Adult Ward; February 16, 2007

I shadow D, who for the last few days has been working in the adult ward in the main hospital of Malawi, Kumuzu Central Hospital. I thought things were overcrowded in the pediatric ward where E spends most of his days. It's just as bad or even worse in the adult section.

We're on the second floor of a 4-floor building, dimly lit, mainly by ambient sunlight. The hallways have a faded, light blue color - perhaps a slightly improved hue when compared to the children's ward, but still nothing to rave about. Why someone chose these colors I do not know.

It seems it's just a matter of jumping right in - no forms needed to be signed, no people we need to talk to, just enter a room and start looking at the paperwork, forms and health passports that were also prevalent in the children's ward, and dig in.

The adults are not afforded any real privacy. Each room houses, or 'fits snugly', around only 6 or 7 patients, if they're lucky. Some people appear sicker than others. None really speak much, some are talking quietly with family members that are sitting and waiting with them. The patients lie on basic cots, and their wares, whatever they have lugged with themselves to the hospital, are placed on a ledge or near a small dresser next to their bed. Many sheets of linen look like they could use a washing. I'm sure most of the people would welcome a shower too. Certain rooms, sections, smell worse than others. Still that light blue color. And the waiting.

D first heads to the High Dependency Unit - this is a room where patients requiring more attention get placed. Yet it seems as though there's not enough help to go around. Once we've worked through what he can there, D leads me to through one of the rooms to the outside balcony - which one would assume is a place for patients can grab a fresh breath of air.

Now, while this area may indeed allow patients to alter their air quality for the fleetest of moments, this space also serves as a run-off section for patients that did not have a bed/room to get placed when they were admitted into the hospital. And it's heaving:

We start looking at a sick patient's record - I notice the handcuff on the metal railing next to the guy - and he is coughing a lot. Welcome to the 'tuberculosis area', complete with a small, cordoned off 'Coughing Room'.

This guy has been admitted from jail - and I don't want to imagine what sort of conditions he came from. D recommends to the clinical officers present that this guy get his left side tapped - that means, I learn, that they intend to attempt to drain this patient's incapacitated left lung. And it's off to the next patient.

Some people, even with my non-medically trained eyes, look like they're in the late stages of AIDS affliction. And they are. D provides counsel to a healthy looking brother who is sitting next to his supine sibling who has been wasted away by HIV. I don't see any resemblance between the two brothers.

Dr. Devang Patel perfoming a thoracentesis

We head to a narrow room, no windows, to pick up with the prisoner where we left off. The clinical officers bring in the equipment for the procedure.

Equipment. Many things are not available, so you need to be imaginative and creative with the supplies that are available.
I'm not liking the size of that needle - it looks too big to me.
The gaunt fellow, barefoot and wearing only shorts, sits slumped on a stretcher. And then the needle arrives and goes into the middle of the left side of his back - pop! - no anaesthesia.

And soon enough, dark red stuff starts flowing through the transparent tubing, ultimately ending up in a medical plastic bag.

And when all is said and done, this guy has deposited 2.5 to 3 liters of reddish liquid out of his left lung.

I notice a solitary potted plant growing in the the center open area. It appears strange to me and out of place, so I snap a photo.