Nkoaranga Hospital

Day one

Amanda and I have now spent two days at our new placement, Nkoaranga Hospital. In a few weeks I am hoping to get a few pictures of the inside of the buildings/rooms and some more of the hospital grounds because it is almost impossible to actually describe how foreign it is. If you have seen LOST, it looks a lot like where the “Others” live, but instead of proper building materials the hospital is all concrete and metal shingles. I wouldn’t have it any other way though, the locations and structure of the hospital adds to the overall experience we are having, plus it is Africa after all. If you have also seen Off The Map, it is a lot like that as well. And I am not exaggerating when I say it is in the middle of the African jungle. Amazing views. 

We were told no certain time to be there on our first day and decided to take our time getting there and to make it a sort of orientation day for us. We left the house around 9 AM and rode the Yellow dala to Manzini. From Manzini, we caught a green dala to Kilala which is a pretty long ride, at least 20-25 minutes. I had been to the hospital the weekend before on the coffee tour, but I was in a car and just knew the general direction of the village. We decided we could probably just wing it and find it ourselves so we told the dala conductor that we wanted to get off at Kilala and when we finally stopped it thankfully looked familiar to me. We thought the walk was about 1 mile, maybe a little more so we decided to just hike up to the village our first day. BAD IDEA. We will never do this again. It took us an hour and 15 minutes with one five minute break to finally make it to the hospital. 4.8 km ALL uphill. It was all uphill and again, not exaggerating, we walked so high up that our ears were popping from the altitude. Some people call the hospital Mt. Meru hospital because it is on one of the slopes of Mt. Meru. We went home and told everyone that we spent the day climbing Mt. Meru. The walk is absolutely gorgeous, all lush jungle scenery and in front of you and all around you, you see the tall slope of the mountain in front of you and all of the tended crops and huts of the villagers. 

When we finally got to Nkoaranga village we were so exhausted that we stopped by a small shop and bought some “Magi” or water from the Mama. We sat for about 10 minutes on a wooden bench while people stared at us wondering what we were doing there. The village is very remote and the only time they see Mzungus there is when they are going on the coffee tour or working at the hospital. When we walked up to the hospital, (you can’t really say IN TO the hospital because it isn’t an actual building), we weren’t sure who to talk to or where to even go. So we walked up to a random woman who was wearing a white lab coat and told her we were volunteer nurses and that it was out first day. She introduced us to another woman in a lab coat and she walked us to registration. They told us that the doctors were in a meeting and that we would have to sit and wait. This was around 10:30 AM. 

We saw another Mzungu who was wearing nursing scrubs and were instantly relieved that she could possibly be someone to show us the ropes and to at least speak our language. Her name is Tanya and she is a nurse from Belgium. She had finished her bachelor’s and knew she wanted to do overseas work so she even took a Tropical Medicine course and is next getting her Masters. To work with any medically abroad organization, you usually need this course. She is so amazing and well travelled. She is living the life that I would love to. This is her third time at the Nkoaranga hospital with her first trip being in 2008. She had a vision to start a pediatric ward at Nkoaranga and went home in 2008 raising awareness and money to make it happen. She arrived for her third time here in February and will we here until this coming February, a whole year. She has seen to building the pediatrics building and even hiring a man to paint murals on the outside and the inside. All we are waiting for is beds and then it will be officially open for business. She is such an inspiration to me and she has welcomed me to come and work with her in the ward as soon as it opens. I cannot wait. Third world pediatric nursing work... what more could I have wished for! 

On our first day on rounds with the doctor we saw multiple appendicitis cases, a young girl in her teens who swallowed poison, a uncontrolled diabetes case, infected wounds, possible internal bleeding with such a strong pulse visible in her throat and abdomen that it literally looked like it was going to rip her skin open, a few malaria patients, a woman with HIV that will probably pass away soon, and many more cases. 

After lunch we went in to the pharmacy with Tanya to help the ladies in there that were backed up with prescriptions to fill with a line of locals waiting outside the window. Medication is not controlled here and there is no system to it. All the bottles are just lined up on wooden shelves and when you need a medication you just grab the bottle, grab a spoon and start scooping out the pills with the spoon and your fingers and placing them into little plastic bags with instructions on when and how many to take. You take no record of the meds given out or anything.

On our way home that first day we were on the green dala dala and a guy got on and started speaking loudly, he kept saying “Mzungu” over and over again and the woman in front of us turned around and gave us an apologetic look. Before I could grasp what was going on the dala driver had pulled off the side of the road, walked around to the dala door, pulled the man out of the dala and they were throwing punches at each other. The dala driver walked back around to his side, got in the van and we drove off while the man was standing on the side of the road still yelling. I am not fluent but I am assuming the man got on, saw Amanda and I, didn’t like it and started complaining. The driver obviously didn’t like it. Five minutes later we got a flat tire and had to catch another dala after already paying for the first ride. The whole way home we were hollered at and called “Doctor, Doctor!”

Day Two

Day two at Nkoaranga was even more eventful. Crazy things always seem to happen when Amanda and I are together. It never fails. On our yellow dala ride there, we pulled over to pick up more people standing on the side of the road and a boda driver (motorcycle taxi) got into it with the dala donductor. Every time the conductor would try and open the door to let someone in the boda driver would slam it shut. This went on for about five minutes and made us nervous as they were arguing with each other, finally we drove away. Then, when we were on the green dala, there were only four of us still on the dala, instead of the usual 30, and they pulled off the main road and drove around the small village of Tengeru which is 5 minutes before Kilala. We started to get worried so I asked the conductor, “Kilala?” and he said yes. We drove around a parking lot, they exchanged some money with some guys in the lot and we were back on the main road and good to go.   

In the morning before the nurses go in to the wards and the doctors start rounds, we have church. It is a Lutheran hospital and the service is done by a woman priest? I do not know much about the Lutheran religion and I only could pick up every 6th word, but it felt so incredibly nice to be in a church and feel God’s spirit. The church is a concrete room with wooden pews. After her message we sang and it was one of the most beautiful sounds I have ever heard. All of the voices rising together in perfect harmony singing in a language so foreign to me but speaking to the same God, it was perfect. They even started to sing, “Nothing but the blood of Jesus” and I sang along in English. After church the nurses, doctors and assistants stay to report on any new admits that arrived overnight. After that anyone who needs to speak can. 

During rounds we saw a young man who was in a Boda accident and had bandages over 80% of his body and all over his arms. There was a man with TB and HIV who was in a room with 6 other sick people and refused to move to the TB ward so he is currently infecting everyone else in his room, including the young teen with chicken pox. Twice we went into this room and the boy with chicken pox was MIA... walking around the hospital grounds spreading his pox like an idiot. We tried to explain to the nurses that it was a respiratory condition and that he could infect others and we could end up having an outbreak and she just laughed it off. Tanya tried to explain that it was a pretty serious matter and that he needed to stay inside the room and it still didn’t sink in to her. There are vaccinations against the chicken pox here to protect people. During rounds someone came and took our doctor away. We found out shortly after that a young man was ran over by a large truck. The tire ran over him from chest to hip bone. Thankfully it had rained that morning so the ground was soft and he was saved from being severely injured by it. They placed him in the “ICU room” a room just like the others and started him on  fluids. They did an ultrasound and found no bleeding so they left him alone and wrote in the chart to redo the ultrasound in 6 hours. 6 HOURS! In the US... if someone was run over by a small semi... they would be in the ICU being checked every 15 minutes AT LEAST and hooked up to so many machines and medications that you probably couldn’t even recognize them. Not in Africa.

Next we were allowed to draw blood for Malaria testing and also made some blood smears for the laboratory. We walked around with a nurse aid while she attempted to change dressings. My 12 year old sister could do a better job at changing dressings than these people. It was absolutely insane the inadequate health care that was being given and I completely understood while all the people we were changing dressings on had infected wounds. There are no sterile gloves in our hospital, so she put on a pair of clean gloves removed the old gauze and tape, put on a new pair of gloves which is GREAT... and then cleaned the wound out but would wipe the wound and then wipe around the stomach collecting all kinds of dirt and grime from the skin and then run the gauze back over the wound. Once she was finished “cleaning” the wound she kept the same gloves on while she grabbed more gauze and spread it out, running her dirty gloves all over both sides of the gauze bandage before pacing it on the wound and taping it down. Amanda and I stood there glancing at each other to see if the other was as surprised as we were. It takes everything we every learned about clean technique, sterile technique and wound care and tears it to shreds. 

I was shown even more of the African medicine standards when we started med rounds. Each patient with an infection is given Amoxicillin, IV push. They give each patient 3 GRAMS of amoxil a day divided in three doses. ,Each dose is 1 gram or 1000 mg diluted in 8ml of saline solution. They they push the whole 8ml into the IV without a second thought. This is more than 2x the normal dose needed to treat a patient with infection. The get saline out of a bottle all you do is open a syringe and stan it through the plastic bottle and draw out however much you need and use the same syringe until you are finished with rounds. After med rounds for the hour you leave the syringes sticking in the saline bottles for the next medication round in 4-6 hours. At one time, Tanya picked up a bottle of saline and squeezed it a little on accident and saline started flying across the room, all we can do is laugh it off because everything is so foreign and bizaar. The hospital had no power outlets and what power it does have goes on and off 6 or 7 times within 30 minutes time. Needless to say there are only drip IV’s and no one even knows what a drop calculation is. They just set it at what looks good to them and let it roll. Nurses and aids are giving medications to patients without charting anything down, so when we go to give medications we do not know if that person even received their insulin earlier, etc. There were multiple patients that we couldn’t even find their med sheet because someone had lost it. The woman with uncontrolled diabetes had a 462 blood sugar and they forgot to give her insulin, and also forgot to follow up on her blood sugar level. 

There is ONE trash can in the whole main hospital ward and it sits by the nurses station.  To thrown anything away you have to leave a room, walk down whatever corridor you are in and throw it away. There are also only sharps containers by the station so you much carry around used syringes with you until you stop back by. Two sharps containers were sitting right by the trash can and a nurse walked up and threw an empty saline bottle with a syringe sticking in it right into the TRASH CAN, in stead of the sharps container. There are no sinks anywhere but in the bathrooms and the nurses station. There is no hand antiseptic inside of the rooms, people do not wash their hands and we have to carry around our own antiseptic if we want our hands to be clean. 

Payment for services is next to nonexistent and the hospital is in great debt to pharmacies and medical companies. Tanzanians receive free care for obstetric services, HIV, AIDS and TB testing and treatment. Also, children receive free care. But other people who cannot pay usually just disappear and the hospital eats the cost. There was a little girl who died not too long ago of full body burns who was in the hospital for three months. They could not give her any care other that pumping her with fluids and pain meds.. she passed away and her mother just left without saying a word. Three months of care unpaid for but you cannot turn away these children and people who need care. Sooner or later though the hospital may not be able to operate. When I asked, Tanya said they run out of medications and supplies all the time. 

I fully expected what I have been seeing but I could’t really grasp it until now. Nursing in a third world with no supplies or technologies... this is what it looks like and there is not much you can do to alter it or improve. I love every minute of it. 

 A group of German surgeons are coming this whole next week and will be performing pediatric orthopedic surgeries. I am interested to see what they think of how the hospital is run, but I hear from Tanya that it is a huge improvement from where it stood the last two times she visited. It is hard to believe. It would be great to have the pediatric ward open so the children coming in for surgery will have some place nice and comforting to stay. But Tanya does not think that we will receive the beds that soon. 

She told me that there is a palliative care outreach team from the hospital that goes to surrounding remote villages and that on Monday when I go in they would be more than happy to take me with them. She also told me that I need to take time to look at Malaria cells under the microscope in the lab and we have also been told we can stand in on whatever surgeries we wish to. Amanda saw two on Tuesday, but I was content outside of the main theater.