Hospital-ity

One week over at the skin clinic, and it's already very familiar - I chat up the nurses, I have the one clinic room that I like best, I know where the secret bathroom (with the unbroken toilet seat!) is. But our little clinic is a little ways away from the true Kamuzu Hospital complex, so my perspective until recently was limited to our building and the canteen.

Yesterday, however, we got a personal tour of the hospital grounds from the Head Matron herself, a friendly woman dressed in a sharp blue suit with green/white epaulets and a matching tiny hat. Very stylish. She led us all over the grounds through the different wards, stopping to introduce us to various nurses, therapists, and doctors, most of whom offered just a "You are very welcome!", but some of whom offered mini tours of their own departments.

I've seen a number of hospitals in Tanzania during my time there, and I have to say that I was pretty impressed with Kamuzu Central Hospital, overall. In what seems to be a common architectural style for hospitals in hot, lower resource areas, most of the walkways between wards are open to the air - probably not the utmost in terms of sanitation, but definitely pleasant when you're walking through. Kamuzu has these covered walkways too, but the hospital was remarkably clean - we saw many folks engaged in active mopping as we walked by, and many the indoor areas were totally spotless, at least to my casual eye.

The actual quality of the care being offered seems to vary quite a bit depending on which ward you happened to be walking through. The general medicine ward, usually the most miserable and crazy place in any hospital, was somewhat disheartening: multiple patients to a dim room, a noteable absence of bednets, and frequent nursing shortages. (Just like University of Chicago, now that I think about it, though with rather dingier beds.) Then there were wards that had great potential but weren't quite living up to it just yet. We saw a fine dialysis unit, for example with at least eight modern machines - but all were broken, waiting to be fixed. Didn't look like any patients had been there in a while.

And then, the brand spankin' new maternity ward, named ostentatiously for the president's wife - very impressive indeed. Wide white spaces, a dedicated OR for C-sections, and individual patient rooms, each armed with its own armada of emergency drugs. A giant reminder to encouarge breast feeding was painted in foot-high letters, high on the wall, and a clear list of prices for patients was tacked to the waiting room wall for all to read. (You can save 700 kwacha (about $5) by not coming in until the third stage of labor!) It was great to see it all. I could work there. I could do this.

So an interesting tour of a hospital working its way towards western standards, albeit a bit unevenly. But there are still a few features to remind visitors that no matter how high-tech the hospital gets, it's still smack in the middle of Malawi.

Today, for example, as the morning in clinic ended, we heard the definite sounds of drumming and harmonious wailing coming from the nearby hospital parking lot. Our chief Malawian dermatology officer, Mr. Jimmy, informed us that a member of the Chewa tribe had recently died in the hospital, and his fellow tribe members had come to collect him from the morgue. Since a hospital death can't be marked by the traditional dancing, singing, and music as it would in the countryside, the Chewa tribe has decided to bring the funeral to the hospital.

We watched, amid the crowd of non-Chewa hospital workers, as a chorus of blue-dressed women and accompanying drummers serenaded a trio of extraordinarily dressed dancers, each stomping and swirling and leaping to the music. Dancer outfits consisted of rather terrifying masks (a skull, an eye-less mass of feathers*) and then hundreds colorful strands of fabric tied to the body, which twisted behind them as they danced. Very, very cool. Not your usual hospital lunchtime.

*More sinister than you might think.