QueenII
Yesterday, I followed around a doctor and assisted him with simple tasks at the national referral hospital in Lesotho, which is Queen Elizabeth II in Maseru. It is probably the most depressing place I have ever been in my life.
It is tiny and dismal, with small ceilings and small rooms serving as wards. Some rooms have six or seven children in them - some rooms have more. For all the children, the mothers are sitting there, looking exhausted and sullen. I don't blame them in the slightest; I wouldn't want to spend days there, much less with a severely sick child. The mothers don't have any place to sleep, so you see them slumped over and resting on their children's beds, trying to get some small amount of rest. One of the doctors told me that once they had a mother that was behaving really strangely It had been so long since she had slept properly that she had become actively delusional, and after they gave her medication which forced her to sleep through the night, she didn't even remember her behavior of the previous day and behaved perfectly reasonably.
The quality of light in the hospital is uniformly bad. The windows are small and dirty and when they are open, the flies are able to get in. The flies are in anyway, so it isn't that much of a big deal - especially since there is no air conditioning and any breeze is deeply appreciated. The breeze doesn't only help with the heat - which is milder than you probably would expect, actually, considering it is the middle of summer - but also with the smell. It is a combination of illness and urine and stale air and it was easily the worst part of the entire experience. I feel sort of like a shitty person for saying that, because shouldn't the dying children be the worse part? And clearly, they were in their way - just the smell was inescapable, unnecessary (hospitals in the US don't smell like that), and proof of the underlying hopelessness of the entire envioronment.
Or, at least that's how I justify it to myself. In reality, I still feel like shit, because there were points where I didn't even really care about the children, the smell was so bad. The doctor I was shadowing had a little container of Purell in his pocket and he used it compulsively; not only in the correct times, which would be before and after touching patients, but all the time. I understood the urge; QueenII makes you feel dirty.
I don't blame the families even a little bit for not wanting to go there, but it is a huge problem. Most of the kids that come to the hospital are at death's door - the doctor I was working with was from the Baylor clinic said that he has had eight mortalities in the week he had been there so far, which was more than he had seen in his entire several years of residency in the states. Another of the clinic docs was telling me about how he was shocked to see the nurses ignoring two children who were clearly, visibly dying while they waited; not because of cruelty, but because there were so many other dying children. That, and learned helplessness - even if the nurses did help, they would probably die anyway. The mortality rate is something like thirty percent, and of those patients which are admitted with severe malnutrition - which is most of them - the mortality rate is more like fifty percent.
The severely malnourished kids were the ones that my doc did rounds with yesterday. Malnutrition is a horrible condition to be in; it often occurs with or because of other infections like HIV or TB, and it results in children which are too week to even have a fever to indicate that they are sick. Some of the kids are just as emaciated and lethargic as you would expect, but some of them are not - there is something called edema which is the swelling of your limbs due to water retention which occasionally occurs with severe malnutrition. This means that some of the sickest kids can look perfectly normal and plump.
Another thing that is tricky with severe malnutrition is that you cannot simply feed the children; these kids are so fucked up that feeding them too much or at the wrong times could send them into cardiac arrest. They have to be fed at specific intervals and with specific amounts of calories. The problem is that there simply aren't enough health care professionals to do this for all the kids; the mothers have to do it. The mothers have zero medical training and they frequently ignore the doctors advice and feed the kids too much; you can't really blame them. It makes sense to feed a starving child food, it is just that the body cannot handle it.
I need to go now, but I promise to have a lighter post up later today. I've started cutting these missives because I figure I'm boring people, so I hope the flist at large doesn't mind the interruption in the normal gay shenanigans.