Two complaints - people over here write dates differently. So February 12, 2013 is 12/2/13 instead of 2/12/13. It's the same way in Europe so I'm gathering that the United States is flying solo on this one. But it's a really hard habit to break. I've started just writing '2' then '12' then '13', but start by putting the '2' in the middle and then the '12' in front before finishing with the '13'. My other complaint is that there are a lot of doors that open in the wrong direction. When it should open out you have to pull it in. When you should have to pull it in you have to push it out. It kind of makes you look like a fool. The worst part is that for some reason it never registers until I've tried at least twice.
I finally made it to the hospital today. It's known as the GRC, short for Gondoma Referral Center. It's located about 20 minutes from where I'm staying and all the doctors, nurses, administrators and workers pile into two vans at about 7:30 a.m. to be there by 8:00. It's pretty rudimentary but functional (the hospital that is, not the car...well, actually the car too).
There are over 200 beds, about 30 for obstetric patients and the rest for pediatrics. I was given a tour of the hospital and I think that was the first time I actually realized how different things are going to be.
There was an entire ward full of children who had been burned, some severely. Everything is cooked over open fires but I was told that that is only rarely the cause of the burns. Usually the child pulls the pot of boiling water over onto him or herself. These poor kids are all in various stages of healing. Most are going through dressing changes and debridement - medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue - at least once every two days. It was heartbreaking to see these little three and four year-olds crying and knowing that they didn't have any idea why they were there and why they were hurting. Their mothers were all there with them, exhausted from lack of sleep and the oppressive heat.
There was another ward for pediatric patients with active tuberculosis. One child, a little girl who couldn't have been more than four, had a chest tube from a pneumothorax that happened the day before. For the nonmedical people, a pneumothorax is basically a lung that deflates, in this case because of the lesions that tuberculosis produces in the lungs. Tuberculosis can cause all kinds of other bad problems too so it's treated pretty aggressively.
Malaria is the single most common illness here. Four patients were tested in labor and delivery today and two were positive. It's common to see patients with hemoglobins of seven on admission (roughly half normal) and transfusions usually aren't even considered if their hemoglobin is above four. Most postpartum patients walk around without any symptoms of what we would consider life-threatening anemia.
GRC is the major referral center for complicated obstetrics. There are usually three or four eclamptics a week, women who are seizing with very high blood pressures as a result of their pregnancies. Fetal deaths are common and maternal deaths happen way too often. The maternity ward is relatively quiet right now with only about 20 patients. I'm on call tomorrow but spent about half the day today seeing and triaging patients as they came in.
The hospital has strict guidelines about who it will admit. If the patient doesn't meet those criteria (eclampsia, previa, abruption, malpresentations, high fevers) they are transferred to a hospital not far away, even if they're in active labor. The goal of MSF is to turn the hospital over to the government in the next 5 years, although it looks like it may take longer than that.