It’s part of the role of Team Leader to accompany unwell volunteers to hospital. Hospital always makes it sound a bit dramatic, but there isn’t really an equivalent of an intermediate “GP’s” here, so for any medical situation it’s directly to hospital. During these trips, I’ve been fascinatedly absorbing all the similarities and differences of medical care in Malawi from in the UK. After several of these quick visits for others during the first couple of weeks, I recently found myself with a very high fever visiting hospital myself, where I then wound up being admitted for two nights.

I wanted to share some of my observations from these collection of experiences in the Malawian healthcare system. I should say these are coming from the point of view of a lay-person outside of the medical profession, and my limited medical knowledge is based only upon growing up on Casualty (maturing into E.R.); having a grandpa who was a doctor and as a patient myself, being very on the ‘inquisitive side’ (something I think quite baffled the medical professional here).

Nearly everything is done on paper. When I saw nothing but a sea of paper on a doctor’s desk, my first thought was that the computer had been robbed. But that’s not to say technology isn’t being used: one doctor checked a volunteer’s tonsils with the flashlight on his phone! I was also given my nurse’s mobile number to call him if I had a problem, rather than having a panic button like at home.

In terms of hygiene, it was a mixed bag. The floors weren’t sparkly clean, the bed sheets and the curtains were ripped (and this was the ‘Private’ ward…) but then again, I often feel like western medical centres are so far sanitised the other way. Bright white everythang. There were other hygiene issues that widened my eyes a little more though, like nurses tending not to wear gloves for taking blood, or there being no soap in the toilet (when diarrhoea is a common symptom of patients).

There are also no food or meals provided, patients are reliant on people bringing it in from outside. When someone is in hospital here they have a ‘Guardian’, a close friend or family member who stays the night with them and fetches them meals etc. My wonderful host mum slept in my room with me overnight both nights.

In the evening, the Chaplain came into my room and prayed for my health as part of his routine. I can’t imagine this just happening at home without a patient’s request, and I definitely didn’t request, but to be honest it was nice social company and we had a quick gossip after the prayer. It was nice to feel that other people were rooting for your recovery, even though I’m mighty glad there was medicine to accompany their prayers…

The most alien thing to get my head around here are diagnostics. With a high prevalence of malaria, that is always the first thing tested once vital signs (temperature, pulse and blood pressure) have been recorded. But if that’s negative, they often still work on the assumption you have malaria as the rapid test is not entirely reliable and there can be false negatives. They can also do a more detailed blood vial test, but yet again, this can be falsely negative.

But beyond malaria, there are big limitations on diagnostic capabilities. Therefore clinicians have to work on assumptions. They look at the symptoms presented and go on what’s most likely based on the cases they’ve seen before. It’s an entirely different way of working.

 

So I was treated with several antibiotics, in case there was a bacterial infection in my blood, or else in my stomach, as well as getting malaria treatment thrown in too – just in case! While I felt at the time overwhelmed by the injections and the thought of my body coping with such a concoction of drugs when I’m barely used to any, I can now see how it’s the most logical way to work under these conditions of limited diagnostic resources. Plus, I got better. It seems to me it’s a creative and effective way to problem solve in this environment.

I received a phone consultation from an ‘International Nurse Advisor’ from my organisation based in the UK and she also added that this working practice means they look at the body a lot more as a whole rather than the narrower, specialised western approach focused on specific body parts. This gives them a chance to piece symptoms together, things specialists back home may otherwise miss.

Still, when people at home asked “What was actually wrong with you?” or “What did they say it was?” it’s bizarre not to be able to give any definitive answer. Three different doctors advised me three different likely diagnoses.

Sometimes I find communication frustrating in these settings too. But on reflection, I think most of these times was me needing to learn the way things work here. On my first night in hospital when I was at my sickest, I tried to go to the toilet after my first dose of injections and proceeded to pass out, hitting my face on the toilet seat (I’ve had an embarrassingly prominent black eye ever since). I was quickly rescued (by superhero duo: Nurse Yami and Host Mum). I kept pointing out my face was sore and I was going to be bruised, but felt like these requests were falling on deaf ears. Looking back, there was probably no ice packs or freezer available. And a bruise on my face was not really their priority compared to getting my fever down.

When discharged, I was also given my oral medication to continue taking in a little blue bag of pills. I didn’t think anything of this until receiving a call two days later from the UK nurse informing me the antibiotic they’d given me was the one antibiotic that actually makes you really sick if you drink alcohol with (other than all the others when they just say that!). Luckily this is a dry programme (and luckily again I’m actually sticking to these rules), because nobody at the hospital thought to mention it when they sent me on my way with a bag of pills and only vocal instructions on how to take them.

Privacy and confidentiality is another difference. Doors are frequently left open during consultations, or random staff come in and out the room. And I suppose this next thing could happen in any hospital in the world, as there is always that weird sense of being on top of one another and needing to exercise subtlety when you hear things, but during my stay in hospital there was a very traumatic situation in the room next door to me. And at one point, the patient’s mother wandered over to me while I was sat by my room’s back door and it was all I could do to rub her back while she repented, wailed, cried and prayed. I won’t go into any more details on this blog out of respect for that family, but their grief spilt over on to me and those moments will be hard to ever etch away.