Shibwe Sub-District Hospital

I have finally become a doctor! Well, not actually… But I have just finished my first week working at Shibwe Sub-District Hospital. The hospital is set up like a compound – there are about five different buildings that are arranged in a half-circle. The main building has the Consultation Room, the Laboratory, the Pharmacy, the Records/Public Health Office, the Injection Room, the Mother/Child Health Room, the Family Planning Room, and the Male Ward. The next building is the Female Ward, which also contains the Labor Ward. The third building is called the Comprehensive Care Center (CCC) and is where the HIV/AIDS patients go. The CCC acts separately from the rest of the hospital, though. Most of the workers are volunteers who have HIV and are the ones to counsel the rest of the patients. Interestingly enough, USAID donated the CCC to the hospital. The last two buildings are the Administrative Office and the kitchen.

The hospital does AMAZING work with the amount of resources it has. It sees more than 100+ patients a day, but only staffs about 2 nurses and 1 clinical officer at a time. There is no actual M.D. working at the hospital – only clinical officers who examine and diagnose the patients. The hospital is in great need of employing more nurses and clinical officers but does not have enough funds to do so. Therefore, the nurses who are working run back and forth between all of the rooms and wards in order to see all of the patients. They do not have one second to breathe. There is no running water in the hospital so everything is sterilized in buckets and the patients need to go outside to the pit latrines to use the bathroom. (This turns into a huge problem (as I have seen already) when patients are in the Labor Ward…) Moreover, there are not enough beds in any of the wards, so many of the patients must share with one or two others to a bed. They also do not use files to maintain patients’ medical records. Instead, patients keep their own notebook to function as their medical file and bring it each time they visit the hospital.

This past week I have mainly been observing each department in the hospital in order to learn how it is being run, and so that I can do a proper needs assessment for my project later on during the internship. I have spent most of my time, though, in the Consultation Room and the Female Ward because that is where they have let me do the most hands-on work. While I was observing the Consultation Room, the clinical officer working would let me examine the patients with him. He taught me how to measure blood pressure and how to do a full-body inspection. He would translate what the patients were saying to me and explain to me his diagnosis. The next day while I was in the Female Ward, the nurses took me on their rounds and allowed me to give out the medicines. They also taught me how to set up an IV and how to examine a pregnant mother. It’s been fun playing doctor!

It is actually UNBELIEVABLE how many patients come with malaria. My supervisor was right when he told me last week that it is easy to diagnose a patient with malaria. It is “malaria season” right now because of the heavy rains (it is winter in Kenya) so about 90% of the patients come with malaria. Some are simply treated with medicine and can go home, but others who have severe malaria are admitted to the hospital. There was one child who had severe malaria who started convulsing and stop breathing. I was so afraid that he was going to die but luckily the nurse was able to resuscitate him. The malaria medicine is free of charge (thankfully!), as well as prescriptions to children under five and to pregnant women. But the rest of the prescribed medicine must be paid for, and on average, costs only about $3. There are MANY patients, though, who cannot afford this and are unable to buy the medicine that is prescribed. I felt so tempted to give money several times to some of these patients, but FSD strictly forbids us to do this.


A few sidenotes:

1. I rode on the back of my first motorcycle (pikipiki)! It is another type of taxi here and a bit more expensive than the busses (matatus), but much more fun!
2. I may have come down with the flu today. The four-year-old, Daryl, is sick and I think may have gotten me sick too. The FSD team took me to the doctor today who tested me for malaria. Fortunately, my time for that has not come yet. I just have a high fever and a bad headache, so he gave me some painkillers and an antibiotic. (I am not sure why he gave me an antibiotic if it is the flu, though. I can’t decide if I should take the medicine.) But hopefully I should be feeling better by tomorrow.