A Visit to the Pediatric Ward

24 June

This is the part I have been avoiding. Went up to Kamuzu Central Hospital during visiting hours this evening. People everywhere. In the hallways. In the courtyard. Visiting family, taking care of them, feeding them with food they brought from home.

Realized at one point I was following my usual New York City subway routine, looking at people's feet so as not to make eye contact. Most people wore shoes, sandals or flip-flops. One young woman walked by in bare feet. Decided to raise my gaze.

Actually a pretty quiet place considering how many people there were. Everyone subdued, hushed, even the children. Didn't notice any particular odor. In fact, I realized it didn't smell like a hospital—didn't have that anesthetic smell that hospitals in the U.S. have.

Went into one treatment room where there were a couple of nurses. Learned there were about 200 babies on the ward that night—with six nurse technicians to watch over them. One nurse said they had no R.N. supervising them that night. Then she quickly reconsidered and said that they did indeed have one RN. The night shift comes on at 4 PM and doesn't leave until 8 AM tomorrow. They get one meal during that time.

Twenty years ago, nurses worked four different shifts to cover a 24-hour period. Sometime in the 1990s, I have been told, the Ministry of Health could no longer afford four shifts and so switched to two shifts. The day shift runs from 7:30 AM to 5 PM (nine and a half hours) and the night shift runs from 4:30 PM to 8:30 the next morning (15 hours).

Would like to nail down the timing of the shift and rationale—was it to meet the demands of the international finance community for structural adjustment? New priorities in government? A result of the burgeoning AIDS epidemic which increased patient loads while at the same time taking a toll on health staff?

Passed by a room with an empty incubator. In a flash I remembered my
mom's stories of how I was born seven weeks premature in wintertime
and spent the first couple weeks of my life in an incubator in a French hospital. Then after two weeks they took me out and placed me in a crib near the radiator because another child needed the incubator and by then I was strong enough to survive.

The main room on the pediatric floor had about 40 cribs lined up along the walls separated one from the other by perhaps a foot and a half of space. A few babies in the beds, most of the rest on the floor with their mothers, aunts or other women eating nsima, a maize-based meal sort of like grits. Family members or friends have to bring food to the hospital for patients. The women stay with the children overnight, sleeping on the floor.

A single junior clinical officer was squeezed behind a table in a corner of the room. A baby scale dominated about half of the table, where he was filling out a form. I asked what the majority of the children were sick with. Malaria, he said. Even though this isn't the rainy season? Yes, if it were rainy season there might be four babies to a bed. Now he was guessing two-to-at-most-three babies to a bed.

Talked a bit in another room with the father of a nearly two-week old baby being evaluated for a cleft palate. Then visited the orthopedic ward for adult males. Talked with a nurse who was washing her hands with a bar of soap that was—no exaggeration—the size of a vitamin pill—one of those translucent vitamin E capsules. She said there were two nurses on duty in the surgical ward for 56 patients.

Just a little further down the hall noticed a strong odor for the first time—smelled like wet, fermenting straw in a stable. Looked through one of the open indoor windows (used to provide light and ventilation) and saw a man lying on the bed, his leg propped up with a very bad burn down the side of his calf.

Twenty years of living in New York City has taught me how to avert my gaze. I tried to imagine myself in the place of the doctors and nurses here who work here every day. How quickly it would all seem familiar, even normal to have three babies in a crib, moms sleeping on the floor, miniscule bars of soap, no blood for transfusion.

There are a few special people who are motivated by such conditions, who get angry and vow to change things. Most of the rest of us just find it depressing and overwhelming. It's natural to turn away and think the need is so great, there is nothing we can do.

And a lot of time I think the dramatic, darkly lit photographs that we see from the poorest regions of Africa simply reinforce that sense of hopelessness and helplessness. They provide an excuse for doing nothing since nothing seems possible.

It's human nature to long for hope, to respond to places where changes are being made for the good. Not to whitewash or be a Pollyanna but in order to imagine what is possible and what is right. I know I will have to keep looking to get the whole picture—good and bad. The goal is to understand more and more without losing the will to action.

How did the Chicken Cross the Road?
On a bicycle of course. In the car traveling from one appointment to another in the early morning with my very careful and punctual driver Steve, I spotted several men on bicycles with about 20 or more fluffy white chickens dangling upside down from the handlebars.

Most of the chicken I ever get to see comes wrapped in plastic with its skin shorn off in the refrigerated section of the supermarket. But even this landless urbanite knows that live chickens are fairly docile hanging upside down like that. What a practical way to get fresh chickens to market.

Tackling Tough Topics
Spoke with Dorothy Ngoma, executive director of the National Organization of Nurses and Midwives, this morning. After I told her a little more about my project, she laughed, and said, "You don't go for the easy subjects do you?" This is not the first time anyone has pointed this out to me.

I told Ngoma that I wanted to write about nurses in Malawi because nurses are interesting and because they form the backbone of the health care system here. And Malawi is particularly interesting because the government launched a program here three years ago to try to entice nurses to stay here instead of emigrating to England, Ireland, the U.S. and other rich countries. Much of the funding for this program came from the Department for International Development (DFID) of the United Kingdom.

Indeed this is the only program in the world, as far as I can tell, in which donor money has been used to help pay top-ups or extra stipends for nurses and other health care workers in the Ministry of Health. Usually international money will go for building clinics, buying medications or vehicles, paying for consultants or program managers but this is the only example I know of where donor money has gone into salaries of the people who provide health care day in and day out.

Of course, I said, it would be very hard for me as a journalist to go into great detail describing a health system as a health system. Reading, watching or listening to something about health systems sounds too much like homework for most folks. And I have to admit it's not that attractive for me as a story-teller either.

That's where the hard part and the creativity come in. People respond to stories about other people—especially if they are meeting challenges. If I do it right, I can tell stories about nurses in Malawi and still get across a lot of information about the health care system. I'll be able to show why focusing on more than just jobs or buildings in the health care sector is so important, how good roads
can improve maternal mortality rates, why you can't just double the number of nursing students without also paying attention to quality control and so on and so on.