I got home from the “hospital” last Monday and cried for the rest of the night. It was by far my worst experience in Tanzania so far, but I cannot blame Africa. Really, I expected it would be like this, but seeing the extreme lack of health care right in front of my eyes was still shocking.
My phone charger was accidentally taken out of the country by a previous volunteer so Sunday night I had very little phone battery left and I was hoping it would stay alive long enough for the alarm to wake me up in the morning at 6:30. It didn’t. Luckily my internal alarm is so use to going to bed early and waking up early that I woke up at 7:05, too bad I am suppose to leave the house at 7:10. I jumped out of bed, threw on scrubs, brushed my teeth and ran out the door while throwing my hair up into a pony tail. No breakfast.
Amanda was still gone from the weekend so I was making the hour journey by myself. I got on two dala’s that were completely empty so it takes forever to get anywhere because they either sit until it fills up or they pull over to the side of the road every 45 seconds to pick someone else up. Our ride usually picks us up at the bottom of the mountain at 8:10. I already knew I was going to be late and would have texted Tanya to let her know to wait on me, but my phone was dead. So I got to the bottom of the mountain at 8:20 and like I figured, Tanya had already left.
I stood there contemplating whether or not I should take a boda boda (motorcycle) up to the hospital. I have always been against taking them due to the lack of road rules/driving lanes in Tanzania and the drivers are just plain kicha (crazy), even worse than the dala drivers, usually. But, I have become even more against taking them since starting at the hospital. We have had at least four people in the past three weeks come in from boda accidents. The road up the mountain is also narrow and very curvy. Oh, fun fact: when the bodas come down the mountain... they do not even start the engine but coast the whole 10 to 15 minutes down. Thankfully, when I was about to say yes to one of the 6 boda drivers surrounding me... a woman and man going up the mountain asked me if I would like to share a taxi with them. THANK YOU JESUS! I knew then that I would live at least one more afternoon.
When I finally got up to Nkoaranga, church had already started so I decided instead of walking in late (although late means nothing, everything and everyone is late in Africa, it is called “Mbongo time,” which really works out perfectly with my lifestyle) I would take the time to go to the bathroom. I then went to the nurses station and met Derek, one of the nurses who was just on his way to church, perfect.... I would end up walking in even later than before!
After church and morning report, we started rounds. The female side was mostly normal, the usual cases of malaria, dehydration, stomach parasites... etc. I cannot remember why but I left to go do something and when I came back I found the three “medical students,” Derek, Tanya, and the doctor all surrounding one of the eight beds in the room. The patient was a 40-something year old man and had come in a few days before following a stroke. When he came to the hospital he was sitting in a wheelchair and was responsive. When I walked in no one was doing anything and the man gasping out of his mouth while on nasal cannula. For those of you who do not know, this is a method of giving oxygen through the nose. It is NOT used for as extreme cases such as this man was in. I immediately looked down at the reading coming from the pule ox they were taking and it was 74%, normal is above 95%, and asked why this patient was not using an oxygen mask. I was told that someone went to find one. It was five minutes of watching this man gasp for air before the person came back with the mask. Like I said, Mbongo time. After putting the mask onto this man, his readings went up into the 80‘s. Still dangerously low.
Oxygen was not making its way through his body. His organs were shutting down. I was told his urine for the last 12 hours has been only 200 mL, this is extreme oliguria. His urine was blood red and extremely concentrated, this is an impossible amount considering he was receiving fluids. His pulse was 110 (which is high), and he was unresponsive, even to sternal rubs. Then things went downhill and he began to show Cheyne-Stokes respirations. This is almost always a sign of impending death. His periods of apnea were so long that I was counting 6 breaths per minute. During this whole time, all people were doing was trying to decided whether or not this man would make it alive to a different hospital if transferred. Tanya and I kept looking at each other and were in agreement that this man should not be transferred but that his family should be realistically told that he had little time left and to say goodbye. It is frustrating to have such a huge language barrier.
At this point the patient started gurgling on his own fluids so I asked why we were not trying to suction this man. Three minutes later an EXTREMELY archaic suction machine was brought in. I wish I could have taken a picture of it. It was a large contraption with two large glass cylinder bottles sitting in it. Both with old secretions from previous usage. They took off his oxygen and started to advance the tube down his throat, without hyper-oxygenating him first. This is unheard of! I asked Tanya whether or not the hospital owned Ambu bags. She said yes but no matter how many times she tried to tell them how to use them and when to use them, they wouldn’t listen. This man was already down to 5 breaths a minute and they just removed his only oxygen.. and shoved a barrier down his throat. The suction machine did not work.. this man was having organ failure and drowning in his own fluids and the suction machine did not work. No one was doing anything. The doctor was standing there just watching the man die. His apnea was longer and longer and Tanya kept asking the doctor whether he wanted drugs. “Do you want atropine or adrenaline? Do you want atropine or adrenaline?!” The doctor was in a daze. Finally he told her to bring both. When she got back from pharmacy I knew that the man was already gone but the doctor told her to push the atropine anyway. The doctor checked for a heart beat with his stethoscope, he couldn’t hear anything so he asked the “medical student” to listen. I didn’t understand why they looked confused, didn’t they know he was already gone? He wasn’t breathing. And hadn’t been in over three minutes.
This was a best case scenario. The hospital has no generator, so if the power had turned off... there would have been no oxygen, and no trying to suction. The man’s son had was standing and watching all of this while there were 7 other patients in the same room as well. Looking at this man realize his father had just died was the breaking point for me. No one had been explaining anything to him, for all he knew, the doctor still wanted to transfer him to another hospital. His IV was taken out and his son took a piece of cloth and positioned it under his chin, up around his ears and tied it in a knot at the top of his head. When I asked a local friend about the meaning of this they were confused and said that it is just something that has always been done.
The whole time this man was in the hospital, only his son was there. Not even 15 minutes after he passed away, 20+ people showed up to mourn him. I know it is a culture thing, but they were all silent just looking around until the last person got there and then they all started screaming and yelling and throwing their bodies on the ground at the same time. Women were rolling around on the floor in the hallway blocking all traffic. The sound of the women wailing was so incredibly loud.
A nurse and I went to the mortuary to find the man from the hospital who comes and collects the bodies. When we walked outside there were six dala dala’s parked in a grassy lot of the hospital and at least a hundred people were all dressed up, some of them in all white, hanging out in the area or laying on the grass waiting. Some of the women were singing. I was told that they were there to pick up a loved one to bury them.
I had been inside of the mortuary before while on the coffee tour. But when I was there, there was only one body in each filing cabinet. The cabinets were full, so when we waked inside there was a body laying on the ground in the corner of the mortuary with a sheet covering only half of his body. In the next room they were preparing the body for the family to take him away and the immediate family members were in the room watching. Later when I told Tanya about the body laying in the corner she said that the cabinets must be full of 9 bodies... apparently when there are too many deaths, they stack three bodies on top of each other in each cabinet.
The only good thing that happened last Monday, was that a little girl who Tanya had treated the year before from serious burns came back with her mother to visit Tanya because they heard that she was back at the hospital. She had been in the hospital at Nkoaranga for months, Tanya paid for all of her surgeries and skin grafts once she was transferred to a different hospital and even stayed the night with her for weeks. It was great to see the outcome one persons efforts. When you are here in the moment you do things blindly not knowing if it will benefit anyone or not. I know Tanya was feeling blessed that day seeing this little girl who had meant so much to her and who she had worked so hard to save, healthy and alive. You could see in her eyes and in her mother’s how grateful they were for her.
For the rest of the day we worked on getting the pediatrics wing ready for opening. Tanya and I treated mosquito nets with water from a coke bottle and little medication tablets and hung them to dry. The government approved for Tanya to receive four new nurses for her pediatrics unit and three of them showed up today at the hospital. It is so wonderful to see all of her three years of work and fundraising result in something so special as a pediatrics ward. It is her baby and I am honored to be a part of the opening. The beds are in place, the nets are hung, the nurses office is stocked and the floors are swept and mopped. We are ready for children!
The German medical group is finally here. They brought two surgeons, a physical therapist, anesthesiologist, two nurses and three students with them. This past weekend they screened over 150 children to review them for surgery. Maybe only half will receive it. The ones who need it the most. All of the surgeries are free. All of the beds in the pediatrics unit are full with children waiting for surgery. Surgery will start tomorrow!!!
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