One of places recommended by Dr.Rylance for the Venulite transilluminators was the emergency (called the A&E) ward of pediatrics. Much of the sorting of patients is done there and thus cannulas are also started in the ward, which would make devicess useful. Liz and I decided to briefly visit the place to talk someone in charge who can then decide how to introduce the device to the staff at the ward.
A&E looked much better than the rest of the hospital with high ceiling, clean white walls and tile floors (we later learned that this building was opened around 2001). The construction was well-designed, which used clear plastic sheets in addition to the regular tin sheets to allow sunlight to filter in for a bright natural lighting. Moreover, specialty rooms were organized in a roundabout fashion that eliminated confusing hallways. We found the head nurse-in-charge, Mr.Tsamba, and demonstrated the device. He does see the potential use for the technology because they not only deal with small children where the veins are hard to find but also obese children. He already knows where to place the device for the most efficient use, but he wants to set a time when we can properly introduce the technology to the entire ward staff. Consequently, we will be demonstrating the device on the Monday meeting to the assistant nurses, clinical officers and consultants (doctors). Moreover, we will also be working in the ward on Monday and Wednesday, days Mr.Tsamba predicts would be most busiest for the ward and when device would have the maximum use.

Luckily, as the time was a slow Friday afternoon, Mr.Tsamba had time to give us a brief tour of the emergency ward. As the rooms are organized in a circle, the center region serves as the triage that is filled with rows of benches. Patients wait on the seats to see the two nurses at the head of the line to be weighed and assessed for the different services needed. This system is something we have also seen on our tour of the Kamuzu Central Hospital in Lilongwe; however, in the latter, the benches were color-coded to prioritize patients. In fact, the mortality rate at Kamuzu emergency ward almost halved because of the coloring system. Queen’s does not seem to use it; nurses see the patient based on a first-come-first-serve basis. Low risk cases are referred to one of three consultation room where consultants are situated. Patients to be admitted usually first stop by “room four” or admission room where IVs or cannulas are started. Emergency or life-threatening cases are directed to the resuscitation room equipped with a vital sign monitor, crash cart, oxygen concentrators and a ECG monitor. However, I was surprised that there was no defibrillator anywhere. A very basic theatre room—with x-ray screen, lamps and a bed—is right next to resuscitation; mostly orthopedic surgeries are performed in the theatre.

A&E has its own pharmacy where patients can obtain common painkillers and drugs for TB or malaria. There is also a lab equipped to perform full blood chemistries and technicians to read malaria slides for the ward itself. I didn’t see a TB isolation room, but cholera and diarrhea are two serious problems that each has its own separate room: a cholera isolation room and a ORS room for severe diarrhea. There is even a walkway connecting the main building to the short stay beds where patients are temporarily housed before they are moved to the wards. Malaria patients waiting for their second dose of quinine (four hours after the first dose) also wait on the beds and are monitored for any adverse reactions. It is interesting that there is another procedure room next to the beds where consultants work on special cases. It is a room equipped with a bed, lamps and x-ray screen, but Mr.Tsamba says that ever since he has been here, only rape cases are referred to the room. Girls who are raped must first report to the police to receive a special note of permission before they can seek help from a hospital. It is a process different from the United States and I wonder if the requirement that the victim must see the police first may be a reason why girls often report the cases days after the rape. It is very often, from Mr.Tsamba, that raped girls go to the hospital three to four days after the incidence.

The ward seemed organized and I am impressed that there is a separate pharmacy and lab solely for this department. However, we did visit very late on a Friday afternoon when things were winding down and incoming patients have slowed to a trickle. It would be interesting to work here in the coming week at its busiest time to not only test out the transilluminators but also observe how well this ward function to meet demand.