Life in a Gambian Hospital
I'm back in the Kombos after a long month in village. What with teaching 100+ tenth-graders, weighing babies, trying to organize a night class for hospital staff, working with the Peer Health Club to put on educational skits for the up-coming World AIDS Day (Dec. 1) celebration we're having, still trying to figure logistics out for finishing the well at Babou Jobe, helping my sitemate with her micro-business manual (and her countless venting and "I think this is the first thing I'll do when I go home, no this, no that" sessions), and trying to figure out information about solar panels for the community lodge, I've been busy! I came down to Kombo this week to celebrate Thanksgiving (we ate at the ambassador's house, even though we don't have an ambassador right now), celebrate the 40th anniversary of Peace Corps, The Gambia, and attend the all-volunteers meeting. Needless to say, there were several nights of partying on behalf of fellow PCVs, but luckily these were not at the hostel, so a friend and I did things like making manicotti and layered jello or go to the beach. What is it about living overseas which drives PCVs to unnecessary drinking bouts whenever groups of three or more gather? I have had a few times when I would like to have a drink, but frankly I don't feel safe doing so, especially not around other PCVs (the rumor mill is insane), plus there's a little voice in the back of my head saying "What would your host mother think?" Ah well, everyone needs a way to let off some steam. As long as they don't wake me up whent hey come stumbling in at 4am, it's all good.
The biggest thing that's happened to me this month is that Hawa came to visit. Hawa is a four-year-old girl who had a very gross malignant skin ulcer for the last three years! Her mother said the "wound" just appeared (maybe it started as a burn from boiling water) and everytime they went to the doctor the wound ended up covered in iodine or just bandaged, but regardless they were sent away each time, and because the wound was itchy, Hawa scratched at it with her dirty fingernails and the wound spread. So I went with the mother and Hawa to the hospital where my toubab status pushed her to the front of the line, and some volunteer Cuban doctors thought she might have anthrax so they signed an admittance paper and told me to take her to the "ward." When I asked which ward the doctor just said "the ward" and shooed me away. So one of my friends who works in the lab took us first to the pediatric ward, but that wasn't it. Go to the surgical ward, so we went to the surgical ward, and that was the correct place, but Hawa could only be admitted if the surgeon cleared the paperwork, so then we had to go to the surgical clinic and get in line. Again, my toubab status assured that we were at the front of the line, but we waited more than two hours for the surgeon to come. After 11 he came, but hospital staff kept pushing their friends through the door to his office while everyone else was waiting patiently (Gambians are very patient people; they're used to waiting). However I, at this point, was quite frustrated and finally just knocked on the door and went in. Meanwhile one of the nurses closed the door on Hawa's face. Once she and her mother were allowed in and the surgeon looked her over, he agreed she needed surgery and signed the paperwork. So once we had Hawa safely established in the surgical ward I rushed off to school to teach my lessons, then ran home and ate a quick lunch while I informed my host mother as to what was going on, then back to the hospital with lunch for Hawa and her mother. Hawa's mother asked for a few things like clothes so I returned that night with necessities. The next day Hawa was supposed to have surgery, but because her hemoglobin level was low she would need a blood transfusion. So in between classes I ran home, talked with some people, and found a way for Hawa's father to come donate blood, only to find out at 2pm that the surgery had been canceled and the father didn't need to give blood because a donor with her blood came in a gave blood. Her surgery would be the next Tuesday (as surgeries are done Tuesdays and Thursdays). So we waited until Tuesday, but Tuesday brought with it generator problems, so the surgery was canceled again. On Thursday everything was a-okay so Hawa was the first surgery that day (I requested time off from school and had permission from the surgeon to attend the surgery). Hawa came kicking and screaming, but with some laughing gas quited down. Once everything was ready and I was thinking how much like a doll Hawa looked, Dr. Spencer came in with his rubber boots. Using a lamp that looked more like a flashlight for lighting, the scrub nurse cleaned the area (with soapy water) and dried it, then Dr. Spencer began. It took several passes with the scalpel to make it through the tissue, and Hawa bled so much for someone her size--clamps were just blossoming around the wound--and at one point I aided the surgery (I grabbed adrenaline to put on the cut area to help stop the bleeding). After removing the diseased tissue and cutting it up for preservation and testing (it may be cancerous), Dr. Spencer pulled out an inflammed lymph node the size of a lima bean. It was crazy. Once the bleeding was under control, Hawa was bandaged and the clean-up started. First removing the clamps, then wiping up the blood--some of which pooled under the gurney and congealed into a sheet which was partly stuck in her hair--then one more sweep over with the soapy water, cover her up and wheel her away. I stayed for two more surgeries (during the last of which, the power gave out and Dr. Spencer tried to continue blind while the scrub nurses ran around trying to get the power to start up again), then visited Hawa, who was still asleep. Off to school for classes, and when I returned she was awake, in some pain, and in the middle of her blood transfusion. She was not at all happy with me. For the last week we've been waiting to see how the wound heals, and if everything is healthy then Dr. Spencer will perform a skin graft. Meanwhile, Hawa is running around and happy. Whenever I visit she likes to beat up on me and we tease each other in Jolaa: "ow, ow jakuut!" "nje? haani. ow. ow jakuut!" ("You, you are bad." "Me? No, you. You are bad.").
During the waiting period I was extremely frustrated and emotional, feeling like if anything goes wrong it's my fault for convincing Hawa's mother to admit her, and the world is such an injust place for not letting Hawa receive the medical attention she needs without a toubab bringing it to her, etc. Upon reflection though, the clinics and hospitals she went to before were not as big as Bwiam's, and probably not even staffed by doctors. For awhile I was mad at the doctor for not doing the surgery, thinking he was making excuses, but once I was in the operating room and witnessed what he is up against, I have a profound respect for the work he does with so few resources. The shopital has three generators, two of which are supposed to be functional at all times, but all three are having problems. Meanwhile the director of the hospital is the only person taking care of these administrative issues; he has no help. And the patients just blindly believe whatever they are told because they aren't as educated as the nurses and doctors (none of the doctors are Gambian, they're all either Nigerian or Cuban volunteers). They call the nurses "doktor" because they don't know any better. Meanwhile, many of the nurses are actually still in training. For patients staying overnight in the hospital, they receive one meal a day, and that is for the patient, not the family. There is a cantina on the hospital grounds, but that's for the staff, not family. There are seven beds to a room, no chairs, and nothing to do all day. I brought some Newsweek magazines for surgical patients so they could look at pictures and such, but the nurses took them. Families from the area bring lunches and dinners to their people in the surgical ward, so everyone shares meals. The people on the ward become like a family since they spend at least two weeks there at a time. It's great to be a part of that and greet everyone when I come to visit Hawa.
Kasumai kep!
The biggest thing that's happened to me this month is that Hawa came to visit. Hawa is a four-year-old girl who had a very gross malignant skin ulcer for the last three years! Her mother said the "wound" just appeared (maybe it started as a burn from boiling water) and everytime they went to the doctor the wound ended up covered in iodine or just bandaged, but regardless they were sent away each time, and because the wound was itchy, Hawa scratched at it with her dirty fingernails and the wound spread. So I went with the mother and Hawa to the hospital where my toubab status pushed her to the front of the line, and some volunteer Cuban doctors thought she might have anthrax so they signed an admittance paper and told me to take her to the "ward." When I asked which ward the doctor just said "the ward" and shooed me away. So one of my friends who works in the lab took us first to the pediatric ward, but that wasn't it. Go to the surgical ward, so we went to the surgical ward, and that was the correct place, but Hawa could only be admitted if the surgeon cleared the paperwork, so then we had to go to the surgical clinic and get in line. Again, my toubab status assured that we were at the front of the line, but we waited more than two hours for the surgeon to come. After 11 he came, but hospital staff kept pushing their friends through the door to his office while everyone else was waiting patiently (Gambians are very patient people; they're used to waiting). However I, at this point, was quite frustrated and finally just knocked on the door and went in. Meanwhile one of the nurses closed the door on Hawa's face. Once she and her mother were allowed in and the surgeon looked her over, he agreed she needed surgery and signed the paperwork. So once we had Hawa safely established in the surgical ward I rushed off to school to teach my lessons, then ran home and ate a quick lunch while I informed my host mother as to what was going on, then back to the hospital with lunch for Hawa and her mother. Hawa's mother asked for a few things like clothes so I returned that night with necessities. The next day Hawa was supposed to have surgery, but because her hemoglobin level was low she would need a blood transfusion. So in between classes I ran home, talked with some people, and found a way for Hawa's father to come donate blood, only to find out at 2pm that the surgery had been canceled and the father didn't need to give blood because a donor with her blood came in a gave blood. Her surgery would be the next Tuesday (as surgeries are done Tuesdays and Thursdays). So we waited until Tuesday, but Tuesday brought with it generator problems, so the surgery was canceled again. On Thursday everything was a-okay so Hawa was the first surgery that day (I requested time off from school and had permission from the surgeon to attend the surgery). Hawa came kicking and screaming, but with some laughing gas quited down. Once everything was ready and I was thinking how much like a doll Hawa looked, Dr. Spencer came in with his rubber boots. Using a lamp that looked more like a flashlight for lighting, the scrub nurse cleaned the area (with soapy water) and dried it, then Dr. Spencer began. It took several passes with the scalpel to make it through the tissue, and Hawa bled so much for someone her size--clamps were just blossoming around the wound--and at one point I aided the surgery (I grabbed adrenaline to put on the cut area to help stop the bleeding). After removing the diseased tissue and cutting it up for preservation and testing (it may be cancerous), Dr. Spencer pulled out an inflammed lymph node the size of a lima bean. It was crazy. Once the bleeding was under control, Hawa was bandaged and the clean-up started. First removing the clamps, then wiping up the blood--some of which pooled under the gurney and congealed into a sheet which was partly stuck in her hair--then one more sweep over with the soapy water, cover her up and wheel her away. I stayed for two more surgeries (during the last of which, the power gave out and Dr. Spencer tried to continue blind while the scrub nurses ran around trying to get the power to start up again), then visited Hawa, who was still asleep. Off to school for classes, and when I returned she was awake, in some pain, and in the middle of her blood transfusion. She was not at all happy with me. For the last week we've been waiting to see how the wound heals, and if everything is healthy then Dr. Spencer will perform a skin graft. Meanwhile, Hawa is running around and happy. Whenever I visit she likes to beat up on me and we tease each other in Jolaa: "ow, ow jakuut!" "nje? haani. ow. ow jakuut!" ("You, you are bad." "Me? No, you. You are bad.").
During the waiting period I was extremely frustrated and emotional, feeling like if anything goes wrong it's my fault for convincing Hawa's mother to admit her, and the world is such an injust place for not letting Hawa receive the medical attention she needs without a toubab bringing it to her, etc. Upon reflection though, the clinics and hospitals she went to before were not as big as Bwiam's, and probably not even staffed by doctors. For awhile I was mad at the doctor for not doing the surgery, thinking he was making excuses, but once I was in the operating room and witnessed what he is up against, I have a profound respect for the work he does with so few resources. The shopital has three generators, two of which are supposed to be functional at all times, but all three are having problems. Meanwhile the director of the hospital is the only person taking care of these administrative issues; he has no help. And the patients just blindly believe whatever they are told because they aren't as educated as the nurses and doctors (none of the doctors are Gambian, they're all either Nigerian or Cuban volunteers). They call the nurses "doktor" because they don't know any better. Meanwhile, many of the nurses are actually still in training. For patients staying overnight in the hospital, they receive one meal a day, and that is for the patient, not the family. There is a cantina on the hospital grounds, but that's for the staff, not family. There are seven beds to a room, no chairs, and nothing to do all day. I brought some Newsweek magazines for surgical patients so they could look at pictures and such, but the nurses took them. Families from the area bring lunches and dinners to their people in the surgical ward, so everyone shares meals. The people on the ward become like a family since they spend at least two weeks there at a time. It's great to be a part of that and greet everyone when I come to visit Hawa.
Kasumai kep!
posted by Hannah | 11:47 PM
1 Comments:
Hannah, Hi I have stumbled across your blog and have some similar experiences. I hope that you might e-mail me? My name is Heather and I am married to a Gambian who is currently living in Jabong. I live in Atlanta and am going to school for ultrasound. I have been thinking of going there to work and wanted to know if you have any advice or if I could ask you some questions about your peacecorp experience. Thanks. hhtouray@gmail.com
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