Monday, October 17, 2005

Hospital Ills

Dear all,

FACT: Hospitals should make you feel good - not sick at heart and nauseous.

I shadowed a fourth-year medical student and new friend, Eni, at the Hôpital Central on Thursday. She was doing rounds in the maternity ward, so I had the good luck of being able to hang around young women and cute babies all day long... Unfortunately, the below-the-surface experience was not so cuddley-wuddley. The maternity ward is set up just as I imagined a hot climate resort hospital: outdoor corridors, open windows, pink single-storey buildings, gardens and fountains, and peach tiled floors. The sparkle quickly wore off when I got close - and saw frothy globs (of soap? of toxic waste?) pulsing out of the fountains, mold ravaging the gardens, and inside the post-partum room, realizing that the windows stayed open to keep the women breathing something other than the stifling and sweaty miasma that filled their chamber. I do not describe all this to put down the hospital, but rather to give a picture of the conditions that sick and vulnerable people face when they come here for care. The public hospital does not have the means to provide its doctors with medical materials, so patients are constantly opening their thin wallets to pay for the next part of the exam - when gloves, cotton swabs, gauze, alcohol wipes, or tongue depressors might be needed. It almost goes without saying, then, that they also provide their own sheets, have family bring them food and good drinking water, and generally look after themselves and their kids, even from a hospital bed with IV tubes in their arms, whenever dcotors are not around.

Above all, I was impressed by the people I met. The women in the maternity ward, just 1 or 2 days post-partum, were already heating their water and heaving around full buckets so that they could wash themselves. The med students, too, are evidently quite a fit bunch. I arrived at 7:30 am to meet Eni for her first patient check-ups, and we stayed on our feet, seeing patients and then doing rounds to hear the other students' cases, until well past noon. We then filed into a classroom and learned all about the signs and symptoms and care procedures for pregnancy (in French, and I understood it all - yay!) - a really interesting lecture that nearly put me to sleep, I was so tired from the morning. It's beginning to look as though whatever I do - go to medical school or focus on benchtop research - I'm going to be running these physcial and mental "long-distance races" all day long...every day...for many years to come. But if school and work are indeed sports, and my ability to stay awake during (and therefore reap knowledge from, and pass) courses depends on my fitness, then at least I'm getting world-class training here. The lab is on the top of a pretty big hill, so I'm sure that my high-altitude vortexing will pay off in improved cardiovascular output!!!

Most of the maternity warders were in their mid-twenties (a very reasonable age for first pregnancy, I thought happily)...but petient histories soon burst my pleasant bubble, and revealed that they were already on their 4th or 5th kids. One woman, admitted for a troubling ovarian cyst and looking no older than 40, had already had 12 children! What's more, not many of the women are healthy enough to be taking care of all these little ones...the majority are HIV-positive, and probably bearing the loads of malaria, anemia, and a host of other ailments, as well. I asked about the hospital's HIV prevention and family planning programs, but all of the responses were unsatisfactory. Once again - this is not because the hospital is not trying, but because there nothing that it easy to change. Everybody knows the risks of sex, the usefulness of condoms, the strains of large families; but it is difficult to address these subjects with women who have little control over their lives. HIV is rarely discussed, because the resultant injury to morale/will-to-live on the mother's part is considered more immediately threatening to the family's well-being, than the long-term physical problems of the illness itself. Condoms are available but not so well accepted from the hospital, because parents complain (the world around, apparently) that contraceptives encourage sexual activity. (But tell me this...if they've already had 5 kids, is a condom really going to "push them over the edge" toward sexual activity???) Birth control by parents' mutual intention and agreement might be equally effective, but, as I saw not a single father in the ward today, I fear that these women do not enjoy the stable relationships required by such family planning. Finally, despite the doctors' pleas to breast-feed the newborns for at least 8 days (if the recommended minimum of 6 months is not possible), the women's nods were unconvincing, and I bet they already know they'll be working too hard to honor this request. If for a moment I thought "wow, quite a start to my day!" - I quickly adjusted the statement to "goodness, what a start to this kids' lives".

On the way out, when I shared my thoughts and observations with Eni, she and I agreed that there is not enough money, skill and education, or time for any long-term treatment of Cameroon's health problems. My initial suspicions are still unchallenged - Cameroon is lacking in all but two things: bananas and policemen. (And since the policemen appear only when you're not looking for them, and never when you are, I don't think that they count.) So unless a patient is suffering from severely low blood sugar, potassium deficiencies, or banana-split withdrawal...which says little for the masses of HIV and anemia and malaria and TB bases...there is very little hope for a cure.

I have finally bought a nice little ring for my all-important left ring-finger, and men's comments have markedly decreased since I started wearing it. For today, at least, with cures for problems put in a realistic perspective, I will call this a minor victory! Love,



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