19/10/11 - Kamuzu Central Hospital

I have finally started work now, after almost four weeks of holiday.
I now work in Kamuzu Central Hospital, at the Gynecology ward. It is a big ward, divided in to two, one for the critically ill patients, and one for the stabilized ones. There are 36 beds on each and from 7.30am to 4.30pm there are six nurses working there. From 4.30pm til 7.30am there are two... Imagine! Working for 15 hours straight! Of course they rest on shifts during the night, but anyways! I feel I have been taken good care of since I started, but there isn't much of orientation to talk about. If I want to know things I have to ask. But everyone is friendly and easy to talk to, so I feel its good.

Kamuzu Central Hospital is Malawi’s second largest hospital, after Queen Elisabeth Central Hospital in Blantyre, and they have 750 beds. They have different wards, Childrens (medical, surgical and NRU – nutritional resuscitation unit), Medical (female and male), Surgical, Burns, Eye, OPD (Out Patient Department), Lab, X-ray, Pharmacy, and the Gynecology ward that I work in, that has several different units, Labor, ICU, Gynae (my ward), Antenatal and Postnatal and Private ward.
The most common diseases we have in the ward, is incomplete abortions (both spontaneous and “criminal”, as they call it here), total abdominal hysterectomy ofogdifferent causes (cancer, fibroids, complications after birth), ovarian cysts, different pelvic abscesses and anemia in pregnancy. So this is a completely new area for me! But I like the challenge, and I think I will learn a lot! And about that; I have to do my CPD (Continuous Professional Development) for Nurses and Midwife Council of Malawi, that means I have to find different aspects under 1. Skills, 2. Knowledge and 3. Appearance. And I have to find goals and things I don’t know much about, and things I want to learn. This is something the nurses here have to do every year. I feel like a student with workplans again! That my teacher have to approve! Well, I just have to do it, so I will. And I had a meeting with the Matron again today, and she helped me a lot with how to do it and what goals to have, so I don’t see it as difficult as I did before.

The hospital is quite different from what I’m used to. Not only the size, but mostly the standard. Yes the building I work in is new from last year, but already it looks like crap! People in this country is not fond of keeping their workplace tidy! There is mess everywhere, and they don’t even try to keep it nice. And this is something I want to try fix!
And the other thing in this place, since it is a government hospital, they don’t have a lot of money. So things are out of stock all the time. There is so much things missing, there is hardly any gloves at the ward, and surgical gloves not at all, the only cannulas they have are grey, sometimes you can find a green one, the strapping we use is useless (!), but what is most disturbing is about the medications. This week there is no Paracetamol, Ibuprofen, Pethidine, Ceftriaxone, Metronidazole, Ciprofloxacin, and these are all crucial medications in so many of the cases we have in the ward. But the medication is just not there. So what can we do? Our best...
The post-operative patients gets pain relieve from Tramadol or Diclofenac. And this is some heavy shit surgeries they go through! Today I met a girl, 16 years old, at 6am this morning they fixed her ileus, open stomach surgery, (why she was in my ward is a mystery), and this morning at 9am we came to do her bed, and she was told to sit up and get mobilized, and to take deep breaths to prevent pneumonia, and this girl didn’t even make a sound. I couldn’t even see at her face that she was in pain. The people here (especially women) are so tough, they take pain so different from us, they don’t even cry giving birth. And when we came to the next bed, there was a lady who has had a different surgery yesterday, and a different scar, she complained trying to sit up, but the nurse told her to not complain, “cause look at that other girl, she had a bigger surgery than you”, and she didn’t complain. She just kept quiet. I think it will be very challenging. And yesterday we had a girl who was to drain an abscess, and when giving the local anesthetic she was in so much pain, she screamed so loud, and then she just lost it. She was not completely unconscious, but didn’t respond to any pain or verbal approach. Her pulse was OK, respiration a bit fast, and I wanted to take a bloodpreassure. But could I find a stethoscope? The doctor that was there didn’t have his, and there was no in the ward, and no one knew where I could I find one. So I couldn’t take her bloodpreassure. We gave her intravenous fluids and after a while she came to herself and was completely normal. I don’t know what happened. Maybe the pain just knocked her out!?

I started off good yesterday by walking from work, and today I walked to and from. It is a 50 minutes walk, and I enjoy walking long distances again. At home I walk alt, but the time I have spent in Malawi, and last time, I hardly move around on my feet. We drive everywhere!
And this week I tried the pool for the first time, cause the weather now is very nice, a bit too hot in the middle of the day, so it was so nice to come home yesterday, hot from walking from work, and jump in the pool! I will try to keep it up, and do some rounds with swimming, its good exercise!

Enough about work. Last weekend I was at the lake with Gunhild and Ingrid, and we enjoyed! We went to Cape McClear and Mufasa Lodge, it was a cheap but nice place, and nice people. We mostly relaxed and enjoyed the sun, and came back Monday relaxed and ready for a new and exciting week.