Wednesday, January 21, 2015

Jan 08 - The Compound: Hospital Side

Jan 08 - The Compound: Hospital Side

Just through the gate that separates the hospital from residential parts of the compound is the garden, a place of brick paths, some of them unfinished or broken, some landscaping with flowering bushes or plants bunched together to resemble bushes, and a couple of young trees, that has spots of beauty, but that few patients or staff visit because it's not in the shade. By 9 o'clock, it's frequently too hot to seek comfort or peace by walking the paths, or resting on the couple of concrete benches which are through most of the day in direct sunlight. I didn't make note of the temperature too often, but I did notice, one afternoon, a thermometer in the shade reading 90 F°.

The right side of the compound is devoted to the hospital itself, which could then be further divided into the old buildings and the empty shells of the new buildings, which just sit with tired hope. The old buildings, the only ones really worth describing, consist of Administration with the Pharmacy, the Cashier, Dental and Lab; "The Bloc" which contains the Operating Room, Pre-Op, and storage; Pediatrics; Obstetrics which has the outdoor worship chapel/waiting area; and Patient Beds. In addition there are a few latrines and "The Garage" which is a storehouse for equipment, tools, diesel for the generators that power the whole compound (which are just behind the Garage), and bats.

Most patients wait outside under the trees to see medical personnel, and their family may wait with them. Some of them camp for days for a referral, or if they're surgery is delayed, or their treatment simply takes time. It is a constant minor medical refugee camp full of Gumbai, Nanjirai, Arabs, and the colorfully dressed Fulani who are further distinguished by their tattooed faces. Women wash clothes at the outdoor spigots, men wait expectantly talking to someone on their cell phone, children cry in their mothers' arms, someone might be sitting with the chaplain on the old hospital bed under the tree by the latrines.

The pharmacy and cashier windows are right next to each other, and there's always a crowd in front of each window. At either, you might present your fiche, your paperwork or your carnet, health booklet. The health booklet is a portable medical record that each person holds onto. It is crucial in the Chadian health system, so of course most people don't have one or tend to lose track of it. In it a doctor, physician or nurse will make notes of treatment, write a pharmacy scrip, record a consultation, make a referral, or write out a course of treatment for a patient to follow. They are glorified notepads, but you can't get certain treatment without an official Chadian carnet.

So you might see your doctor, and she'll write out a scrip in your carnet to take the cashier and pharmacy, but there's a little bit of a language barrier so you accidentally stand in line at the pharmacy waiting/pushing through the crowd to the front, and the pharmacy tells you to go to cashier first, then you wait/push through to cashier, pay what you hope is the fair amount (sometimes a problem …), then you're sent back to wait at pharmacy where they look at your scrip and tell you the hospital doesn't have any more of that medicine and to go back to the doctor. It is anyone's guess whether you will see the money you already paid for the medicine you never received. In addition there are tragically necessary signs around the hospital translated roughly as: "Pay ONLY the cashier; do not pay ANYONE else."

Down the hall from the pharmacy and cashier is the "dentist's" office. As previously mentioned, Zach, with no previous dentistry experience (his dentist father notwithstanding) is the local dentist. The only dental service the hospital currently offers is Zach looking into a mouth, and if a tooth (or teeth) is rotten it is pulled. Occasionally, he'll call over someone from the Bloc to do a quick local anesthetic, but not usually. Zach can also offer advice about dental care (which also features prominently in his public health lecture), but that's where his limits lie. Naomi serves as his assistant, providing suction—so "they don't choke on their own spit" as Charis puts it—and translation.

The Bloc will get described in greater detail when I write about the case I observed, in a blog entry I'll title "Barefoot in the OR" but it's a one bed Surgery (two if Drs. Danae and Bland decide they're behind and need to cram) with a Pre-Op where additional surgery might also occur if the hospital is slammed. Dr. Bland truly does the lion's share of the surgery, but Dr. Danae works there quite frequently sometimes alongside her father. Mason's at the head of the bed; first assist to the surgeon is often the Chadian doctor who lives on the compound, but Charlie the visiting resident has been taking turns there while he's here, and then there are three male nurses, including Jeremy: provider of the chicken.

The patient ward is best described in Mason's words: "unlit parking garages." Mason and Dr. Danae often have to fight to get the nurses to provide the necessary follow up care to surgery. There are no blankets for patients unless the family provides them. Other than to spend a moment praying at the foot of the bed of Jessica's first patient in Bere, I spent little time in the parking garage. Considering how the importance of prayer and that "visiting the sick" is one of the corporal works of mercy, I should have spent much more time there and in Pediatrics. I imagine and hope that on future trips, that will be my priority, but it took me until about the end of our trip to realize it's where I should be focused and that anything else was secondary.

Pediatrics may be more depressing for it is likewise dingy and dirty, but it is perhaps more obviously so with the dust and stains over someone's attempt to brighten the place with wall murals of smiling bees and flowers and happy clouds on blue skies, while flies buzz around the children's faces; and while the sounds of suffering adults is saddening, the sound of so many children in pain is heart-breaking. However, there may be more hope in the sight of a child recovering, even smiling, in Pediatrics. It was there that my most heartfelt prayers went out, and I've missed so many moments of grace by not spending more time there.

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