I have been waiting to write about this topic, because I wasn't really sure what to say about the current state of the healthcare system here. The best way to describe it is to begin by saying that there is a great deal of injustice here in Tamatave. Ever since the coup in 2009, funding for the healthcare system has been cut drastically. There are very few resources available in hospital. In fact, there is no oxygen running through the surgical wards, no ambu bags in case they need to provide CPR. Chemotherapy and radiation do not exist in Tamatave - they are only offered in the capital city of Tana (a 9 hour drive away) and are incredibly expensive.... so a cancer diagnosis here is basically treated by palliative care. They have basic sterilization for tools to use for wound care, but no supply room with shelves filled with dressings in every material, NG tubes, plugs, IV catheters in every needle gauge, a PYXIS machine. In fact, there is so little money for the hospitals here that patients are expected to provide everything needed for their care. And when I say everything, I mean EVERYTHING. Every single medication, IV needles, tubing, syringes, gauze and tape for dressing changes, gloves and alcohol for the staff to use are bought at the local pharmacy. Sheets for the bed and food for the patient must be provided by the family. A wonderful, entrepreneurial woman has taken it upon herself to clean the restroom (so at least it's useable), and then charges for her services there. Family and caregivers are charged to use the restroom, 100 Ariary for pee and 100 Ariary for poop. And the nurses? Imagine being a single nurse caring for, on average, FIFTY (50!) patients over a 24-hour shift. That is the normal schedule here. In fact, only four nurses are employed by the surgical ward and they rotate days. How is it possible to spend time with each of your patients and their families when you have thirty dressing changes to attend to?
As for the patients? A woman in the middle of an asthma attack must have a prescription for an inhaler written by the nurse or doctor at the bedside, the family then runs it (literally) to the pharmacy to buy it while she struggles for breath. And what happens if you cannot pay? Then you cannot receive care. And it's not because the staff does not WANT to provide care, but rather it's because they lack the resources to do so. The operating room has basic sterilized instruments, but everything else required for surgery must be provided by the patient. So if you come into the hospital needing surgery but cannot afford the supplies, they cannot help you. There is a financial aid office that they can apply to, but it is open only regular office hours. So when a woman came in on a weekend needing an emergency C-section because she was in obstructed labor, but was unable to pay, they had to turn her away. Where is there left for her to go? When an eight year old boy came in with an open fracture (bone sticking out), his mom just took him home because she could not afford the repair. A cancer patient with severe anemia stays there laying in bed because her family cannot afford to buy blood from the blood bank across the street and they are not matches. I see both the doctors and nurses being incredibly frustrated by their patients having to be turned away or choosing to leave without receiving care because it is simply too expensive. A total prescription bill for a patient this week was 24,000 Ar... that's about the equivalent of $9. However, the patient was unable to afford everything recommended for treatment so the nurse had to help them pick and choose which items were the most important for their care. It breaks my heart. It is difficult to see people who could be treated so easily at home, suffer because they simply don't have the necessary medications or equipment to treat them as we would. Although the American medical system is deeply flawed, at least those in need of emergent care are not required to pay in cash before they can receive it.
However, the patients themselves are incredibly generous towards one another, offering to share their tape and gauze when the patient in the bed next to them cannot afford it. There are many car accidents here, and several times I have seen other people offering to pay for the patient's care. In fact, a young boy had his foot broken by the wheel of a car rolling over it, and the driver came to the hospital every day to check in with the nurses and see what supplies they needed in order to care for the boy. A man was hit in the street and a passer-by drove him to the hospital and paid for his initial treatments. Even in a place where people may not have very much according to American standards, they are incredibly generous with the resources they do have.
The hospital itself looks like an abandoned building. Our nurses will actually be going in to clean up and paint the surgical ward, but Mercy Ships is currently in the process of updating and renovating the original medical ward. Just so you can get an idea, here are some of the before pictures:
Amidst all this, I have still been greatly encouraged by our partnership with the local nurses on the surgical ward. They are amazing. They are incredibly knowledgable, and excited to work with us. They work impossible hours at the local hospital and are still enthusiastic when they come to the ship or back to the hospital for education on their days off. I call it a partnership, because I feel like I have learned just as much, if not more, from them than they have learned from us. I have spent two days a week by their side at Hôpital Be, and they come to the ship to work on the wards with us for two days a week and receive education. Although they don't have the same resources as us, they are incredibly innovative. I have seen them make a negative pressure drain system out of a syringe, some tubing, and an extra plunger. They are the MacGyvers of the nursing world. We have started to see some positive changes in their practice as well since we have been here. After explaining on the Africa Mercy why we swab injection ports on IV lines with alcohol before injecting anything, I noticed the nurses gathering cotton and alcohol from their patients so that they could do the same. They are talking amongst themselves about the topics that we spend time developing teaching sessions on. Every day there a little victories and we are able to offer them some much needed encouragement and support! The program will now offer those same things to the pediatric and labor & delivery wards in the hospital as the year goes on. Then, in April/May, Mercy Ships nurses will be returning to the surgical ward for another four week period. Although my official mentoring time has come to an end (for now), I am excited to continue building relationships with these nurses. They are really the most wonderful and inspiring people! Plus, they have the best senses of humor! I am not exaggerating when I say it has truly been an honor to work with, and get to know, each of them. Here is a photo of our lead educator, Amy, with some of the local nurses and translators that we work with, my friends:
This Christmas season, I am reminded of how incredibly blessed I am to be working on a hospital ship with so many resources and supplies... everything I need to take care of my patients is right at my fingertips! Please continue to pray for the work we are doing here in Tamatave, and for all the local healthcare workers as they continue to provide care in such challenging circumstances.
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