At the end of last week I started working on a poster that can help nurses and new clinicians know how to wean a baby off of CPAP. Because of the mechanics of the CPAP, it is essential for health care providers to have a complete understanding of how to wean a baby off of the machine so that they don’t end up doing harm to the patient.
The patient pool for the CPAP machine is neonates whose lungs are underdeveloped. When babies are so premature, their lungs often collapse and are unable to let the baby consume oxygen. The CPAP delivers constant air flow that provides enough pressure to inflate the lungs. With this help, the baby can inhale and exhale to get enough oxygen into their bodies until they can breathe on their own. Weaning a baby off CPAP improperly can cause even a negative pressure, making it harder for the baby to breathe on the machine than it would be in normal room air. The baby also still needs continuous monitoring, so any deteriorations in their condition will be noticed and rectified before the child is seriously harmed. The goal of the poster I made was to be both specific and concise so that any health care professional attending the baby would be able to wean the baby properly without risk to their health.
After looking back again at the blogs of interns of previous years, I remembered how limited my knowledge of Queens and Blantyre was before coming here. I thought it might be helpful to future interns or others less familiar to have a more extensive image of the two. Queen Elizabeth Central Hospital is one of the largest hospitals in Malawi. Its two nurseries alone house upwards of 200 patients a month, which means the whole hospital sees thousands of people monthly. Because of the climate, a lot of the hallways and waiting areas are outdoors. There are a number of small grassy courtyards where families lay out blankets and wait for their loved ones that are in the wards. It is far from uncommon to see women doing their laundry in the large sinks in the courtyards while waiting.
The wards at QECH that I’ve visited are always busy and sometimes overcrowded. The nurseries in particular are always packed during visiting or feeding hours. As far as I have seen, neither nursery tends to have the problem of not enough nurses or staff. Both Paeds and Chatinkha are kept very warm to help the babies regulate their own body temperatures, as incubators are expensive and uncommon. They sometimes would feel pretty stuffy, but never very dirty or unhygienic. Queens has a very large janitorial staff that is almost constantly mopping hallways and dusting windows, which makes me feel that the hospital as a whole is very clean and as sanitary as possible.
As far as technology goes, it is hard for me to asses the extent to which the nurseries and the rest of the hospital are well- or under-equipped. The nurses I’ve met in the nurseries are always enthusiastic about the idea of any new technology, and they have told me often about how shorthanded they are with specific devices, such as oxygen concentrators and pulse oximeters. I have seen a lot of broken technology that is either too difficult to fix or the parts to fix it are too expensive, which makes for a sad waste of equipment that could be put to use. The hospital staff though is very diligent and resourceful and they are good at making use of every available device, even if it seems outdated or in less-than-pristine shape. As far as I have seen, there have been holes in the availability of certain technology, but the standard of care- especially compared to other hospitals in low-resource countries- is still very high.
Queens is a different environment than I had expected, and than future interns might anticipate. While there are a lot of striking differences between the luxury of an American hospital and what is possible here, it is also remarkable the difference between what I have seen at Queen’s and what I saw at Machinga, or what exists in other smaller hospitals. Although I have spent most of my time in the BTB office or in the nurseries so far, I hope that I will have a chance in the next four weeks to see some of the other wards too, so that I can impart more information and experiences to the interns who will be here in future years.
This post is already probably one of my longest, so I’ll save my description of Blantyre and the people I’ve met for the next one. In the meantime, here are some of my pictures of Queens: