husband and wife

A Hospital with no drugs.

Yesterday on my ward round I took a moment.  A lightbulb went off in my head.

I sat and stared at yet another floppy baby who was having diarrhoea and vomiting.  I have about 3 of them on the ward, they all look the same – and I can’t do anything for them.  I’m just watching them daily, hoping that they will turn the corner… hoping that they don’t die….. please don’t die little ones, not of dehydration, not here, not now.

I will share with you The lightbulb moment: “I simply can’t do this anymore, I can’t watch children die when I have no drugs to help them” …… “I’ve got to leave”

What’s happened I hear you ask?

Sigh.  It’s complex.  Basically the way it works here is, the patient buys health insurance for a year. It costs about $10 NZD for an adult and $3 for a child.  Once you have insurance the hospital I work for will provide you free health care and drugs.  Then we claim the money back from the government…..but here’s the thing.

The government is simply not paying.

Granted I can send the family to a store to buy the medicines needed, we are not in the middle of nowhere like some facilities, but this means them leaving the hospital (taking the extremely sick and dehydrated baby with them) and roaming around town, trying to find a pharmacy that will sell them.  As you know too most of the patients are living in extreme poverty so asking them to mobilize cash is often difficult and takes time for them to phone their village and get someone to send money…. Meanwhile the little girl waits.

Cut to me …..now: I’m staring at this 3 month old floppy baby and have no clue what to do.  My options are limited.  We have no fluids, no oral rehydration salts, no oral malaria treatment and no oral antibiotics.   I have only two IV antibiotics at my disposal – I call them husband and wife and use them on a daily basis (Penicillin and Gentamicin).  Ok I gotta be creative.  Hmmmmmmm – I beg the next door patient who no longer needs her normal saline, for it and find a bit of 50% dextrose from the emergency box and mix them together.   Whew.

Cut to next baby; fever of 40 - At least we still have paracetamol I think.  I will watch and wait.

Number three: hmmmmmm – floppy baby – this one has infection in their lungs – is it pneumonia? Hard to say as the CXR has spoiled.  Bring out the husband and wife again.  They are so reliable.

Number four: one year and no symptoms besides fever – hmmmm shall I do investigations? – oh hang on ….what was that lab?  No urine strips, full blood counts, blood sugars, typhoid tests, and no containers for a stool test, huh…? Ohhhhh No malaria tests either… what?  Ok….. I scratch my head…. Come on Creativity come onnnnn…. Husband and wife plus malaria treatment.  perfect cocktail, yes!  oh what? Oh yeah that’s right no fluids to put the malaria treatment in…. sorry.

Number five: Febrile convulsion – quick it’s an emergency – everybody rally around. Keeps going. IVL check.  Still going.  Diazepam, no.  Phenobarb, nope. Fluids, ahhh nope.  Treatment for meningitis just in case – ha ha ha now universe you are laughing at me.   Convulsion not stopping.  At least I can inject you with quinine. At least I have hope that you are young and it won’t be serious.  At least I still I have two fingers I can cross with.  It’s these times I kinda wished I was religious.

Seriously though – I hear the loud carpenters banging away building our new radiography area that will be first rate in Bolgatanga…. And I’m sitting once again staring at a baby trying to work out how to save them…. can I live with myself if he/she dies because I couldn’t give the treatment they needed, because I couldn’t live up to my Hippocratic oath of ‘do no harm’, can I watch them die as the xray area is being built in a hospital that simply has NO drugs.

Lightbulb moment

When is the next flight back to NZ? ……..

                                                 this is a true example. - look at all the 'Nil's

finding fame! :) in case you haven't seen!

http://www.stuff.co.nz/sunday-star-times/latest-edition/6367750/Catching-malaria-comes-with-the-

job

Sorry, your story is not tragic enough.

Sorry, your story is not tragic enough.

The other day I bumped into some Asoyamias (white people) at the guest house.  This guest house is run to support mama laadis and I often go and visit those working there to say hello.  Anyway, this film making couple were staying there from the UK.  They were very nice people, doing a documentary on Hunger.  It is to reflect the desperation of Africans after the short rainy season this year and henceforth the poor crop yield during harvest.  They are looking for tales that show the outcomes of people living on the poverty line, who have to rely on the weather/harvest, and especially the the effects it has on the children.

This documentary, once made, will be shown to people to raise money to help many of those suffering, ultimately providing aid/food to hundreds if not thousands of people. 
Which is great.

But something just didn't sit right with me.

They are looking for people's tragedy to tell a shocking story that will pull at consumers heart strings so they will ring a phone line, and give over cold hard cash.
They got sent to Bolgatanga to find such tragedies.  Of course all the locals rallied around finding them struggling families, and of course these stories are ripe for the picking..... but sadly none 'bad' enough. 
How awful..... They turn up to a house that is clearly dysfunctional, the occupants do not eat more than one meal a day and haven't had a protein product in the last week ... there is already illness lurking in the shadows.... BUT it simply is not bad enough?

This is someone's life - this is a family who are fighting against becoming a statistic, teetering on the edge - and the director has to try and explain to the locals and family who presented their story; "I'm sorry, I can see your child is very malnourished, yip she looks like a skeleton, yip she cannot walk by herself because she doesn't have the energy, but she is simply not 'skeletal enough', sorry.  It's not enough to get the white people who will see this film to help you".  Sorry.

What is this?

They termed it 'over-saturation-of-the-starving-child-advertisement-campaigns'.  In advertising you always need to manipulate the masses to give over their money to buy into something they are talked into 'needing'.   With so many starving-help-the-child-the-little-girl-waits-advertising-campaigns, us 'whities' have essentially been there and seen that, and now we actually need to see a child 24 hours away from death to do something? What can be the 'wow' factor when we have seen it all? What about a child dying on screen, this is bound to move a few television watchers to get up off their tv-dinner arses and make the call? No?

What is this?

Is this kinda fucked up? Or is it just me?  Is this just natural instinct of humans? I guess I'm just too close to the children of Bolgatanga to see this situation without judgement.

If it's any consolation it made the documentary makers feel wierd and uncomfortable, and they have aborted their mission and gone home.  However, they are coming back when it's really dry season, when the harvest has run out, to catch 'proper' malnourished suffering children.

Free range

Free-range.

Where I'm from, clean and green New Zealand, we know 'free-range' as natural, organic and most commonly animals who get to roam around freely, eat the 'organic' grass that is growing around the garden and live happy 'holistic' lives.  Take chickens for example; their eggs are eaten daily by the family (yum, yokes as yellow as the sun!). They get given no 'evil' pesticides, antibiotics, hormones, and get to grow to a ripe old age, until they disappear once they are plump enough to be eaten at the Xmas table.

Not in Bolgatanga .......

In fact I came face to face with 'free-range' when I was driving to work on my moto last week..... A grandmas butt up in the air, buttocks flowing in the wind, and shit coming out in front of my eyes! "WHAT! " I  hear you cry! Yes! And this is before 8am, before my second coffee of the day, and before I had a chance to turn my head so I no longer get haunted by that memory! I was in shock! 

'Free-range' is what many of the locals do here, they poo everywhere!   One day I decided to go and see the river in town, but I couldn't get to it because of too much human faeces. And now I don't walk through fields or in any green leafy patches, just in case!

Old ladies shitting, men shitting, kids shitting, dogs, goats, donkeys shitting, I have seen them all!

Sometimes I feel as if I just don't fit in! He he

At the hospital I work in, people even 'free-range' just outside the ward window or next to where the nurses put IVL's in, despite security telling them off.... They are unstoppable!

I have heard the problem is, people are just so used to it.  Some don't have toilets in their house, and there are no public toilets, so you can't blame them.
But weirdly, even at mama laadis, where the kids know better, they have toilets, they have soap, they will still sneak out and go 'free-range'.  I know cause I saw them too! (wish those visuals would disappear) 

Why?
Maybe I should conduct a survey?

Madam... I see you are shitting right now.... Can you please explain why?  Madam ... You are shitting in front of small children and in public view, next to public toilets... Can you please yell my why? Ohhhh why???

Free-range has problems.... especially now it's hammattan.  Everyone is having diarrhea and vomiting.  These people are 'free-ranging' (I just created my own verb!), and the bugs spread... Then the hammattan wind picks up, dust blows this diarrhea in the wind, and innocents (like moi) breath in the mix of dust/wind/faecal matter into their perfectly innocent 'free-range-free body!  It just doesn't seem legal!  It certainly brings a new meaning to 'blowing in the wind!' ha ha

In fact writing this I feel slightly short of breath, .... I have a cough coming on.... I start sweating in realization .....oh no .... my mask fell off my face last night whilst i was driving my moto..... Oh no...... Free-range faecal pneumonia! ...... Ahhhhh


Photos to be posted in upcoming blogs! Ha ha