Almost older but definately not wiser yet!
on Rachael's VSO experience (Malawi), 12/Mar/2011 09:11, 34 days ago
More March!!So this week I spent some time in ETAT and it was definitely an experience! What I learnt about Malawi from ETAT: Malawian women don't believe in triage if the other woman's child is sick then she should have been worried enough to be at the hospital first! Malawian men have priority over everybody apparently! One dad walked in and said the doctor must see my child she has a cough and the thing is they did!! If Malawian women feel that people are pushing in or getting an unfair advantage they go proper mental, like hitting each other. (This was entirely unintentionally my fault) We have a security guard to keep the mothers in check outside ETAT!So ETAT is scary, well maybe not ETAT itself but parents here are scary. I've spent time in the Emergency Department in the UK and yeah parents start to get a bit annoyed if they've been waiting hours but they get annoyed at nurses not at each other.A basic guide to Malawian health care; the only GP's here are private and get a lot of money. This means if you want free treatment you come to the government hospital or one of the government clinics. So for example if you live 50 miles north of Mzuzu and your child is sick and you aren't rich you take them to your local clinic or local hospital, if you are lucky your local clinic opens at 7.30. If the clinic thinks they need some simple oral antibiotics they give them to you and you go home (I have simplified that a lot the actual process takes hours!!). If the clinic are worried about your child they refer you to the ETAT at the 'central' hospital, in Malawi there are three central hospitals, one in Blantyre, one in Lilongwe and one here in Mzuzu. MCH (Mzuzu Central hospital) has 3 ambulances and I have no idea who manages to get these ambulances but I suspect it costs!! So the parents have to make their own way normally. Now if you live near MCH and your child has woken up with a sore throat and you want some antibiotics you come to ETAT. Are you beginning to see the problem? Monday we saw 500 children in ETAT some with absolutely nothing wrong with them, some half dead. Parents normally start queuing from about 6am and once the main doors open they queue outside the ETAT room. Once the medical officer sees the child they can send them to pharmacy for drugs or get the nurse to take bloods or do a blood film to check for malaria parasites or they can admit the child. They very rarely send people home with nothing, parents here firmly believe antibiotics will cure everything! If the child is admitted the nurse in ETAT takes bloods and inserts an intravenous cannula the parents then walk the child to the ward along with the doctors admission notes. If they suspect malaria but the child is 'conscious' then we take bloods and a blood film and the parents take the child to the lab and then come back with results. When they return they start a separate 'lab' queue and are given more priority as they have already queued. Before they are seen by the doctor all the children are weighed and in theory their temperatures should be taken but when only 1 thermometer works apparently it is better for the doctor to check the temperature! Why would that be a problem I hear you cry?! Well when one of the triage signs is based on temperature it's a bit difficult to triage people when you can't take a temperature!!Simplistically in ETAT we give emergency treatment to: Airway or breathing; obstructions, cyanosis, severe respiratory distress Circulation; cold hands, CRT3secs, weak and fast pulse Coma and convulsions; coma, convulsing Severe dehydration; diarrhoea, lethargy, sunken eyes or reduced skin tugorPriority signs (move child to front of queue) Tiny baby Temperature Trauma/surgical condition Pallor Poisoning Pain Respiratory distress Restless Referral Malnutrition or oedema BurnsBut generally speaking triage is rubbish and needs a lot of work!! One of the biggest problems is with only one doctor it can take a long time to get through so many children.Not many children seem to be that sick really, there are a few febrile convulsions and seizures but once you've given PR diazepam they normally pick up. To be honest it was nice to have a break from death!!This week I finished ETAT and started in the nursery. The nursery is really nice and has surprised me so far. The previous volunteer spent a long time lobbying the hospital to allocate a nurse in the nursery as it is on the delivery unit and the mothers used to have to fend for themselves if the nurses were busy with deliveries. There is a nurse allocated to the nursery Mon-Fri and he is really interested and really keen! Very new out of training which I think really helps, he really cares about these babies and that is part of the battle won already. There are 8 cots in nursery A (clean room) and I think another 8 in nursery B (dirty room). Generally A is for very premature babies or babies needing phototherapy and nursery B is for children from outside normally with bronchiolitis, sepsis or surgical issues (mainly spinabifida which isn't repaired at birth here!) All the other babies are nursed in the post natal ward in the kangaroo unit. So in nursery A we have a set of 29week gestation twins, a 27week gestation baby two babies on phototherapy and two others who I think are 31/32 weeks gestation. The mothers are encouraged to breastfeed the babies if the babies can't suck they express into a cup and cup feed the babies. They are encouraged to do this every two hours. One of our babies was very apnoeic today so I spent some time trying to keep him breathing, after giving him some extra NG feed as I don't think he is feeding well and unfortunately we have no sticks for the glucometers (a very frequent occurrence here!) so I couldn't check his sugar so decided just to do it! He picked up a bit and started moving a bit more I then discussed with the nurse about putting him on phototherapy. The lab can't run LFT's at the moment so we can't check bilirubin levels but he looked yellow to me. It's hard to walk away at 5pm knowing that these kids might not be very well cared for over night, I made the nurse explain to the mother how to stimulate the baby if she doesn't think he is breathing. No one records the volume of feed the babies get so no one really knows whether the babies are feeding well or not. There is no ventilation here either the babies breathe or they don't, they give oxygen to babies with respiratory distress but 0.5L isn't providing much CPAP!Life in Malawi is interesting, I still manage to attract all the freaks and weirdos! Obviously very harmless but annoying, mainly guys trying to get me to buy crap from them like paintings. The guard tells me it's because I'm too nice to them but I've tried being rude and that didn't help either!! He told me to just ignore them and they'll soon get bored when they realise I won't give them money. It's hard tho because the paintings are nice but going to have to spend more money buying them from a proper shop as I don't want to encourage them. A guy stopped me the other day in ETAT to tell me he works for the red cross and they are looking for support in England!! very random.....Socially things are beginning to pick up for us you have to be quite persistent here before people realise you want to go out. People just presume that you'll be busy. So I have become like the annoying unpopular kid in school and text everyone every Friday to find out what's happening. We are going for a curry next Friday night, this is a big deal in Mzuzu as the curry house is quite an expensive place to eat. We are having a mixed Paddy's day/Rachael's birthday party!I walked into town again today mainly just for some exercise, it's hard to get much exercise here most of the vols wake up at 5am and go running or walking so I think I might have to start doing that. It's hard to do in the evenings as it's not safe really to walk in the dark and it's dark by 6pm. I normally finish work at 5 so sometimes I can squeeze a half hour walk in. I always take my head phones as it's nice to not feel like you are just directly ignoring people but you don't always feel like letting people practice their English on you!The other interesting thing is everyone is desperate to get me to church, maybe I show that I need some kind of salvation... if only they knew!!!! One of the nurses at work is desperate to get me to her CCAP church (Christian church of African Presbyterian's) our tumbuka teacher wants us to go to her church to a tumbuka ceremony. She also weirdly invited herself to my wedding! She obviously knows something I don't, she decided it would be too expensive to fly to the UK though so sadly she can't make it!! In some ways I am curious and it seems like a good way to integrate into the local community but on the other hand I'm an atheist and feel weird about going to church when it's something I don't believe in. I've been invited to go on Sunday so next week I may have an insight to church in Malawi.