medicine here. Almost everyone I see needs testing or is already known to be infected. Getting people onto ARV's is difficult as they can be started but often run out of medication and don't get a refill because they cannot get to the clinic due to illness or family issues or distance. Stopping ARV's is good and bad as it can breed resistance...it is worse if they stop their anti-TB meds as well.
One positive is that the doctors and clinical officers that I make rounds with are very keen to learn (unlike the nursing staff)and seem to want to try to institute some of the suggestions I have made. The biggest (and most fixable) issue I see right now is that there is no running water in the pediatric ward (a nice looking broken sink) and moms (the dads are rarely around) who have babies with diarrhea cannot wash their hands easily. The families do all bathing and diaper changing of all patients (adults or children). If the sink does not work they need to go to the patient washroom area (and supply their own soap and towels) which is small and filthy and serves the whole hospital...you can see how disease gets spread...lets just say that Purell is my best friend! They are also expected to supply food if they can. Patients with no family are given millet porridge or maize porridge(ugali) and beans.
I have added picutres of a child receiving burn treatment (happy to say that Roman and Sharm pulled out the Flamazine that was locked in a cupboard for a year and the child has now gone home!), other pics of our soccer teams and some children at the nearby school.