Woe to the patient who is unattended

Third world hospitals rely on relatives to care for and feed the patients.  As a result staff from Cornerstone have to be delegated to remain with our children.  I recently spent a week at the bedside of one of our children who was admitted to hospital with appendicitis.  I am not sure if I am the first ever white person to care for a patient in Nimule Hospital, but I was certainly a cause of some surprise.

Nimule Hospital is run by Save the Children, an internationally respected charity.  On a banner outside the hospital are a large numbers of logos from other aid foundations and governments, including the UK.  In spite of this apparent support, I suspect that it is similar to many hospitals in the third world.  As I know from previous experience, there is no x-ray machine and no specialisms apart from HIV/AIDS.  There are only two doctors, both non-specialist.  The doctors also act as surgeons.  There are very few nurses.  The ward we stayed on has three shifts of only one nurse at a time.  The nurse is responsible for more than one ward. 

Standards of hygiene are poor.  Each ward has an allocated latrine, which is kept padlocked.  At one point while we were staying there, the key was mislaid and nobody was able to use the latrine at all.  Some were forced to squat at the edge of the compound.  Fortunately as Cornerstone is very close by, I was able to walk back and use the toilet there.  Even when the latrine is operational, it is filthy.  There are no hand-washing facilities, or even water.  Family members prepare food squatting outside.  We took turns to go back to Cornerstone to shower, change our clothes and fetch food.  We sponge-washed our patient on the ward.

I am told that the hospital was originally composed of tents.  Now, it has improved to the extent that the wards are made of metal, with boards of wood on the outside and corrugated iron roofs.  As a result they are unbearably hot during the majority of the day.  Trees are planted outside, with some stone benches and space for mats to sit or lie on.  There are more than 20 beds on the ward where we stayed, but six of them were out of use as they had no mattresses or mosquito nets.  Relatives sleep either on vacant beds, on mats on the floor or two to a bed with the patient.  As it is a women’s ward, most patients had a baby with them. 

The next door ward is a feeding centre for malnourished children.  The children were pathetic to watch, sipping their porridge.  They were often unable to finish it, so their mothers drank the remainder.

As the week went by, injured children started to take up beds in our ward, as the paediatric ward was completely full.  Some of these children’s parents were very lacking in caring skills.  My heart bled for two little children, one severely burnt and the other with a fractured leg.  As the children howled in agony, their mothers simply sat and said, ‘khalas’ (Arabic for ‘enough’).  No attempts at distraction or any signs of love at all.  I am sure this is symptomatic of the brutalisation of South Sudanese society by the traumas of decades of war.  I have been told before now how parents don’t dare to get too close to their children for fear of the hurt of losing them.

The nights were very difficult, although by the end of the week I was becoming acclimatised.  The electricity comes on at dusk and is not switched off until the morning, so we had to sleep with bright lights blazing.  There is no concept of privacy.  Some families chatted and laughed all night, as babies and injured children cried.  Some families came complete with menfolk, so it was difficult to undress.

One day, as we were sitting outside in the shade, I noticed some smoke next to the wall of our ward.  I went to investigate and found that the electric cable running from the ward to the operating theatre was on fire.  I sent one of our older children, who was visiting, running for help.  A man came with an extinguisher.  Thankfully not too much damage was done, but it could have been serious.

Our child had had appendicitis twice before.  On both previous occasions she was simply sent home with medication.  This time however, the hospital decided to operate.

The first thing that went wrong was that the member of staff who was with her before I came on duty, made the mistake of giving her a drink of tea when she was supposed to be ‘nil by mouth’.  That caused the operation to be postponed by 24 hours.  In the meantime the poor girl was on a glucose drip to keep her going.  Her veins kept collapsing so that she suffered many hours of pricking with needles in attempts to find fresh veins.  She is not a stoical child, so the whole experience was difficult for everyone concerned.

Finally we got to the operating theatre.  After about an hour a nurse came out and told me that they had no general anaesthetic.  She asked me to buy some.  I phoned our clinic, who fortunately had some in stock.  They rushed it over to us.

When our child came out of the theatre, it was our job as ‘family’ to wheel the heavy stretcher trolley to the ward, across very bumpy unpaved ground.  I thanked Heaven that she was unconscious.  Hospital porters have not been invented yet.

Back on the ward, the nurse brought us the news that the medical store was unmanned as the store keeper was ‘not around’.  Apparently he had been gone for days.  Therefore Cornerstone would need to provide all her medications.  To continue the theme of my previous post, what a blessing that we have our own clinic.  Pity those who can’t afford the drugs or haven’t the manpower to get them.

Later that day, the doctor called me to speak to him.  He told me that our girl’s appendix was in too bad a state to operate.  It had fused with bladder, bowel and intestines due to hardened pus.  The doctor had not been able to remove it without damaging other organs.  He therefore cleaned and applied antibiotics before closing the incision.  She will need another operation after a course of antibiotics.  Poor girl. 

In the meantime she came to in a delusional and unfocused state.  Twenty of her friends from Cornerstone had arrived, eager to see her.  She looked at them and said, ‘Who are all these people?’  The children at the home all see themselves as brothers and sisters, so they were very hurt.  Some cried. 

Fortunately she improved steadily from the next day and was discharged a week after the operation. 

I suspect that all African hospitals are like Nimule Hospital to some degree, hence the huge difficulties faced in countries with the Ebola epidemic.  Let us hope Ebola doesn’t reach us.  I don’t think Nimule Hospital has the capacity for an emergency of that type.