Some of you know, by now, that I (yes, Debbie is actually writing a blog) am working at Good Shepherd Hospital three days a week. Currently I am visiting each department in the hospital so that I can get an understanding of their operations. The goal is for me to work with Quality Assurance to help them improve their policies and general quality of care. It has been an eye opener for sure and the challenge will be to build relationships and be able to help them within the context of a different culture and a severe lack of infrastructure and supplies. It will probably be the biggest challenge of my “working life” and will take me the two years I am here to, hopefully, make a small contribution. GSH was evaluated about 3 years ago by an accreditation body from South Africa and failed in many areas including nursing and administrative policies. Currently, GSH ranks second best hospital in the nation. Swaziland is setting up their own accreditation body and the Senior Matron (Director of Nursing) wants to get this work started now. I have the previous volunteer that worked at GSH to thank for paving the way for me and providing me this opportunity.
GSH is a 250 bed regional hospital that serves about 300,000 people and an area roughly a quarter of the country. It is about a 25 minute walk from our home and is truly an uphill walk both ways as I walk down into the valley before coming back up the other side. GSH has a huge outpatient department which serves as access to physicians. Physicians do not have their own offices except those that cater to the rich (mostly whites serving with development organizations). They have 8 docs and 2 small operating rooms. They have an active ED, mostly for trauma. The illnesses they see are mostly chronic opportunistic diseases from AIDS. TB is HUGE here. The inpatient area is really one long corridor and you can tell that you have gone from one nursing unit to the other by the color of the tile floor (e.g., Maternity has pink floor tile, and the next unit, male medical-surgical, is blue). The male TB ward is on the other side of the open doors to maternity. The wards are on one side of the long corridor with the bathrooms, utilities rooms etc. on the other side. The latest structure was built in 1980 for peds and the eye clinic but the main hospital is 1960 vintage with 1940 equipment throughout. . Rooms are 4-8 pts. with communal bathrooms and no sinks in the rooms. No air-conditioning of course so windows are wide open. Losing electricity is not unusual and sometimes they run out of water. They are trying very hard not to have patients on the floor for infection control reasons. They are proud of this achievement and only rarely have floor pts in maternity.
My first experience was in maternity. All deliveries except c-sections are natural with no medication. Privacy doesn’t exist and I never saw a dad in the maternity ward. All moms go home the day after delivery. All moms have pink cards that they bring with them that contain all their medical history. They do have a preemie room and moms stay in the hospital to breast feed the preemies. Breast feeding is strongly encouraged here particularly with HIV positive babies. I saw four babies born and all were to HIV positive moms. All the nurses are midwives and do the vast majority of the deliveries. Of note, a nurse must be a midwife to advance to being in charge of any unit in the hospital.
I just spent two days on the female ward. It has been a long time since I gave a bed bath or made hospital beds and I learned a lot by just doing things. I constantly had to remind staff that I was not licensed in Swaziland so couldn’t put in IV lines, give meds etc. They are quite understaffed and the student nurses give a great deal of the care. GSH has a “LPN” program. The biggest problem I can see is infection control with TB and HIV being the problem in this country. The TB wards doors are open as there is no ventilation if they are closed. There are not enough masks so nurses write their names on them and use them for who knows how long. There are not enough gowns to use in isolation so pt. gowns are used which leaves no pt. gowns for the patients. Most of the time nurses are double gloved. For the whole ward, that holds a general census of 40 pts., there are three places to wash your hands; the dirty and clean utility rooms and the nurses’ station. So how do you creatively write Infection control policies taking into account the current realities? I expect I will be learning more from these nurses who must be creative to function in this environment then I will ever teach them.
I worked with two nurses from Zimbabwe that told me they liked working at GSH as the hospital pays more and is much better equipped than in their country. Speaking English will not be a problem for me as most of the physicians and some of the nurses are foreign. All professional staff speak English and all records are written in English. I have been very pleasantly surprised at how easily I am accepted here. I think they have been conditioned to think that people coming from developing countries are smarter than they and have all the answers. In reality, they have the answers and perhaps with some guidance can be confident enough to find them within the context of an infrastructure that is not going to change any time soon.
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