Tuesday, 25 March 2008

No Guarantees

Dedicated readers have questioned our failure to dedicate any blog space to “what work is like”. Given that we are here to work, and spend about a third of our day on work, a little piece on work is entirely appropriate. Let’s visit Kilu’ufi Hospital (approximate pronunciation is “Kee-LOO-fee”)..

Our workplace is one of two hospitals in Malaita Province, the other, Ato’ifi, is over on the east coast, and I don’t know very much about it, other than that they had quite a long time without a doctor. Kilu’ufi Hospital is the major healthcare facility for Malaita. People from south Malaita, however, are sent directly to the National Referral Hospital in Honiara for logistical reasons (no roads, and the distance by boat is shorter than to come up the coast to Auki). Kilu’ufi has 127 beds (some of those belong to the national psychiatric unit), and an occupancy of about 90 each evening. There are four doctors who are all registrars, and must work without the support of consultants here. The wards are set up a little differently to what you might be used to: rather than having “co-ed” medical and surgical wards, there are instead the male and the female ward, loosely sub-divided into medical and surgical areas. There are also the maternity, children’s and isolation (tuberculosis) wards.

If you are a hospital worker, or perhaps a frequent visitor to such facilities, you may have noticed an increasing tendency towards “cheerful” décor, to the point of garishness at times. Also a feature of the modern hospital is the array of floor coverings: tiles, pavers, carpet, linoleum, and a host of non-slip surfaces. Not so at Kilu’ufi, where the scant budget dictates concrete indoors and out; it is exceptionally slippery when a brief downpour or a morning floor mopping is added. This is not to say that it is a concrete jungle – there are plenty of flower beds with pretty exotic blooms, and green, green lawns (with that tropical, broad-bladed, low-growing grass) – just that it did strike me initially as very dim and grey. The grounds are well-looked after, and received quite a makeover in the lead-up to the hospital’s 40th anniversary celebrations last year, with my favourite being the (okay, kind of kitsch) garden bed out the front that spells out in leafy green, “Kilu’ufi”.

Design features aside, this is a hospital in a developing country, and I think an appropriate motto would be “no guarantees”. Just about anything you would take for granted in a Western hospital is, here, either not available, or is on a tenuous supply. Need a blood test? The machine has broken, so there won’t be any results until further notice. Need an ultrasound? Sorry, the radiographer is on annual leave for six weeks. You child’s got meningitis? We don’t have the facilities to diagnose what bug is causing it. We probably wouldn’t have the antibiotics you need anyway, so we’ll give you the best we’ve got. Had a stroke? Maybe it was caused by atrial fibrillation (a heart rhythm disturbance) but we don’t have an ECG to check. Got a wound? It’s gauze, gauze or gauze for dressings, cut in lengths from a big roll in a very non-sterile manner, counted out on the nurse’s desk, and wrapped into paper parcels. Need a bandage to hold it all in place? There’s none on the ward, try the operating theatre, who suggest asking pharmacy. Pharmacy haven’t had any in stock for weeks. Don’t know when they might arrive.

I have seen parents, patients and relatives get angry over such trivial things in Western hospitals: a less-than-pristine bathroom, hospital food, the doctors being late on the ward round, a physiotherapist not performing treatment exactly the way they like, a wait for government funding for their mobility equipment, their favourite nurse being assigned to another patient. I wonder how long it would take for their attitudes to change in a place like this. Our children’s ward doesn’t have functional toilets, so the kids pee in the sink. Some taps in the maternity ward leak with such veracity that the staff have jammed a length of hose on the ends, and shut them off (mostly) with surgical clamps. The baby bathing sinks don’t work. Some of the ward bathroom areas don’t drain, and are constantly wet, scummy and slippery (arrgh, falls risk). The patients have to bring their own crockery and cutlery to hospital, and the food (every day) is rice, greens and a little bit of tinned tuna, maybe a slice of pawpaw if they need a special diet. There are only two or three nurses (not all RNs) looking after twenty-plus patients, and that’s providing everyone shows up for their shifts. People don’t have telephones to call in sick, or to get shifts covered, so it might be just one nurse for the ward that day. A patient is admitted with a neurological condition (undiagnosed) that has left her with lower limb paralysis, but we don’t have any wheelchairs to give out (although the village environment is not appropriate terrain anyway). Her daughter will have to keep lifting her on and off the floor where she sleeps.

There are a hundred frustrations every day, but there are rare and thrilling moments where we can help someone who wants to be helped, and make their life better. One was just last week, where Steve, Willie (Steve’s local trainee prosthetist) and I discovered the husband of our amputee patient had had a stroke recently. He was discharged from hospital with a pretty severe weakness of his right arm and leg. Steve and Willie rigged up a device (made from an old tyre inner tube) to help lift his foot, and almost instantly, he was able to walk by himself for the first time since his stroke. He is working on a therapy programme I’ve given him, and we will see him again at the end of this week.

Recently, I had a staff member come and see me with acute sciatica after injuring her back the previous evening. After about fifteen minutes, all her leg pain had gone, and she had only a little central back pain left. She was quite bewildered (and, to be honest, so was I!! As you know, I’m not a musculoskeletal physiotherapist, so it was very exciting to have someone respond so brilliantly, even better than the textbooks. It doesn’t usually happen here, as people abuse their spines in a very long-term way, and therefore take a long time to improve.) She has been doing her homework, and continues to recover well.

We hope you have enjoyed this short visit to our workplace, and will return soon.

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