Wednesday, February 10, 2016

Upendo Ward

Upendo means love in Swahili. It's a fitting name for the ward that I am currently rotating in at Moi Teaching and Referral Hospital (MTRH). Upendo Ward is on the 2nd floor (3rd floor in american standards) of the Shoe 4 Africa Children's Hospital. This huge building is the newest on the MTRH compound. Bright yellow and blue accents contrast with its plain concrete sides. The building is simple. All concrete, no elevator but plenty of windows.

When you walk into Upendo or any of the other wards you first notice uniformed nurses and people in white coats walking around slipping into corridors to either side. Despite being one of the largest buildings on the campus it still has too few beds for the patients. As you turn into one of the "cubes" or rooms for the patients you notice many people standing, sitting or laying down. Each "cube" has 12 beds. Each bed is resident to two children and their caregivers. Often four or five people will share a bed.

Other than the large number of people you will see large metal oxygen cylinders, most split for two children sharing one tank. This provides poor oxygen delivery to both children but there is no other way as oxygen tanks are hard to come by. Fluids and blood bags hang from poles suspended from either side of the patients beds and personal belongings are strewn about the floors.

Children cry in pain as their caregivers try to comfort them. To your right is a boy with cerebral palsy, left to die on the streets of Eldoret. He cries for food so often that you wonder how he could be so malnourished.

Children with blue lips and fingers gasp for air as their mothers cradle them. Another girl with a huge abdominal mass sits coloring a paper. A boy with hemophilia rolls by you on a rusty old wheelchair. Children lay unresponsive on beds as their bodies try to fight brain and blood infections. Mothers fan their children who are febrile from malaria. A boy with a mass on the side of his face wanders in and out of the room. A girl barely able to see stares out the window from her bed.

A girl grunts as she takes her last breaths, her mom wailing, but she is pallative, so all we can do is calm the mother. Other caregivers come over to offer condolences and kind words. In the next door room a priest yells loudly over a girl in her bed as she convulses ... now she is cured.

Its a sight I never see in the states. Its a scene attributed to poverty and corruption. A scene that could be prevented had resources been divided equally. Often I am frustrated at the doctors and nurses that they don't do more, but what can they do? Nurses work tirelessly day and night administering medications, food, cleaning patients, hanging bags, checking vitals, bedside blood sugars and comforting caregivers. One intern covers over 50 patients all night while the residents and consultants (attendings) moonlight at private hospitals to make a living.

Illnesses such as pneumonia and anemia that can be treated successfully elsewhere lead to death because we lack oxygen and enough blood. Everyday we see children suffering or dying due to congenital heart diseases that are treated at birth in the states. Children die of type I diabetes because they have no access to daily insulin while at home or the tests that would check for metabolic disorders are not provided where they live.

I asked the intern yesterday, after we finished seeing a patient with a congenital heart disease, "What will we do next?" He shrugged and replied. "Nothing." In reality we do a lot with what we have, and if all else fails, we just provide love. Isn't that the most powerful medicine anyways?

The Intern and I

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