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NOVEMBER 18, 2007

An African Hospital



My two main fears in coming to Africa were contracting a serious disease, and visiting an African Hospital where the risk of the first happening was a distinct possibility. Unfortunately after arriving in Axum after three days on the road my condition deteriorated and by 4:30 in the afternoon I was shivering in bed with a temperature pushing 38 degrees.

Donna and I made our way to the local clinic where the Doctor on duty was quick to see us, took the usual readings including a blood test etc and sent us home with the view to us taking some aspirin and seeing how things were in the morning - he suspected Malaria but with the tests being inconclusive could not be sure.

Now most of you think Donna is a pretty nice person (at least I think you do), well she was darn right mean to me that night, While I was lying there shivering she would not let me cover up at all, here I was freezing cold and it took me four hours just to get her to let me cover myself with a sheet - blankets were not even worth discussing...

Unfortunately I also spent most of the night in the smallest room in the house as every time I drank water it would - well you know the drill...

By morning my temperature was steady at 39 degrees, my head was throbbing, my skin was sore to touch, I was feverish and not in very good shape at all. Donna rang the doctor from yesterday who agreed to see us down at the local hospital. Donna had been speaking to the management at the Africa Hotel who were kind enough to organise a mini van to run us the short distance to the hospital

After filling in the suitable documentation we then had to sit in an open courtyard for a good half hour waiting for a doctor - as I deteriorated even further Donna finally got up and asked around until she found a doctor to see me.

On entering the doctor's room I basically plonked myself on the bed in a shivering mess while Donna went though the formalities. After about ten minutes of consultation it was decided I would be admitted to hospital immediately and put on an IV drip to treat Malaria.

Now do not be thinking this is one of those fancy western hospitals you have all been to - this is Africa my friends and things run a little differently here. First of all we were walked to the far end of the hospital where Donna had to pay a deposit to cover all expenses for my stay. Again I just sat in the corner while she filled in the forms and handed over the cash.

Next I was walked to the ward where we met the head nurse (aka the "Pink Lady") who took me to my room - thankfully I was given a room to myself (although it had six beds in it. The ward contained eight rooms of six beds each.

Let me describe for you a little about the hospital - I do not want to be dissing it or anything because they looked after me superbly - however it needs to be said.

First of all the rooms - the six beds were all just mattresses with a pillow under the mattress for some head support on a basic steel frame. When I arrived I was given a sheet and a single blanket for the bed - for most other patients it looked as if they brought their own blankets. There was a hand basin at one end of the room but it did not work. Otherwise the room was bare. There were no dividers, nothing to provide any privacy.

There was a single toilet for the whole ward - when I say toilet I mean squat hole - it did not flush, there was no where to wash your hands and it was constantly flooded with water from the nurses trying to keep it clean. Thankfully we brought our own 'soft' (toilet paper).

Once the bed had been made I quickly laid down before passing out - by now I was not just a quivering mess - but was very weak and faint as well. Unfortunately the hospital did not have much in the way of drugs on hand so Donna had to take the doctors prescription down to the Red Cross to get the necessary medicines - she returned with a huge box full of IV solution, vials of antibiotics, quinine and all other manner of medicines.

On her return she was slightly shocked to see the room filled with nurses - it must have been student day or something because she counted 22 nurses standing around my bed.

Not only was it student day - but it was their chance to get practical as well - I had at least four nurses working on getting the first IV drip into my arm - on my previous encounters with drips the needle has been rather short, say 15mm, in this case the needle was a good 2-3 inches long. On their first attempt they managed to rupture the vein, and after a good deal of pushing and yanking (to much pain) a senior nurse took over reinserting the needle further down the arm and applying a good deal of tape to the area to staunch the bleeding.

A short while later I had my first humiliating experience. The stand the drip was on had no wheels and was made from heavy steel. Unable to lug this down the corridor to the toilet I had to have Donna carry it for me. By the time I made it to the toilet I was completely exhausted and barely able to stand. Unfortunately for Donna, with no where to hang the bag she was forced to stand with me for a few very uncomfortable minutes. Getting back to the room we were both nearly ready to pass out and a male nurse had to take over form Donna to get me back into bed.

By now the nurses were a little worried about my hydration or lack thereof - seeing me lying in bed quivering they looked a little on the nervous side to say the least. When the senior nurse arrived (no Doctor today - the Doctor only does rounds once a day in the morning and we missed that) she quickly told them to stick a second IV in my left arm, this one went in without a hitch and before you knew it there I was, pretty much out to it.

The afternoon ticked by without major incident, as evening came around Donna ducked back to the hotel to have a bite to eat and pick up some blankets etc. I could not manage to eat anything despite the nurses persistence. I did manage a few mouthfuls of oral re-hydration salts (ORS) - however this just caused me to throw up - bring on the second humiliating experience.

With Donna out of the hospital I was in desperate need to - well go. A male nurse carried my IV bags into the toilet - however as soon as I entered the room the salty ORS had there way and I threw up all over the squat toilet. Before I could even think about what was happening I had dropped my dacks and completed what I had set out to do.

The students were gone by now but their impact was still felt. I had managed to work out a method of using the bed pan on my own, and with Donna on guard by the door (a faranji in hospital is a rare thing and I had a constant parade of locals filing past the door for a look see) I was mid way through the business when I noticed the student inserted IV needle leaking blood down onto my hand and IV fluid dripping onto the floor - this was panic stations for me and I could barely pull my dacks up before the nurses rushed back in to patch me up and get the drip working again.

Evening came and the lights were turned out - I had managed to find a semi comfortable position which is actually pretty difficult with two plastic pipes plugged into your arms by three inch needles. I was half dozing when I felt a strange sensation in my left arm where the drip was attached. There was little light in the room, however looking at the IV pipe it looked to be very dark, rather than the normal clear colour, panicking I called out to Donna who was in the next bed who quickly turned on the lights to reveal that my blood had backed up the tube nearly all the way to the IV bag. A nurse was called and although she tried to pump the blood back into my body in the end she had to call it a lost cause, change the pipes and hope for the best.

The remainder of the first evening was relatively uneventful other than by morning my fever had broken and the Malarial symptoms were slowly subsiding.

I spent all of the next day wiling away the hours, watching the saline drips fall out of the bag into the tube, listening to some tunes and entertaining the constant stream of student nurses and well wishers (I had attracted quite a following). The doctor finally managed to see me on his rounds - he whisked into the room with the 20 or so students trailing him, looked at my chart - asked if I was ok and then went on to more important cases.

With my medical supplies running low, and with fresh prescriptions from the Doctor - Donna was again forced to trek down the street to the Red Cross to re supply my IV needs.

Feeling a hell of a lot better in body and mind - I actually started to feel guilty about taking up valuable doctor and nurse time, as well as a whole room in their hospital - with so many sick people next door to me. And by sick I mean really sick - Africa sick, think as bad as you can get and they were lying in the room next to mine coughing up a lung during the night or wailing in pain during the early hours of the morning - for my own sanity I had to get out of this place.

That night Donna brought in a couple of bowls of food from the Africa Hotel which went down a treat. I was now in no mood to be hanging around in a hospital and was constantly asking to be released - drip or no drip. Which nearly came to fruition when first of all my right forearm started swelling, by the time I noticed it was almost popeye-esk. The nurses were forced to pull the pin on that IV and persist with just the left arm for the remainder of my stay. The second incident was shortly after we had eaten and were settling in for the evening. All of a sudden the power went out in the whole hospital and we were plunged into darkness.

Now I am not afraid of the dark and neither is Donna, we had eaten and were quite comfortable. None of the equipment in our room was powered by electricity so we calmly sat back talking for the half hour the power was out. Finally the maintenance men got around to plugging in the generator and we were given the gift of light again - luckily we were ok because no one checked on us the whole time he power was out. The thought did cross my mind however that with the lights out it would be a prefect time to sneak out the back window.

It seems at this hospital families are a critical part of the care system. Almost all of the patients had family members sleeping either in the same bed or working in shifts to look after their kin. The nurses would never empty the bed pans (and I would not want to either) expecting family members to do so. When Donna advised the nurse she was heading home for the evening to get some sleep the nurse looked positively sour. To be honest if you were in this hospital on your own - I do not know how you would go about getting medicine or looking after yourself - without Donna's help this would possibly have ended my Africa trip.

That night I was in pretty good spirits - it seemed I had beaten the Malaria thanks to copious quantities of anti-biotic's and Quinine, and I was positive I could wrangle my way out of hospital at the latest by the end of the next day. A few tabs of Paracetamol taken every few hours managed to kill the headaches - and with a bottle of life giving Coke on the side table (thanks for sneaking that in Donna) what else could a man want.

One thing that constantly amazes me in Africa is the lack of education in supposedly educated people. I am lying in hospital, admitted with a severe case of Malaria, when we see numerous mosquito's flying around room. Donna valiantly tried to kill a few but their numbers were to great for even her. Finally she resorted to asking the nurses if they had any spray (there were no nets in the rooms). She was curtly told by the night nurses that to get rid of the mosquito's all you had to do was turn off the lights! But guess what - they were right, when Donna did finally turn off the lights I could see any mozzies at all!!!!

The night nurses were definitely a moody bunch - their plan was simple, get everyone tucked into bed by eight o'clock and then kip down in the nurses station. I am a bit of a night owl and with Donna waiting till 11 for a ride back to the hotel (not wanting to walk Axum's back streets at night alone) they were positively edgy. When Donna finally did leave their final task was to change my IV bag for the night. It had a good 200 ml's left but this did not persuade them. First they came in and cranked it up a few notches. Then they came and prepared the new bag, with this done they disappeared for a good half hour before returning to check on the drip. They were so bored they even emptied the bed pan without being asked. They came and filled the new IV bag with the additional drugs, and finally in a fit of frustration changed the bag without waiting for the final fluids to pass through - with a huge smile I was bade good night...

The hospital was extremely poorly supplied and the Doctors and Nurses were doing a fantastic job short of staff, massive numbers of patients, and sub standard facilities. The ward had no running water, and no shower to speak of. Donna, bless her cotton socks, had the foresight to bring in some soap, a face washer and a towel. After a refreshing wash, some clean clothes, capped off with a fresh breakfast of omelet and a drink of water I was positively beaming.

When "Hoppy", the ever cheerful day nurse came to change my IV bag in the morning I told her not to worry and that I was going home. She looked positively confused so in a poor attempt at pigeon English I explained that according to the chart at the end of the bed my vital signs had all returned to normal, and that I would take Quantum (a tablet Anti-Malarial cure) instead of the drip now. It must have been my positive attitude and the fresh smell of soap because, slightly confused she left the room, then returned a few minutes later and looked at the replacement IV bag, then left again and returned ten minutes later - Doctor in tow.

Every time I saw a Doctor in Axum it was a different person, my final MD was the best of the bunch, he gave me a detailed once over - went over the chart and accompanying folder covering my treatment. Then after chatting about social things with Donna for around ten minutes agreed to discharge me then and there. I was a little surprised at the suddenness of the decision thinking at least he would want me to stay for the remainder of the day to take in more Quinine. Not to be and before I knew it Hoppy was pulling the tape off my arm and laughing as I winced every time she took out a chunk of arm hair.

Other than a quick run past the pharmacy to stock up on drugs, so ends my adventures at St Mary's Hospital Axum. I spent the next two days recovering at the Africa Hotel popping pills and guzzling "Highland" by the bottle full. Because Donna had bought most of the drugs from the Red Cross we had a fair idea about how cheap this stay would be, however we were surprised when a few days later we dropped back in to St Mary's to get the all clear when they gave me a cash refund for 60% of the deposit we had paid.

This time around the Malaria fully knocked me on my ass - when they told me I needed to go onto a drip I knew it was more serious than last time and with all the complications (the bad stomach turned out to be dysentery) thrown in I was very lucky to have had the excellent care from Donna and all the Doctors and Nurses down at St Mary's and to have such a speedy recovery - my thanks goes out to you all.

     
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Look forward to seeing the photo album from this chapter!

Al - 01 December, 2007

 
     
     
 

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