A generally medical ward...

Folding gauze for casuality department

Verity next to "ICU" beds on the medical ward

Kerry, Piri (and baby Kevin) Radiographer Tegan from Brisbane and Verity on the general medical ward

Verity pegging out the washing at laundry

Me taking the bloods to the lab for testing in the hospital corridor!

Kerry and Verity taking the laundry skip to the laundry house, on the hospital corridor

The bit of the hospital where the cart gets off-roaded! Laundry hous in the background

On our first day on placement Freddy and Brian collected us from the house and we were driven to Mount Meru Regional Hospital. The locals looked on with feint interest as we walked through the main entrance, which serves as a waiting room for A&E or “casuality” as it is called locally, I’m not sure they understand how apt this is. The hospital is made up of several wards or departments, all in separate buildings. The original hospital was built in the 1920’s with new additions to it throughout the last century. The wards are joined by concrete walkways sheltered by corrugated tin roof and edged with pretty planted borders, and just to ensure no-one steps on the grass, these are edged with lethal, ensnaring barbed wire. Even as we walked towards the admin block, I witnessed an unsuspecting visitor become its victim.

The admin block is a pretty square with one storey buildings surrounding it. It’s very small, but houses Matron’s office, the hospital manager’s office, a doctor’s meeting room and very small library. Rather importantly it houses the hospital’s only western toilet, which is fairly clean and a welcome sight after a long morning on the ward, if you’ve overdone the rehydration. It was here we met the hospital manager, using our “Shikamoo”’s for the first time – the respectful greeting, accessorised with a nervous curtsy which appeared from nowhere at the crucial moment. It went down well and the hospital manager introduced himself and welcomed us to Mount Meru regional hospital. After the formalities we were given a brief tour of the hospital grounds and then Lizzie, Verity and myself found ourselves at the general medical ward.

To be honest, I had been preparing myself for the worst, and yet it was still pretty shocking. This particular ward had been built in the 1960’s as the children’s ward originally, and now the adult general medical ward, nothing else had been changed, nor apparently maintained. The walls have peeling paint, which can only be seen in some parts through the dirt and years of grime. The smell that hits instantly is of bleach and it appears to be the morning ritual that the floor is washed with bleach from one end of the ward to the other. The ward itself is laid out in the traditional nightingale fashion and presently there are is just one patient to each bed, but this is where the similarities to North Manchester General end. Sister greeted us with a slight indifference, but when we looked enthusiastic about joining in the bed making process, she seemed to warm slightly. Nurse Piri was more forthcoming with the chatter and we soon discovered she is full term with her first child, and sees the practicality in working in the hospital where she expects her baby to be born! The bed making process was a little different to home, the sheets are ‘past themselves’ (as mum would say) and when you run out, a quick turn of the old ones completes the process. There are only a couple of pillows on the ward, reserved for the very sick patients. The beds are made up with the ill-fitting sheets and a scratchy hospital blanket and so often patients have their clan colors or a garment from home to compliment the linen. Sister’s delight was plain to see when we asked where the dirty linen went and she directed us out of the ward and down to the laundry house. The fresh air at this point was welcome, but there is an unmistakable stench as we entered the laundry building. Here the sheets and blankets are counted out into stone basins and these numbers are reported to the laundry master who notes it in his book. We are now able to do this in Kswahili, much to his amusement!

Back on the ward, the nurses then prepare for ward round. This involves cleaning a trolley and laying out the patient notes ready for the sometimes imminent arrival of the doctors. However, on Thursday we had a little change of routine, when we arrived back on the ward, sister Vicky announced “and now we dust”. Agreeing to assist immediately, I then found myself looking around and wondering what exactly she meant by dusting, as there were no obvious signs of this phenomena occurring in recent times. I enquired tentatively if she meant the patients, which she found amusing and said simply just the beds. A bowl of water and disinfectant was produced along with three rags and very methodically we got stuck in, in a fashion that Kim and Aggie would have been proud of. The patients were amazed at this odd ritual the Mezungus were performing, but the perplexed expression on the nurses’ faces said it all – this was not normal, a sentiment backed up by the layers of crusty bodily fluids of all varieties and whiff of old anti-biotics.

Ward round is an interesting occurrence. The medical consultant Mr McCoolie is an intriguing character, with his sincere face, which would give nothing away, but his eyes sometimes betray a twinkle. His passion is in teaching, and in nurturing the up and coming doctors, who seem a little timid around this influential character. His attention to detail is admirable, but in a hospital where funds and resources are highly restricted, it feels a little like “look at what you could have won” when discussing the options for patient treatment, and then settling for the only available options. My favourite scenario was when McCoolie was visiting a patient who had been admitted with convulsions and while discussing the various reasons which regarded epilepsy, tumour or trauma, the trauma options were extended to the various types of fruit peeling that the patient may or may not have slipped on during a hypothetical incident which didn’t really occur!

Nurse Vicky approached me later in the shift on the Thursday, “Kerry! Come!”, Eagerly I asked what she needed, and I was dearly hoping I misheard her when she said “Last offices”. A term I truly dreaded hearing. The other girls offered their assistance, but Nurse Vicky was adamant it was just Kerry, I wasn’t sure if it was praise of punishment and still reserve judgement on this. It was very odd indeed and while the dear departed was most definitely at peace, the process was much colder and matter of process than I had previously experienced. Nurse Vicky clarified her actions by saying that death was inevitable, and while I completely agree, I wondered if a little more palliative care delivery may have been appropriate beforehand.

I really can’t finish this post until I give a special mention to Hugh, not the Aussie Doctor who looked after us so well on the medical ward during our first week, but to his names’ sake rat who apparently frequents the nurses room where we get changed, and who gave Lizzie and Verity quite a surprise visit! Although, I’m not sure that “Hugh” is not the Sister’s way of ensuring the Mezungu’s breaks are kept to a minimum!! Hugh doesn’t live alone there. During a break on my first day, apparently unable to cling to the cobwebs on the ceiling, a lizard plopped onto the desk, narrowly missing Sister’s cup of Chai which evoked a squeal from her and some very nervous giggles from me!

I have so many more tales to tell, and I really hope it comes across how much I am enjoying my time here so far, and I only hope that the stories do the reality justice. The staff here do seem to work hard in the face of adversity, and things are just very different, which is much easier to accept than to try and change.