The Wards

My routine during the week consists of morning rounds at Moi Teaching and Referral Hospital (MTRH) that usually start around 9am. Tuesdays and Thursdays we have 8am morning report, where students and staff will give presentations of interesting patients or topics commonly seen on the ward. I’ve been grateful for being able to sleep in until 6am or so, when Kim & I go on a 35-45 minute run just as the sun is rising. It’s peaceful in the mornings, compared to midday when people, bicycles, and cars hurry around the hostel and hospital across the street. Plus, the morning air isn’t filled with diesel fuel fumes from all the cars and matatus (or buses), which are quite noxious.
When walking from the hostel to the hospital in the morning, I usually pass by relatives of patients on benches outside the hospital gates waiting for one o’clock in the afternoon when visitors are allowed into the wards. I next walk past workers diligently mopping the outdoor stone hallways, which sometimes look cleaner than the ward floors themselves. The hospital consists of a number of small buildings, with covered walkways connecting them and beautifully landscaped grounds in between that starkly contrast the dark, decaying building interiors.

As I enter the main building housing the men’s, women’s, and pediatric medicine wards, I take a deep breath and prepare myself for my next few breaths of the hospital air. I’ve talked to other students about how to describe the smell of the wards, and the most consistent response is that it is a mixture of bleach, urine, human body odor, and musty old shoes. The first few days I had to suppress my gag response upon entering the unit, and was advised by our medical director to keep a low-threshold for stepping out should I feel faint. The hospital scent is now expected and I’ve adapted, now only occasionally being caught off guard by especially foul odors, like when an elderly patient with a purulent pleural effusion pulled out his chest tube, filling the wards with a smell of decay.
The patient’s records are all kept on paper, and often my morning is spent rummaging around the nurses’ station or wards to find the charts. The patients keep their X-ray films and CT scan films at their bedside – there are no computers at the hospital at all to read radiology scans or enter in orders or prescriptions. Treatment sheets are present for every cube of beds, and it isn’t uncommon for a patient’s medication schedule to be missing, thus leaving us to guess what medicine’s he has been receiving! Our pharmacy students do a wonderful job of working with the available stock of drugs, advising the team on what medicines are on hand from day to day to treat patients with, as supplies commonly run low. We have to ration a lot of our resources, like the oxygen tanks for example. The men’s ward, which houses anywhere from 50-150 patients, has only 2 oxygen tanks that are available for patient use! ICU-level patients in the US often sit on room air on the medicine wards here, and we’ve had patients die during our rounds in the morning. One patient, with an intracranial mass of unknown origin with subsequent hydrocephalus, herniated and died two days ago, because the neurosurgeons procrastinated coming to see him for 1 week. My intern told me this isn’t common for many surgery-related consultations, because the surgeon’s don’t get paid as much for treating these patients and also know they will be more ill, and more work, than patients in the private world. To me, this goes against the Hippocratic Oath let alone respect for human life, and has been one of the most bothersome realities of this experience for me.

My frank comments about these hospital conditions are made to illustrate the difference between our standards in all hospitals in the US. Though Wishard County Hospital in Indianapolis might not have the flat-screened televisions or posh interior design of Clarian West Hospital, it at least meets basic sanitary requirements and standards to keep patients and staff safe. If there is one good thing about living in such a litigious society, it is that physicians adhere to their Hippocratic Oath and are monitored for malpractice to ensure that patients are not harmed or killed because of physician negligence. A dichotomy most definitely exists here between the public and private wings of Moi Hospital. The private hospital wing across the street allows neither students nor residents rotate there, and is where Kenyans who can afford care turn for medical attention. I asked a sixth-year medical student on my team, Philip, what he thought about health care in his country, and he told me he is a supporter of basic coverage for his people. Within the last few years, some legislators have proposed different plans for health care coverage, but the plans were shot down quickly. The government officials get paid an extremely large salary by Kenyan standards: the Prime Minister gets paid $450,000 a year compared to the average income of $100 per year for an average subsistence farmer in Kenya. Philip said the officials are very far removed from the common people, and have no concerns about health care, since they are able to pay for their health care services without issue. Though the US has its own health care issues, I cannot help but be thankful for our standards of care and the faith I have in my physicians.