July 13 - The Hospital

Q.E.

July 13

The World Health Organisation lists 177 countries from first to last in order of quality of life as assessed by life expectancy, literacy, education and standard of living. This Human Development Index places Malawi in position number 164, making it the thirteenth worst country in the world to live in from a health perspective. The bottom 24 countries in this list are all African nations. Not a single mainland African country sits within the top 50.

Queen Elizabeth Central Hospital, or ‘Q.E.’ as it is known locally, is something to behold. An overcrowded, under-resourced sprawl of dilapidated single-storey buildings that grab you by the shirtfront and smack you straight between the eyes the minute you walk into the wards. Q.E. is like nothing Heth or I had ever seen before, let alone considered working in.

Liz, the Head of Paediatrics, picked us up on the Friday morning for a tour around the hospital, less than twenty four hours after being in the country. I wasn’t starting work until the next Monday, but this was a good opportunity to have a look at the conditions we would be working in for the coming year or more. Several weeks in I am so accustomed to everything at Q.E. that it hardly seems abnormal, yet that first stroll around the wards was one of the most truly memorable experiences we have had since arriving here, and that is not meant in a complimentary way.

The smell hits you first. Africa. It smells of Africa. Everything about the continent is condensed, boiled down into one all consuming, all powerful smell that literally knocks the breath out of you the first time you walk into the hospital. Body odour, unwashed clothes, dirtied nappies, flies and food scraps, and of course the unmistakable scent of death. Q.E. is like nothing I have ever smelled before. Within a day you are used to it, but for those first few minutes the smell is almost nauseating… not so much for the smell itself, but perhaps for what it represents, and the fact that I would be responsible for the multitudes of tiny lives with thin dark bodies and boggly white eyes in front of me in three days time.

The general conditions on the wards are what grab your attention next. Small African children littering countless numbers of square boxed cots, packed in two or three to a bed, their mothers or guardians (many don’t have mothers, such is the devastation of HIV/AIDS in this country) sitting forlornly at their side awaiting what feels like a palatable inevitability. The neonatal ‘Chatinkha Nursery’ is a chaotic jumble of makeshift wooden ‘hot boxes’ where newborns lie in their own excretions and wait helplessly to receive what little treatment there is available to them – mostly antibiotics, oxygen and anti-seizure drugs – and the temperature of the entire room stifles any sense of wellness, kept high rather than heating each individual crib, as that would require unobtainable resources.

Then comes Moyo House, the nutritional rehabilitation unit, the word itself meaning ‘health’ in Chichewa, the national language alongside English. This place doesn’t even draw vague parallels to the western world of medicine. It is a large barn-style room – exactly what you don’t want for keeping the warmth up to these desperately sick kids – lined with bed after bed of gaunt little skeletons of children who all gaze at you with the piercing stare that usually adorns the faces of television commercials pleading for aid from far away countries like Ethiopia or Sudan… or Malawi. Moyo House is the ward that most makes you feel as though you’ve stepped into a different world, a world where everything you take for granted is pushed aside, and the cold reality of desperate poverty is shoved straight in your face.

Passing through the Paediatric Nursery, for kids under 6 months, and the Medical Bay, for the ‘stable’ patients, comes the piece de resistance, the Paediatric Special Care Ward. For me this was initially the most confronting of the wards, with well over one hundred children squashed into two completely inadequate bays, their families sprawled in a mayhem that permeates every inch of floor space. This place redefines chaos, a chaos that should never have to be associated with a hospital… yet it’s simply the norm here. One or two nurses are completely engulfed by the commotion in this place, and there is little doubting that staffing is a major issue. They also have an isolation room here, for such diseases as rabies or cholera or measles… the ‘really’ infectious kids.
‘… and tuberculosis?’ I inquired, ignorantly.
‘Far too many to isolate them,’ countered Liz matter-of-factly, ‘they’re all in together.’

One week in and it all seems normal. The smell; the crowding; the lack of resources & nursing staff; the near nonchalance with which one meets disease in volumes simply unthinkable in the developed world. Strange, isn’t it, that a scene like this could ever even be contemplated as one which you simply accept as how you now practice medicine.