Before going to Lilongwe, I had never spent a significant amount of time in a hospital. I have shadowed rounds in the orthopedics at Shriner’s Hospital for Children in Houston, but that is pretty much it. Due to this lack of experience, spending time at Kamuzu Central Hospital in Lilongwe was surprising for a number of reasons.
When I went to Lilongwe, I had no clue what to expect. The other interns were going to small district hospitals, but I was going to a hospital that served the same purpose as Queen’s does, being the main hospital for one of the 3 geographic regions of Malawi. When we arrived, I was surprised to see how large it was. We went on a tour of the hospital lead by one of the technicians in their PAM office. On this tour, we saw many wards, including the general medical ward, the pediatric wards, the labor ward, and the neonatal ward. As we toured the hospital, many details stood out to me, some of which were difficult to see. I was struck by how crowded the hospital was. In some wards, there were people sitting on mattresses on the floor in an open-air hallway. In others, children shared beds as mothers crowded the floor space between the cots. The equipment shortages were apparent as well – in Pediatrics, the nurses would regularly put 5 patients on one oxygen concentrator (which only produces 5 L/min), and that would increase to 10 patients during malaria season. The hospital only had one CT scanner, and it had been broken for a considerable time before being repaired the weekend before we arrived. The medications in stock would constantly be changing, forcing clinicians to frequently change their practice to adapt to available resources.
One of the most difficult things I saw in the hospital was in the labor ward on the first day. We began by looking at the delivery rooms and speaking with nurses. Eventually, we got to the resuscitation area. At first, I only saw the radiant warmer with a pair of twins under it, They were wrapped in colorful chitenjes as they waited to be returned to their mother. However, behind them, I noticed 2 nurses and a doctor working on a neonate. When I asked what they were doing, I learned that they were doing compressions on the newborn. I stopped and stared, in shock at what I was watching. I saw the newborn, but I was not sure if it was alive or dead. Shortly after that, we left the ward. The team was still working. I do not know what happened to this baby. I do not know if it saw the end of its first hour, day, or week. I do not know if it is still alive. Through the rest of the week, I saw many patients in pain, and a couple patients pass, but the newborn has stuck with me. I was not prepared to see that, but I am now more motivated than ever to continue working and producing designs that could help with birth, resuscitation, and survival of newborns and premature infants.
Later in the week, I was shadowing a prominent physician, Dr. Peter Kazembe, who was doing rounds in the neonatal ward. At one point, he asked a nurse “Why are babies getting cold?” to which the matron of the ward replied “Almost all have hypothermia; our heaters are not enough. We need more.” We need more. This statement sums up what we saw in the hospital that week. In the words of Dr. Kazembe, “We have shortages of everything… except patients.” We are here to give them more. We spent the past week compiling information and are now beginning to work on projects to fit the needs they communicated. Specifically, we are designing a temperature monitor to help catch hypothermia sooner, so babies can be rewarmed before the temperature drops significantly. We hope this tool can be used to prevent hypothermia from becoming more serious in the neonates. In a way, we hope this too can be a small part of their more.