Today was not easy, to say the least. We've been spoiled by feeding giraffes and playing with babies every day, but today was our wake up call. We spent the morning in Kenyatta National Hospital and the second we walked in the front door, I knew we were in for it. The smell literally hits you like a ton of bricks. Nothing could have prepared us for it. I remember talking to Aunt Maryanne about the hospital conditions on a few different occasions, but I never imagined it would be like this, especially so many years later. We were taken up to 7D (the adult ward) and with every step up the stairs, the smell grew stronger and stronger. The pungent smell of sweat from the fifty something patients in the waiting room when we first walked in seemed like a flower garden by the time we opened the 7th floor doors. I thought I was going to throw up, and that's not an exaggeration. Anna (we were partners for the day) and I literally had to hold it down on multiple occasions, it was absolutely miserable. And I don't even mean just for us (although it was awful), but for the patients, nurses, and doctors working in these conditions. We actually got to do rounds with a group 5th year Medical students and a couple of doctors/consultants, which would have been interesting had we been able to hear/understand a word they said, but it was still pretty cool... at least in the sense that we got to see what actually goes on behind the scenes. Not so much in terms of the conditions or the manner in which daily processes are carried out. I obviously couldn't take pictures of the rooms, so I will try and describe it the best I can. They were about the size of any normal double hospital room, but there were not 2 patients in the room and they were most definitely not being attended to the way we would be in the states. Each room held 10 patients, 5 on each wall with about a foot between each bed... just room enough for a filthy "bedside table" (an old rusting pile of metal) covered in empty bottles, rotting food, and the occasional (prepare yourselves) cockroach. The beds were a whole other story. They looked like they had been pulled out of a dump; old metal frames, falling apart under the patients, and covered with "mattresses" that looked like old gym mats that didn't even fit on the beds. There were no sheets or pillows, just a blanket covering the mat and another covering the patient. And as for privacy? There was none. Each room had a few curtains that could be pulled around the bed if necessary, but considering the cramped space, there was not much use of them. We even saw beds in hallways because there was not enough room for them in the actual rooms. And the smell was unbearable... some rooms were worse than others. One room I almost had to leave; a nurse walked in and went over to a bed that I thought was empty until she lifted the covers and I saw the woman who was literally a sack of bones lying there. The nurse stripped her down in front of the other 9 patients, Anna and I, and the 15 plus doctors/students (without even closing the curtain around her bed) and I was honestly shocked that she was even alive considering her condition. She couldn't have weighed more than 30 pounds, no exaggeration. I swear I couldn't tell she was even in the bed it was so bad. After she stripped her clothes off, the nurse pulled out a bedpan and just drained her catheter like it was no big deal. I was doing everything in my power to suppress my gag reflex; I felt like I was breathing in poison. There are some smells you get used to, but not this one. Maybe after years of experience with it (the med students didn't even seem to take notice), but I couldn't believe that she was just dumping it into a bucket and carrying it through the room. Sanitation did not seem to be of any concern. I also saw a nurse take a blanket from the bed of one patient and put it on the patient in the next bed over. No one was wearing gloves when working with the patients either... I later found out that this was not out of neglect for sanitary precautions, but out of inability to afford them.
I wanted to cry thinking that this was typical expectation for these people. If any hospital in the United States fell into such conditions, we would be in a state of emergency, no doubt. In the states, when a patient has TB, they are put into extreme isolation so that no one, not even the doctors, can come into direct contact with them until they are treated and out of the contagious stage; infection control is very well developed. In Kenyatta Hospital, the "isolation rooms" were rooms with maybe 5 people instead of 10 and the windows were left open for ventilation, as one of the nurses told us. Of course we won't ever have an issue because our immune systems are not and probably will never be compromised as the African's are. Therefore, even if we test positive for TB (which we probably will upon return to the states) it will never become manifest TB. Anyway, every room was a different story but the horrifying conditions remained constant pretty much the whole way through. Another thing I was in complete shock about was the fact that there was not a single computer in the whole ward... all the medical records were written out by hand on what were basically scraps of paper thrown into a ripped up folder with a name scribbled across the front. I actually watched a girl drop a strip of ultra sound pictures on the floor (because nothing was secured into the makeshift folders), realize it 10 minutes later, and then poke a hole into it with a pen and put it into the single clasp in the folder. Not only were the records a mess, but there was no record room; they just sat on the bedside tables or under the beds of the patients, along with any x-rays they might have had. I really couldn't believe it.
After rounds, we left for lunch and then went to Nairobi Hospital, which is a private hospital (as opposed to Kenyatta, which is public) to speak to Dr. Orsono about the differences in the two hospitals. She had been a resident at Kenyatta several years ago. She told us that at one point, Kenyatta was the best hospital in the country with top of the line (for a developing country) equipment and services. That was before the population skyrocketted and doctors started leaving to find better opportunities. She said that among the many problems we witnessed today, there are thousands more we can't even begin to imagine. For example, there is little to no running water in Kenyatta Hospital and for that reason, many patients (especially children) die of dehydration complications. Remember that next time you leave the sink running for an hour, Mom. At this point, they are lucky to even have physicians at the hospital and a majority of them are only med students. Nairobi Hospital on the other hand is very clearly a private hospital. The building was actually really nice, there were no unbearable smells, floating through the halls, and the equipment was much more state of the art. It was really upsetting to me to see such a high end facility directly across the street from such a low end one and know that even though everyone should be receiving the same type of care, only a few can afford it.
Something needs to change.
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