The Three Legged Race: QECH

Queen Elizabeth Central Hospital is home to many wards, specialties and levels of education. It is the training location for Malawi College of Medicine students to train as well as many residencies. There are hundreds if not thousands of patients at all times, L&D averages 15,000 deliveries a year. The hospital is set up like a big grid which Dr. Taylor likes to compare to the human circulation with the main hallway in the middle as the aorta. Always people going here and there.

Each ward serves a different purpose. This week I'm working on 5A, the men's surgical ward. The hospital has a BYOB policy (brig your own bedding) an when you ask someone if they have been able to eat, you always have to ask the follow up question "was there food?"

It is a beautifully sad place with much palliative care because most disease here presents at a stage that is beyond the level of treatment that can be offered/available. The patients are very willing to do whatever the doctors say, but whether or not that is always the right thing, I do not know. I was excited when one man was refusing BL amputation because I think they may be quicker than in the states to jump to that solution for a diabetic foot ulcer. And it made me sure that he knew what they were proposing, whereas sometimes it seems patients go to the OT (*OR) not really realizing what they are getting themselves into.

Yesterday I spent the day in Operating Theatre One. Gloves, masks and gowns are in short supply and sterile technique leaves something to be desired, however, even though it is soo different it also feels surprisingly familiar. The OT has air which is nice compared to everywhere else. There is a ventilator, intubations and succinylcholine just like in the USA. But the OTs are not sterilized between patients, they just put a new sheet on the table after one is done and it's time for the next. Some of these things occur, I know, out of short supply but others I think more of ignorance. Or just laziness on the part of some visiting physicians.

I took my first minibus to work today, with the help of our guard Christopher. Turned out the one we took was actually a private driver on his way back from dropping some rich kids at school, but he charged the same rate, I guess he just wanted the extra Kwatcha. More on the minibuses later.

Here we are, nearing the end of week one already. Tonight is movie night and The Help is cued up. This trip is amazing and tiring and hard and great and sad and all of the adjectives you could think of combined so far. It will surely fly by, but as often as I can, I am trying to mentally stop and take it all in.