On Monday and Thursday of this week, I joined Arun, a UPenn MD-PhD student, on his rounds at the Deborah Retief Memorial Hospital (D.R.M.H.). DRMH is a district hospital located in Mochudi, about a 30 to 40 min drive by car to the north of Gaborone, and a 1 to 1.5 hour bus ride back.
On both days, I started out my mornings by waking up at 6:30AM, leaving the house at 7AM, getting out of of the car at 7:45AM, remarking on how cold it is (it’s at a higher elevation and therefore much colder than Gaborone!), and then trudging up the hill to morning report. Around 8:30AM, the doctors disperse to go on rounds at their assigned wards; they rotate between the wards every other week or so.
This past week, I observed at the Female Medical Ward on both days with Arun, since he was providing very thorough and helpful explanations of the different patient cases we encountered. Of the patients in the ward, I met an asthmatic patient with a cold, a CVA (“Cerebral Vascular Accident”, aka stroke) patient, a patient with a clinical diagnosis of Alzheimer’s, a patient was a suspected DVT (Deep Vein Thrombosis… aka a clot), a jaundiced patient, and a hyperglycemic, diabetic patient in a coma. To confirm the diagnosis for these patients and to monitor the effectiveness of the treatments, a lot of tests need to be done and sent to the lab and back. That’s often the rate-limiting factor at DRMH — with its limited supplies, lab tests often need to be done at Princess Marina Hospital.
[As a side story: In the case of a patient who needed to do a blood test, the lab technicians said that since they were out of a necessary reagent, the patient had to be transported down to Princess Marina Hospital to get his blood drawn. They refused to draw the blood at DRMH and send just those samples down, so Arun decided to do it himself and transport the blood down to the PMH lab in the afternoon for testing.]
I took a picture of the tests that are often requested, and plan on doing some more research on each of those tests to see if there’s any potential for a global health technologies project.
While Arun and the doctor rounded the patients with tuberculosis, I stayed inside the nurse’s office since I didn’t bring an N95 mask and wasn’t in the mood to catch TB. While waiting there, I had an interesting conversation with a nurse about the challenges that DRMH faced. She listed several things:
– lack of equipment; patients often had to bring their own blankets, and there aren’t any functioning heaters in the wards
– dysfunctional cardiac monitors
– outdated computers (the ones that are the size of a microwave)
– lack of oxygen outlets; sometimes the patients need to be moved around so that those in need of oxygen can be placed near an outlet
– old beds with broken brakes and missing wheels
– a shortage of ambulances; for example, sometimes patients need to be transported from the female medical ward at the top of the hill to the x-ray machines at the bottom of the hill
Although these weren’t exactly the challenges I was looking for in terms of a global health technologies senior design project, the nurse’s comments offered a truthful depiction of the state of conditions at not just DRMH, but quite a few other district hospitals as well. Interestingly, when I discussed what I’d learned with Mma Monare, she told me that it wasn’t really a lack of resources — Botswana had enough money to fix all those problems that the nurse had mentioned — but rather a breakdown in the supply and distribution chain somewhere. She said that when she was the matron at PMH, she frequently found piles of new linen and blankets in storage closets, completely unused. She also followed that comment by telling me the story of how she’d tried to get the heaters and air conditioners in the IDCC offices to be fixed for an entire year without avail.