Coping With Frustration

July 16

We have found out that there are certain cases that are kept from us because the staff is either too embarrassed by them or they feel we should not waste our time with what they consider hopeless. One such case is a girl of 13 who had a badly botched surgery by the assistant medical officers. She had an intestinal perforation that was not adequately identified and treated originally and even though Jasper had made a great effort to re-operate and fix the damage it had not gone well. Continued leakage of intestinal contents, now through the incision, was causing the skin to become extremely irritated, inflamed and painful. Her inability to eat was depleting her nutrition making the likelihood of any healing quite small. The appearance of her abdomen was too dreadful to describe here and she had essentially been placed in a corner to await the end.

To be honest if I had been here alone I probably would have looked at this girl and concluded that it was indeed hopeless. However, to a recently trained, bright-eyed idealistic young surgeon without too many heartbreaks under his belt not to try to help was unacceptable. So after a full clinic day on Wednesday Ara and I spent about three hours in the OR seeing what we could salvage. We arranged to get all of the drainage coming from one place so it could be kept off the skin and managed to get the abdomen completely closed which it had not been before. From a technical point of view it was something of an accomplishment. It is still doubtful that she will survive because there is just no way to provide the nutrition that she needs to even begin to heal, which brings me to the point of this piece.

  As I mentioned earlier C-sections (or anything dealing with maternal and child health) take precedence in this hospital. Looking at the maternity ward with its clean floors and walls, uniform clean bedding and attentive nursing staff you would think you were in a well run if not terribly modern facility. The contrast with the abysmal conditions in the medical and surgical words and even the ICU is startling. There are probably two main reasons for this. First, maternal and child health is the key to a strong population. If one has limited resources better to expend them adding fresh, healthy members to the population than to try to save the sick and dying. Besides, great things can be accomplished in terms of mother and infant mortality rates by doing some basic things well which are neither expensive nor complicated. By contrast, improving outcomes in the medical and surgical areas requires a huge investment in equipment, training, personnel and ongoing maintenance.  Unless massive transfusions of money can be injected into third world economies such investments are just not possible. This dichotomy of priorities gives rise to the awful conditions I describe here. But, in the end the expended available resources are geared to producing the maximum number of life years.

However, things are changing. The hospital is about to complete two new buildings. One is a new surgical unit with three OR’s and amenities heretofore unavailable and, of course, a new women’s health building that is really impressive by almost any standard. Their successful operation is fully dependent on two things. One is equipment which can be had from a variety of organizations which supply used, modern serviceable equipment world-wide at minimal cost. The more difficult challenge is personnel. There are precious few well trained physicians, nurses and technicians in Tanzania.  These people want to live in places that provide the lifestyle they feel they have earned. Sumbawanga is not one of those places. There is not much to do here. There are only two paved streets and the lack of a paved road to or from anywhere makes the city unattractive. The success of the hospital, the city and everything else in southwest Tanzania is dependent on road construction and the pace is excruciatingly slow.

And so I have ranted on for 2 pages giving no news. I’ll follow up in the next post.

Comments

[Chad Wilson]

All I can do is sigh, and tell you that I totally understand why you are frustrated...unable to keep good staff at a small hospital in rural Africa is a major problem. I worked at a hospital with it's own shool of nursing in rural Kenya, and we STILL could not keep good nurses on the wards. They all wanted to move to Nairobi or Mombasa or some other better paying more exciting locale.
I just wanted to offer some encouragement to you and Ara, as you continue to serve there. Nothing done in good faith is in vain. It may seem like your attempts to salvage that young girl are in vain if her malnutrition and fistulas do not allow her to recover physically, but you have provided something very important. People see that you stayed late after a long clinic and took on a difficult and not very rewarding case. Sometimes, I think demonstrating that commitment to services is the most important thing we bring to a hospital. Maybe one of the nurses, techs, or medical officers has taken note, or maybe that girls family will believe that "everything" possible was done for their girl, and even if they lose her, will have more peace of mind.
I have seen some amazing collateral benefits of our work even when the primary outcome is disappointing. HAng in there, and continue to give it your all.
Blessings
Papi
(Ara, will tell you who I am)