We came from America to work in a rural hospital in Malawi. Since our team was already working in the trading center of Mponela we decided it would be the rural hospital in this community where we would set up shop. This way we could learn firsthand what it was like in one of their front line facilities before we set out to persuade others to come and work along side us. Before leaving the comforts of America I had read the book “Out of America” by Keith Richburg, the bureau chief for the Washington Post. Keith had come to Africa to find his roots and found himself based in Nairobi, Kenya and traveling from one war zone to the next. During the course of his travels he had gone in and out of a number of African hospitals. Some of his descriptions were a little more vivid than the average layman would want to experience. His words embedded themselves deep into my intellect. I played them over and over in my mind.
“In almost every place, conditions were, to put it mildly, disgusting. Stiflingly hot, windowless rooms, with flies swarming through fetid air. Patients stacked up almost on top of one another in crowded wards. Blood everywhere. Sick people, most likely with TB, coughing uncontrollably in open wards. Family members lining the hallways and packing the courtyards, cooking meals for patients inside who might not otherwise eat. If you weren’t sick before you went into an African hospital, I always mused, you most certainly would be by the time you emerged.”
Page 128 “Out of America”
“I would feel a great weight of sadness wash over me, as thick as the stale air of death that hangs over so much of Africa. So many Africans died needlessly, it seemed to me, from infections and diseases that could be cured so easily with a simple injection or a week long supply of antibiotics.”
“I also thought that perhaps these Africans thought the same way I did — that there was no use in going to a disease-filled African hospital because in many places the hospital was simply a place to die.”
“But this is up-continent from us” I thought to myself as we walked along the dusty rut filled road toward the beige earth colored buildings that marked the location of the rural hospital in Mponela. “And besides, this is Malawi. This country does not know when it has been in a war. Keith is described the conditions in a war-torn country. Of course their health-care situation is going to be desperate. And on top of it all I am a nurse and I am accustomed to medical conditions. I have seen it all of my life.”
The hospital we entered was considered to be characteristic of most of the rural hospitals in the nation of Malawi. We realized it would probably be a hot zone for HIV/Aids, TB, and every other tropical disease that is characteristic of this part of the world, and that is why we wanted to come here. Front line. In the action. Being where it is taking place. Seeing it all.
“Nothing prepared me for what I saw during our first day of working in the hospital,” I said with my eyes closed, recalling the nightmare that I experienced that first day. “We first entered the men’s ward. The smell was overwhelming: Urine. Man after man lying on old, ragged, threadbare cots. The mattresses were ripped and torn. There was no linen except what the families had brought from home. I could hardly believe what my eyes were seeing. This was not a war zone. These were not causalities of genocide. This is a peaceful country. A kind and gentle people. Why were they suffering like this? Why these conditions in a country that is so pro-western? Why this place?”
“Next we went to the women’s ward. The smell was not quite as bad, but almost everything else was the same as we had seen on the men’s side. Old mattresses torn and ripped. Only the linen brought from home. No food except what the families prepared, often on charcoal or wood fires they built right there on the grounds around the hospital. There was no privacy. There was almost no medicine. And we quickly learned there was no doctor. Almost all of the work fell on people that are trained to about the level of a paramedic in America, and to the midwives. There were 20 small cots in the women’s ward, ten on each side of the room. There was no heat, no air-conditioning, and the windows stood open with flies everywhere.”
“Next we went to the labor room. Three small cubicles. Again, wooden beds and torn mattresses. Women with no linen, naked, trying to deliver. There were no curtains and no privacy. There was no medicine for the pain, no antiseptic and surprisingly there was no screaming. I guess when you learn it will do no good to express pain you stop feeling. They were just breathing and pushing, trying to deliver. I realized they did not even have anything with which to tie off the cord after birth. The forceps did not clamp tightly together. They had broken, probably years ago. The scissors were broken as well. The nurses would use pieces of gauze dipped in antiseptic to tie off the cord. The baby would then be free. They were laid, with no wrap or blanket, on a cold metal scale. They just laid there on that cold metal and cried.”
“Then I watched a strange thing happen. Up to this moment I had been in an African hospital. Third world. Nothing. No resources. But then, they brought the baby to the mother and laid it on her breast, and it was just like in America. The love between the mother and her newborn baby was the same. The holding. The cuddling. The pride. Mothers are the same everywhere.”
“A little way down the hall we looked in on the pharmacy. The director was so proud of what he had on hand. But, by western standards there was almost nothing. The smallest drug store has far, far more on hand than this entire hospital. They were out of most medicines and had no idea when more would arrive. Even Tylenol, or Ibuprofen, or even an aspirin. There was none. Anywhere in the hospital.”
“In this hospital of no medicine and no supplies, they open every day, all the time, year in and year out. They come to work to help the suffering. All over this tiny nation they come to work every day to help the suffering. They do it because they are medical professionals and they do it because they care about people. I would later learn they were there that day working and none of them had been paid their salaries for over three months.”
“At the end of the day we walked back to the tiny brick house where we were staying on the south side of the trading center. Words cannot really describe it. Neither can pictures. You have to be there, there in the middle of one of the wards, with its sounds, its smells and its suffering. You have to be here to fully understand what it is like in an African hospital, even in the part of Africa where there are no wars.”