We had more chance to work in A&E this week. It is one of the places where the IV drip monitor would be the most useful—other than the inpatient pediatric wards like pediatric special care. A&E, not by its own intention, serves as the triage of the pediatrics department. Queen Elizabeth is no doubt a huge, sprawling hospital. Potential patients seem to find A&E first and the doctors and nurses try to sort them, whether it is admitting them into the general wards or referring them to the different departments—oncology, dental, ophthalmology—with directions as to how to get there. It is a system not unlike the emergency rooms in the US except that Malawi has a public healthcare system so every doctor and nurse is paid by the government. What I was surprised to learn was that every service and medication provided by this hospital—in fact by all government hospitals—is free of charge. The only part that the patient needs to pay for is the transportation. It is one problem but it is a big one considering how most of Malawi is composed of extremely scattered rural villages with no paved roads leading anywhere. An interesting situation actually occurs from this: Queen Elizabeth is established as the country’s biggest referral hospital, but it receives a constant flux of non-referrals. In A&E, nurses are constantly telling groups at time to go to their district hospitals first before coming to Queen. From the nurse, anyone who can afford the transportation to get to Queen come and skip the visit to the district hospital. When asked why families would choose to do so, nurses feel that it is the level of service and amount of resources available here. In district hospitals, medication and resources are constantly out of stock. Families are much more assured and certain of the care at Queen, which is something I can believe. Going to the daily department meetings, the doctors and medical students I meet are of a different quality and upbringing than what I seen at Namitete; Queen also receives a lot of government attention in addition to many donations from Europe that I have seen.

However, this does not mean that Queen does not face a constant shortage of supplies. Nurses have to constantly improvise in face of shortages. When nasal prongs are used up, nurses improvise with nasogastric tubes connected to oxygen concentrators. Moreover, when doing research as to how to improve the IV drip monitor, I learned that although the hospital’s standard IV giving set is 15-, 20-, and 60-drops per ml; nurses have to use whatever is on hand. I tried to get a sample of an IV set for each option, but currently all they have are 60 drops/ml sets. In A&E, to make sure children are given the correct amount of fluid, liquids are measured in burettes and then given to the child. Not surprisingly they have currently run out of the burettes, so all the kids are hooked up to adult IV bags. The nurses were really excited about a way to automatically monitor IV fluids even though my model is no longer working from the various revisions and tests I did in-country. Queen Elizabeth is a hospital that is trying to perform to the standard of a hospital in the developed world. However, it truly lacks the resources to do so even though the nurses and doctors I meet are just as passionate and dedicated. It is definitely motivation for me to continue perfecting the technologies I have been working to help deserving hospitals like Queen Elizabeth.