Saturday, April 3, 2010

Tour of Queens

On Thursday I had a chance to take a mini tour of the pediatric section of Queens Hospital (the biggest hospital in Southern Malawi) with Erika, an attending physician from WashU who is living with us for a few weeks and working on an HIV study there.

Queens is huge and very sprawling as it needs to be all on one floor because elevators+frequent power outages would be a terrible combination. Like everywhere in Malawi, there are people everywhere. Families sleep on the floor near the patients bed and do their own laundry and cooking outside on the covered walkways so there is a colorful mishmosh of people, clothes, food, chickens, dogs etc.

As you might expect, it was sorely lacking in certain ways. There were no linens for the beds so patients sleep on their own chitenjes or nothing at all. The beds are all lined up next to each other so viral illnesses are easily communicated between patients. The patient: nurse ratio ranges from 1:25 to 1:50 or more ( especially during the night) so parents have to be trained to monitor their children for signs of trouble.There is little to no cardiac care at all so patients with heart issues generally die if they don't have the means to get to South Africa. Even mosquito nets are in short supply so patients frequently get malaria while staying at the hospital.

I was most surprised, however, that they did not quarantine patients with tuberculosis (which is very serious and spread by coughing). They did have a room where they had quarantined measles patients (they were having an outbreak) but, in typical Malawi fashion, the door was open.

I was pleasantly surprised by a few things: They have a child protection program which handles "defilement exams" (for victims ofrape) for example. Even if offenders are rarely (if ever) prosecuted, the fact that they have dedicated and trained group of people to help is great. They also had a pediatric palliative care program (which Madonna is apparently very fond of). There is also an effort to get everyone tested for HIV upon admission to the hospital which would be great but there is a shortage of reagents for the rapid test right now. They also had a new pediatric emergency room and triage system so they have fewer kids dying in the waiting room.

I'm hoping to spend some time at a comparatively more rural and basic
hospital to have something to compare this to. All in all, however, given the facilities, the staffing, the risk of contracting an illness from fellow patients and the fact that you need to be accompanied by a family member to take care of you (thus losing their labor at home and in the field), I can understand why people wait until they or their children are very sick before coming to the hospital.

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