June 4, 2012

Today was our first day at Queen Elizabeth Central Hospital!  It was very overwhelming…thank goodness Jocelyn is here to show us around!  Here is a summary of our first day:

     We began our day in the Paediatrics Department with an 8am meeting to go over the daily statistics (# of patients who were admitted, discharged, or died in the past 24 hours).  The on-call doctors from the night before presented a few cases that were particularly challenging or interesting.

     After the 8am meeting, the doctors went on their rounds.  I went on rounds with one of the doctors in the High Dependency Unit (HDU) of the Paediatrics Special Care Ward, which is similar to a children’s ICU in the United States.  It was overwhelming…I have never seen so many sick children in such a confined space.  There are 11 hospital beds in the HDU.  Thus, there are 11 sick children and 11 tired mothers who stay with their child at all times to feed and care for them.  There is also usually at least 1 sibling with each mother.  Add in the nurses, doctors, and medical students…and you have one VERY crowded room.

     But although I was initially taken aback by the crowded space, I quickly realized that crowding is the norm at QECH.  In the neonatal ward, there are typically five babies lying side-by-side in one warming bed (which is meant for one baby at a time!).  The doctors and nurses constantly have to adapt to the limited resources that are available.

     After rounds, we went to journal club meeting.  Every Monday during lunch, the Paediatric doctors meet to discuss a medical journal article.  This week’s article was about the effects of education and monetary educational incentives on HIV, herpes, and behavioral risk factors in girls age 13-22. The doctors discussed and critiqued the paper, its methods, and talked about its relevance to the current practices at Queens.

     Bridget and I spent the majority of the afternoon learning about the CPAP clinical study.  Jocelyn took us around to meet each of the CPAP nurses and introduced us to the general study procedures.  We have a lot to learn over the next few weeks!  Jocelyn will be leaving Malawi at the end of June, so we’ll be overseeing the trial during the month of July.

 

Overall, here are my main impressions of QECH so far:

• There are nowhere near enough doctors on staff…and about 50% of the doctors are short-term visiting physicians from Europe or the US.

• HIV and malaria are very common among patients.   Every child who enters the hospital receives an HIV blood test (indicating if the child is reactive or non-reactive for HIV).

• Families of patients essentially “live” at the hospital.  Most of the lawn space is occupied by women cooking, doing laundry, and looking after their other children.

• There are wild dogs, chickens, and roosters throughout the hospital property (the roosters outside our office are especially loud!)

• Everyone in the hospital stops working from 12-1:30 to eat lunch.

• The doctors and nurses at QECH are VERY intelligent, innovative, and patient.  It is amazing to see what they can accomplish despite a lack of equipment and personnel.