St. Mary's Hospital, First Day

Today was our first day of rotations. We are at St. Mary’s Hospital this week, and were in Surgery Theatre for half of the day, and outpatient rotations for the other. We firstly got a tour of the hospital grounds, and discovered it to be quite small. It is surrounded by a Catholic Church and University. We saw the HIV/AIDS and TB wards, pharmacy, the E.R., outpatient rooms, Pediatrics, which included babies of all age plus an orphanage and ICU, pregnant women waiting to give birth regularly or awaiting c-sections, and post-birth recovering mothers, and the non-emergency patient visitors. That is pretty much all there is to the hospital. I was astounded at how dated and unsanitary the hospital was. There was no hand sanitizer to be found but once, the walls, linens, floors and most things in the hospital were old, worn and dirty. Nobody with spreadable germs, diseases or suppressed immune systems were isolated (if they were, in the case of the ICU, their ‘isolation’ was nothing like ours) , there was hardly any hand washing, mask or glove wearing by the doctors and nurses, and there was also clearly not enough space for anything that needed to take place; there were chairs and benches lined up all outside of the hospital for patients to wait on until it was their turn to see a doctor. Sometimes these patients wait a full day sitting outside and still do not get in to see the doctors, and are left to come back the next day for another chance. Masks in the hospital were rare, and when I asked for one in one section of the hospital, they unlocked the closet, shrugged their shoulders and told me they were out and walked away as if it was nothing. I was absolutely astounded. All hospital records are recorded by hand; nothing is electronically stored like in the United States, and hospitals in South Africa also have to record each and every supply used on all patients. There is such shortage and limitations in terms of updated equipment, amount of equipment and available supplies. During rounds, a patient with gangrene only had a layer of saran wrap placed on top of their bacterial-ridden rotten wound, in a room with 20 beds! Pregnant women in South Africa that are going to give birth ‘normally’ sit in a waiting room pushing their baby out until it is just about to crown, and then are taken to a room to be laid on a metal table. The baby is delivered with no pain medication given to the mother, and is expected to leave the hospital four hours after giving birth. There are also so many patients coming into the hospital to be treated for things you would never find in the United States as well .I do not think we understand nor recognize the amount of luxury and privilege we have access to.

We started our morning with Theatre. There were two c-sections lined up straight away that Miles and I scrubbed in for. The pregnant lady was already in the operating room, fully naked on a metal table. She was told to sit up by the nurse, who held her head forward as far as it would go so that the doctor could give her an epidural, while the other nurses in the room unwrapped the tools for her procedure; that’s terrifying to see the tools going to be used to cut into your own body! The women are given no other pain medication. The nurses started to sanitize her stomach, and then threw the used swabs held by tongs across the room onto some gauze placed on the floor at the foot of the table. Some of the gauze even landed on the bare floor and wasn’t picked up until the end of the procedure, and then the soiled floor wasn’t even cleaned afterwards! It was horrendous to watch. Once the procedure was just about the start, a sheet was placed between the woman’s head and stomach so that she couldn’t see the surgery taking place. The doctor started immediately, and was quite swift and rushed the entire time. He was making incisions (Miles left the room at the epidural; that part always makes him nauseous), and put the scissors down quickly and started using his hands to split the skin instead. He did this, and then shoved his hand down the inside of the incision and the lady howled in pain, and that is when I got nauseous. It was so barbaric to me! I had to sit out for pretty much the rest of that c-section. I stepped in at the end once the baby was already born and the doctor was stitching her back up, and was fine to see the finishing of her. The nurses pushed on her stomach and helped guide the blood out of her crotch onto the metal table. They rolled the new mother onto her side as they wiped her back up, and then rolled her onto a rolling table to be brought to the recovery area. The bloody bandages thrown on the floor had to be picked up and counted, and then thrown into a plastic bag for assumed disposal. I don’t know what happened with the used tools, as Miles and I walked out with the doctor at that point to prepare for the next waiting mother. The proceeding c-section was a little less barbaric, and I saw everything except the doctor pulling the baby out of the womb (I had to leave to find a new mask). This time, I decided to focus my attention on the new born baby. The nurses didn’t give her a bath once she was pulled out, simply wiped her clean, and wrapped her up in a towel to lay on the table they had designated for the babies. They didn’t clean her eyes off either; they let her struggle to unstick them herself. The doctor, Miles and I cleaned up and headed to the outpatient ward for rounds.

I was surprised to find only large rooms with 20 or so beds in them each; there is no such thing as a private or single room. It all happened to be men in the room as well; I’m not sure if they differentiate by gender or if it was a coincidence. Each man was in the hospital for a different reason, and no matter if it was contagious or not, they all shared the room. One man was there recovering from a burn injury extending from one side of his face and head, down to his neck and shoulders. Two men were there getting bed sores treated resulting from being paraplegic. We were told that because drinking and violence are such problems in Africa, many car accidents and shootings take place, leaving many paraplegics. Another was there for a fever, one for a migraine, one from developing celluloses on his ankle and top foot that needing burning and then a skin graft (his wound was covered by one thin layer of saran wrap that was then taken off for the doctor to examine), another from a gunshot wound to his spine, and one awaiting for a social worker to arrive; he was very loopy and allowed to get up from his bed and walk around the hospital where and when he pleased. None of these men had any shoes on, and the condition of their feet was often very poor. We saw another man with TB, and one with HIV, Diabetes and Gangrene eating away his ankle simultaneously that was waiting to see if the condition of his gangrene was bad enough (yet) to require an amputation. His wound was also only covered by one thin layer of saran wrap that was removed as the doctor took a look at it. This is the clinic where I was unable to find a mask, and this was probably the most dangerous for me to be without one. The doctor saw each patient for maybe two minutes, and didn’t explain anything he was doing to the patients. He was accompanied by a nurse who held each patient’s files open and told the doctor the latest on their condition, if they were awaiting some type of procedure, and their medication situation. The doctor then gave “doctors orders” that were signed and to be followed through with (the nurse recorded them by hand in the file), and then he continued to the next patient. After these rounds, it was time for lunch.

The ‘tuck’ shop at the hospital was extremely different from a cafeteria at a hospital in the U.S. Food was actually home cooked, and served by hand onto your plate. Because it was homemade, there were only two options. They even made juice in a pouring container that you would keep at home, and had cups sitting on the side for you to pour yourself a drink. The tables and trays were extremely dirty. On the hospital grounds, there was also a ‘convenience’ store out of a metal storage bin for you to purchase various items. It was the oddest experience for us both. Lunch is an hour long in South Africa, so when we returned, we only had an hour left to our day. There was a woman that came into Theatre that needed an abscess drained, that was apparently very large and on her buttocks, and Miles and I were contemplating scrubbing in. We were going to go check the size and severity of it first before we made a final decision, but as soon as we opened the doors to the theatre, they were sending her back up to her room because she had renal failure. They were going to test her blood and give her some medicine and try again the next day. Maureen, our local coordinator, works at St. Mary’s, so it was very convenient to have a meeting with her straight after our rotation. We talked about the rotations we will be doing for our duration in Durban, about Durban as a whole town, and about our weekly meetings with our medical director, Dr. Kahn. My day was overall very shocking and eye opening; I never realized how little access some have, yet how advanced others are. I have never experienced such ‘repressed’ hospital conditions and it definitely wasn’t easy for me to adjust to, having come from working at Children’s Hospital, one of the most beautifully kept and medically advanced hospitals in the country. I didn’t think a hospital such as St. Mary’s was legally able to keep its grounds; things are very much different here. I think I will have just as hard a time adjusting to the even poorer conditions of the Malakazi Clinic in the Umlazi Township further in my stay.