15.03.2011
Nope, luckily not as a patient... The stomach pain is still there, but I didn’t want to miss this opportunity… Two girls from the house, Danish Sara and Maja, are doing their nursing internship at local Mawenzi hospital and got permission from the matron to show us around. The wards were separate small one story buildings joined together by a concrete walkway across the premises. Most entrances were crowded by waiting relatives. Sorry, no pictures allowed. Friendly word of advice: don’t read if you’re easily disgusted.
Psychiatric wards; male and female: Disturbing. Patients sat outside on the ground or inside on their beds. Some were asleep, others swung from side to side murmuring to themselves, some welcomed us happily, some were tied to bed and looked at the ceiling deliriously. The smell was awful. The lack of staff causes limited washing possibilities. A male patient took notice of us by shouting: “This is Africa! I am the King of Africa! Salute the King of Africa!” As we didn’t react in the way he wished we we’re escorted out of the ward by two pointed hands and threats to shoot us all in the head. Most patients don’t get any medicine, but the ones in danger to themselves or others are doped up to the extent of losing all function ability. Mental illnesses are still a taboo in Tanzania.
Surgical wards; male and female: Broken legs, burns etc. Beds covered the long hall-like room by the dozen on both sides. The nurses only get a limited amount of gloves for each week, thus only tasks involving a lot of blood deserve the use of protective gloves. Hands are washed in water poured from a container into a basin sort of like at a camping ground. There were few medicines in a wooden closet. The patient’s charts are often misplaced and sometimes even travel to other wards by accident. The bed sheets are changed daily, but more often than not there aren’t enough to go around. The nurses start at the closest end every morning, leaving the ones at the other end in dirty sheets for days. At female surgical ward there is a small side room where abortions are performed mostly by scraping. No pain killers are provided and crying is portrayed as a sign of unnecessary weakness. The room has nothing but a bed with stirrups for the feet and buckets on the floor, where the fetus is dropped and then thrown in the garbage. The smell was horrible. Small children were at the female surgical ward with mothers by their sides. These tiny patients don’t receive pain killers either which makes the daily cleaning of the burns and removal of clothing and other dirt from the body a very heartbreaking experience. A girl of about 2 had had hot oil fall on her body of which half was completely burned. She lay on her bed covered by a metal cage preventing anything from touching the healing flesh. Bandages are scarce so infection is very common. The wards are only so called surgical wards since the Tanzanian government closed a large number of surgeries about a year ago due to serious deficits and poor hygiene. When complications raise patients need to be transferred to the nearest surgery at KCMC hospital on the other end of town.
Medical wards; male and female: set up as the surgical wards, but treatment is provided for malaria, infections, hiv etc.
X-ray: People waited by the tens in the sun outside of the x-ray room. We weren’t allowed to enter, but Maja said most of them will have to wait the whole day. It was a positive surprise that the hospital has an x-ray machine. Apparently old, but it works.
Laboratory: Around forty to fifty people sitting or standing outside waiting for their test results. According to the nurses, in general, most come to get tested for HIV.
The morgue: In front a pickup truck waited covered by flowers and a cross on the hood of the car. The family of a deceased one was waiting for the body to be carried out so they could start the funeral proceedings. We went in through the back to where the bodies are stored in supposedly frozen temperatures on metal gurneys in iced boxes (like in CSI). Unfortunately the electricity often goes out so some of the bodies melt and freeze again repeatedly. We had reluctantly agreed to go into the morgue in the hopes of not actually having to see anything, but to our bad luck a body was wheeled in from the right at the same time as one was pulled out of the frozen box. Both were wrapped in dirty bed sheets. Tanzanians have memory services for the ones that have passed away for days at a time which seems more touching then a two hour coffee and cake function sitting around crying strangers.
Laundry room: Sara and Maja had talked about the sheets only getting washed in 40 degrees, but today for a happy surprise the machine tumbled at 60. Judging by the stained and bloody “clean” sheets hanging outside drying, hygienic is not a word I would use for anyone having to lie in them.
Maternity and labour ward: About ten soon-to-be mothers lied on beds in one big room, some sharing with one or two other women. No one had visitors and the nurses we’re nowhere to be seen. Birth in Tanzania is a quick process. The mother’s are admitted a bit before and discharged only a couple hours after giving birth! According to Maja and Sara no pain medication is given in this ward either. If something goes wrong during the birth transfer to another hospital is needed which decreases the babies chance of survival. If a baby doesn’t survive the birth, no empathy is given and the patient is expected to get on with life immediately. The second room of the maternity ward housed about six mothers and their newborn babies getting a demonstration on how to use diapers. In a few minutes they would all be on their feet on their way home with the newest addition to the family.
Neo-natal ward: We weren’t allowed to enter because of a high risk of infection, but a glance through the door was met by worried mothers. Babies with complications from or after birth are brought here. When the electricity goes out, this ward has the most challenges of keeping the little ones alive.
Pediatric ward: Malaria, worms, infections etc.
HIV clinic: They organize lectures on life with HIV on a weekly basis and have nurses available for advice. HIV is a huge taboo and many who get sick are shun by their family and community. HIV awareness has taken a huge step in Tanzania and people are terrified of the disease. Yet when I arranged for a group of Norwegians to come have a lesson about HIV at Mahabusu they weren’t allowed to show condoms to the group of 14-17 year olds as condoms are regarded as inappropriate and should only be known to adults.
In general: The nurses do their best with limited resources. In some cases the hospital provides one small meal per day. Most have to be fed by visiting relatives. Sara and Maja have helped a couple women financially who haven’t eaten for days or are stuck at the hospital because they can’t afford the bus fair home. Many times we felt that we saw too much as the nurses ushered us in, but no one seemed to be bothered by visitors. They don’t have any privacy in the wards either way. Many methods used are straight from the 60’s or 70’s and of course lack of resources provides additional obstacles. Sara and Maja are trying to educate in alternative ways whenever possible. Since going through updated research or case studies is pretty much pointless show and tell has proved to be the best.
