half the battle

so many thoughts in my head now that we’re back at the hospital. it was interesting to make the transition from some vacation time (where you see fancy resorts and wealthy travelers) to working at mt meru, where the need is so great and you feel tremendously helpless. thursday was rough, we spent the day in casualties (again, what a terrible name for the ER dept, am I right?!) and there was never a dull moment. first thing we see is a guy come in with a huge cut on his face that they had sutured closed with massively thick sutures (for faces you should always use the very thin sutures). they work with what they have. The woman removed them with a scalpl, which looked so precarious I kept fearing she was going to cut right through his skin! not that it mattered, the wound was still completely open, hardly healed, and when the sloppy sutures were removed the skin just splayed apart and you could see the deep anatomy of the face. what. the. heck?! She put some gauze and tape over it and sent him away. That will be a disfiguring scar if he manages to avoid infection.

next was a guy post-draining of a huge abscess under his chin. he said it had been grapefruit sized and showed us with his hands. when they removed the bandage it actually looked really good, aside from the gaping hole larger than a quarter on the understand of his chin. here you could really see the muscles, fully exposed and partially eaten away from the infection. wild. thu and I were all up in it trying to see everything up close and the guy was a very good sport about it.

we had another man come in wearing handcuffs, apparently he is accused of theft but the trail is pending and in his statement he claimed that the police beat him. he showed the doc a swollen knee, ankle and side of his face. I always feel conflicted about these cases because until you really know the entire, true story, it’s hard to decide your opinion… we learned something interesting though, apparently the prisoners here who are given long sentences, if they behave well, are allowed some freedom (with restrictions of course) toward the end of the their sentence. as long as they are in their orange uniforms they are allowed to walk around. that’s the gist of what we understood, does explain why you see people in the orange prison uniforms wandering around unsupervised. not exactly comforting.

the one doc we were shadowing was very young, only 25, and he actually extremely immature. his feet would literally be kicked up on the window sill as he spoke to the patients, and I got the creeping feeling he was flirting with all of the young female patients. professionalism has a whole different meaning here, though I suppose with a salary so comparatively small, and facilities so poorly maintained and supplied, what do you expect? part of me gets angry and frustrated, can’t they see they’re part of the problem?! but part of me understands that they are not the ones at fault… conflicted, im often conflicted here.

I glance into the waiting room. it is packed. no obvious injuries at the moment… except… not another burned child. It is so sad, and far too common. this mtoto, so young and in such great pain, crying on a woman’s lap, holding his arm tenderly out from his body, almost his entire left side is covered in fresh burns. his dark skin is peeled fully off, exposing tender pink flesh that is weeping without the protective epidermal layer. I cannot imagine the pain. and to make matters worse the woman is trying to cover him, as if she is embarrassed, and the khanga against his raw skin makes him cry out in excruciating pain. I try to tell one of the nurses to instruct the woman not to touch his open wounds, she tries, and the khanga comes off for a moment, but then it is instinctively draped back over him and he cries yet louder. it hurts me to watch so much torment… this baby is brought in, I can hardly take my eyes off his suffering.

beside me a guy is removing a bloody bandage from his finger. he’s in a lot of pain too and keeps wincing as he tenderly unwraps the bandage. he finishes, revealing a smashed finger, the bone exposed and shattered, the fingernail almost completely detached, swollen and bleeding. I peel my eyes away in time to see a many carry in a young girl, she has a makeshift case around her leg, made of cardboard and cloth, a terrible break from the looks of it…

it goes on like this, until we’re exhausted and can’t take much more. fortunately, on this day dr. lee had told us that there would be a talk at 1 in the church, so we left just before then to meet him. a projector was set up, the small korean computer displayed the powerpoint created by one of the local docs. here’s a summary of what we learned. It’s a little outdated, but definitely interesting…

-life expectancy of tanzanians – M: 54, F: 56.
-they recommend 4+ antenatal visits, only 64% of women here make that (I think it’s lower based on what we’ve seen)
-only 46% of births are assisted by a skilled healthcare worker
-cesarean section rate is only 3% compared to the WHOs recommended 5-15%. a lot of women die from what is called CPD – cephalic-pelvic disproportion.
-only 1,311 sites throughout the country offer some sort of PMTCT services – preventing mother to child transmission. very important for HIV+ moms and those with certain STIs.
-postnatal care: only 13% of women were examined within 2 days of giving birth as is recommended for childhood immunizations and checking the mother
-only 20% of women use a family planning method (this is mostly the fault of the men, what they say goes)
-between 8,000 and 13,000 women die here each year in pregnancy related deaths.
-major causes of maternal death are HIV, hemorrhage, eclampsia, self-induced abortion, severe anemia, sepsis, complicated malaria…this list goes on and on.
-53% of women deliver outside of a healthcare facility. very dangerous for the mother.
-main reason is that it is too expensive (often they are responsible for buying their own supplies) and very far to get to a hospital (also costs money, need to wait for husband’s permission before they leave, no transportation options)
-other challenges faced by the women:
no money
high fertility rate (5.7 children per mother)
poor nutrition
inadequately trained staff and supplies (we were surprised he acknowledged this)
he definitely touched on the poor attitudes of the staff at the hospital saying that they do not take a humanistic approach to the care of their patients.
there is a big problem with inadequate management of obstetric emergencies, no protocol, not the proper training or supplies
so many reasons that maternal mortality is this high here

there are also delays in the care of the women:
-as I mentioned, she has to wait for her husbands approval to go to the hospital and often he is rarely home
-bad transport system – too expensive
-the theater is occupied or the doc isn’t in…

they need to work on standardized protocols for treatment of emergency situations.
the neonatal mortality rate is a whopping 32/1000 live births. this is through the roof!! absolutely unacceptable… and there has been no improvement over a decade. tragic.

even though im aware of a lot of these adversities, I’ve studied them in college, seen them firsthand here, it doesn’t take away from the shock factor when these facts are reiterated. it is frustrating, but at the same time a bit of a relief to know that one of the local docs is willing to acknowledge these statistics and issues. often it seems like everyone here turns a blind eye… admitting there’s a problem is half the battle, right? except that from what I’ve seen there’s a lot more than half the battle left to be fought….