Lilongwe/Cure Hospital — Experiences 15

March 18, 2015
Guardian Experience

Upon returning from Cape Town school has been exceptionally quiet without the students. After trying to contact a local friend for a few days I finally heard from her that she had broken her ankle while hiking Mulanje Mtn. This is a mountain where you hike up for seven hours, stay all night, watch the sunrise in the morning and then hike down. I’ve been hesitant to do this because of my foot. On her way up it rained the whole time and she decided to skip the sunrise. After two hours of the down hike, she slipped on a wet rock and broke her ankle. The two hired porters took turns carrying her down for the next five hours. This was on a Sunday. On Monday the physiotherapist that I had seen for my foot, gave her a wrong diagnosis telling her that her ankle was sprained and that to walk on it as much as possible. She did but it hurt. Tuesday she went for an x-ray and the fracture was seen. Wednesday she saw a local doctor and he told her to go to a private orthopedic hospital (Beit Cure Hospital) in Blantyre for surgery, Johannesburg or the States. Blantyre would be best, and it is a simple surgery so they should be fine for doing this procedure. The other locations require air flight and that caused an increased risk of a blood clot. I told her I would accompany her since I didn’t have to be in my office, but she needed to rent a car. Surgery was scheduled for Monday, March 16th in Blantyre, about five hours south of Lilongwe — the other ‘big’ city in Malawi. Her roommate, who owns a car but doesn’t drive, right; I don’t understand that either, allowed Emily to borrow her car. Emily is from Buffalo, works for the CDC, is a Fulbright-Clinton awardee, and is working with the Malawi Ministry of Health on data collection tools. This is my first driving adventure outside of Lilongwe. The roads are good but the number of people walking along the road and bicycles on the highway are just plain nerve racking. We had to be to the hospital for her to complete blood work on Sunday by 3pm. I got a speeding ticket going 80km in a 50km zone. I was kind of excited to show off my temporary Malawian driver’s license but Emily took over talking to the policeman, had her ½ casted foot in the window and a walker in the backseat, explained to the policeman that we were in a hurry to the hospital for surgery. She paid the 5,000 kwacha fine on the spot, got the receipt and off we went. The policeman didn’t even ask to see my license! Emily said we could now go as fast as we wanted because if we are pulled over again we show the receipt from our first fine and we are good to go. While she says you can only get ticketed one time a day I have trouble believing that. But, it is Malawi so maybe. There are very few road signs and Emily had not done her homework in getting directions. We missed a turn somewhere and ended up going through Zomba. This added 45 minutes on to our trip.

Emily getting her initial caste at Partners in Hope Clinic in Lilongwe

We arrived at the hospital at 1:00. It was open house day but no one was around and it was quiet. Eventually a nurse appeared and asked us if we were wanting something. Emily explained she was there for blood work and the nurse explained she knew nothing about it. She did verify that the lab technician worked on Sunday’s but not until 3pm because he was at church presently. He would come in after church. Emily explained that she was told the hospital closed at 3. The nurse told her that was wrong. Emily, in a wheelchair, asking more questions that had no answers, begins to cry. I’m sitting in the hospital entrance room chair staying out of the ensuing anger. A lady, from Zimbabwe, who had a knee replacement gets up with her crutches and goes to Emily explaining that everything will be alright and gives her as much of a hug as possible. Now, I’m realizing that I’m already failing in my guardian duties of compassion, but she doesn’t need two of us hugging her so I continue to sit and watch.
Pam, the secretary that failed to leave documentation about Emily’s arrival was called and Emily spoke to her. She came in about 45 minutes later and apologized to Emily saying everything was her fault and assured Emily that she is scheduled for surgery tomorrow morning and that they will prepare a room for her and her guardian tonight. The Zimbabwean lady said the surgeon was coming in later to discharge her so she was sure he would stop and see Emily. Emily did have contact via email and phone so she was sure the surgeon knew he was fixing her in the morning — just the hospital didn’t.
Two o’clock we leave and go to an Indian restaurant that Emily had heard good things. Around 3, the phone rings and the hospital called to say the lab technician was there and would be until 5 or so. Back to the hospital, she has blood taken and cleared that she doesn’t have malaria.

Entrance to the hospital

Biet Cure is an orthopedic hospital that primary fixes children for free but charges adults for fixing. There are 8 private wing rooms and then a ward of 50 beds for children. The children’s ward is completely full all the time. Each child stays about one week and when released another automatically appears. They seem to do a lot of club foot repairs and removal of extra fingers. There are two surgeons. One from Atlanta and one from the U.K. Emily had the Atlanta doctor work on her. The man from the U.K. is the one investigating my foot. The nurses are all Malawian. They have one night shift nurse and three on shift during the day for the private ward. Each room has two beds with mosquito netting. One for the patient and one for the guardian. The hospital expects that each patient will have a guardian stay that will take care of everything except medication distribution. I went in to the supply room, needing towels, and saw that there were only six towels. Three that were basically rags. Remember, they have only eight rooms. I had brought my own towels but Emily forgot. There also was not toilet paper in the room. That, we both forgot. Thankfully, I did find four rolls in the supply room, and I only took one. The first night there were three patients in the private wing.

Our private room with bed for guardian. Mosquito netting hanging. This was discharge day — hence all the stuff.

The surgeon did come in Sunday night and spent a long time answering questions and consoling Emily that everything would be fine. He said they usually start surgeries around 8am. The night shift nurse came in a 6am and gave Emily a bottle of chlorhexidine, to clean her leg and a gown to wear. The surgeon returned offered to answer any questions, and then said they usually start around 8:30am. The finance lady came for money. Before any procedures are done, they must be paid ahead of time. They take cash or Visa. I went to pay the bill with Emily’s credit card. For the operation, three meals a day, with two snacks, a private room for two for three nights, crutches and medication, the bill was around $2,650. The food — we get menus for selections and the food has been good. The chicken enchilada that I had tasted like a chicken pot pie — a bit different but good. In the central hospitals, there is no food preparation. All meals are prepared and served by the guardian. Emily is lucky this place serves food; so was I.

Chambo — the local fish. This was lunch.

I got to go to the room right outside the OR with Emily. There, the head nurse and the surgeon came out, asked if there were any other questions and checked on Emily’s anxiety. She assured them she was ready and then the surgeon asked if we could take a moment for prayer. He led the prayer and the four of us participated. They then scrolled Emily into the OR and told me it would be about an hour. The surgery seems to have gone well with the stainless steel plate and six screws attached to her fibula. She’s in a ½ caste non weight bearing for six weeks.

Fixed! A bit of fresh air.
No more club foot. Fixed. Now healing!
Hallway of the private ward

Hospital things of note

*The only two computers I saw were are the reception desk and in the payment office. All documentation is on paper. A good thing I verified was that the nurses were keeping nursing notes. This doesn’t happen at the Kamuzu Central Hospital in Lilongwe. *The nurses distribute medication but also ask the patient what they want for pain. Emily has been given choices of morphine or codeine. When given a shot of morphine the nurses ask which buttock she wants it in. There are no medication computer regulating machines and no procedures are documented in the room. *Blood pressure, there was one machine used about four times then it disappeared. The night nurse reported that it was no longer working well. They were back to the manual listening and pumping device. *The hospital quality check lady came in the final morning. She asked Emily is she was Michael or if she was from Zimbabwe. I told her that is the person across the hall. She didn’t care and went ahead asking Emily how everything was. Only a couple minor suggestions. At the end, she asked if we could have a prayer. She led it. *In the children’s ward, every evening at 7:30 they sing with their parents. Glorious song resounding through the hospital halls. They sing for 30 minutes or so and then have a 30 minutes church like service. They repeat this in the mornings at 7. Emily and I joined for the singing Tuesday night. It’s all in Chichewa so I only clap and sway. *Like the States, people come in the room and don’t tell you who they are. For the nurses though, they all wear the same uniforms so they are pretty easy to determine. *Like in the States, I believe no one should be alone in a hospital. They are dangerous places. A guardian is expected here and I guarded but I didn’t feel that I had to guard from ‘health care’ as much as I have had in the States. Maybe because the ‘care’ is less and treatment is the only duty? Don’t know.

The nurses station for the private ward

On the return drive to Lilongwe, sadly, I did get another speeding ticket. Ironically, it was the same policeman as on Sunday. He said to me with a smile, “You are cruisin’ too much. You were going 65km in a 50km zone.” His phone then rings, and stepping away to answer the phone, tells me to pay 5,000 kwatcha. He never came back. The policeman taking the money remembered us from Sunday and completing the receipt for the fine, wishes us a pleasant journey. Still, nobody asked for or looked at my license.

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