The fact that the ward itself functions so well might surprise you if you were just looking at it from the outside. It is probably one of the most well organized places I have seen, but it appears to be mass chaos all the time. There is a main hallway where new patients come to be evaluated. Once they have checked in, they go to the triage room which is probably only 30 x 30 feet and crammed with at least a dozen beds. Oh yeah, I almost forgot my favorite part! Above the reception desk there is a giant lighted sign with red and green letters that run across, showing the names of the physicians and midwifes on duty and random information about what is going on during the day. It reminds me of a sign you would see flashing on Wallstreet or Times Square. It just stands out as a little odd when everything else on the ward is recorded on paper that is falling apart, basic medical supplies like gloves are constantly running out, and most communication is by directly speaking to the next person who will care for the patient.
If a women is determined to be in labor, she is brought to the labor and delivery room which is a giant room with around 30 beds. (Another fun change - ALL THE BEDS ARE NEW!!! At first I thought it was just this ward with new beds because I had left Infectious Disease with beds that were falling apart, half without mattresses, and some adult patients in pediatric sized beds. It turns out the hospital had a goal to get all new beds and they somehow managed to do it! So I checked the ID ward a couple of days ago, and sure enough, they have new beds, too! There are certain places - appropriately, one is next to the morgue, with hundreds of bed frames stacked as high as they can go. Hopefully they are getting rid of them and nobody will have to sleep on them again!) Back to the L&D beds - the 30 beds are almost always full. In fact, you know it is no longer a "slow" day when they women are on mats on the floor in addition to filling every bed.
Privacy is another resource in short supply. Above every bed there is a track where a curtain can hang, but most are rusted and bent so hanging a functional hospital curtain wouldn't work. However, somebody at some point donated whit shower curtains with yellow rubber duckies and blue bathtubs on them. When we are lucky, there is one hanging at the foot of every bed, but often there are some being washed and if you end up in that bed, you have even less privacy. It doesn't make a whole lot of difference though, because with the windows open all the time, the curtains are usually blowing all over the place and you have to hold them down so they aren't in your face during deliveries or while you go around as a team to assess the patients.
The privacy issue leads to another important point. NO VISITORS ALLOWED! That's right, none! Occasionally a female relative will be allowed to come in to look at a new baby if the mother has passed away or they really need a confirmation, but they are only allowed in for a few minutes. It makes sense that you can't have extra people around in a room without curtains and dozens of women in a lot of pain (also, no epidurals or even IV pain medications here! These women do it naturally and they are TOUGH). Without a relative to coach them through labor, a lot of women make it through the process just fine. Even in the few days I have been here, I am usually able to tell which women are having their first baby by how much they seem to be stressed (I mean, more than the normal stress of labor)
On the ward, there are usually only a couple of doctors and the rest of the work is done by nurses and midwifes. As long as a delivery is going smoothly, they handle the situation very well but the overall management and instructions are given by the doctor and his team. If a women is determined to need an "emergency" C-section, they are put on a list. There are two operating rooms and they are always full. One of the physicians told us that they have plenty of doctors - Mulago has over 45 people working at any given time who can do a C-section. The problem is space and tools. They have to wash everything. Often, they run out of tools before they run out of patients. As many of you may be able to attest with loved ones who have had emergency C-sections, there is usually very little time between the decision to use surgery and the arrival of the baby - on the order of minutes. Here, it might be hours depending on the number of other women in line and the determination of severity of the woman.
When a baby is born, they are assessed and then brought back to the mother. There is the equivalent of a neonatal ICU but it is packed full - there is barely room to set a baby down anywhere and there are just a few incubators and supplies to put in a breathing tube if necessary. So if a baby is doing well or having just a little bit of trouble, they get oxygen for a few minutes and maybe a little extra help breathing with a mask, but it doesn't last long because there are usually other babies that need it. (there is only one oxygen hook-up on the floor).
Surprisingly, there are lot of babies that do really well in this setting and most of them end up going home, relatively healthy, with their moms. There have already been some heartbreaking cases of women who had lost their babies or, rarely, women who have passed away in the process of delivery, but it is actually pretty rare for the complications to occur once they arrive in the hospital. The doctors and midwifes are really skilled at what they do and they are excellent managers of their patients and the ward.
I hope you got a bit of a picture of where I am. Obviously, I will NEVER bring a coverall near this ward, so maybe my words help a little. I will post again later about some really intense moments Pamela and I had without sharing too much of the patients' stories. For now, I will leave you with a picture from Sipi Falls. We went over the weekend for some great hiking and had a wonderful time meeting some other people from Minnesota. It was a welcome change from the busy-ness of the city!!
No comments:
Post a Comment