not always a good day

Not surprising, people are very nice here, the proverbial smile is on everyone’s lips, the pace is relaxed, physical contact is friendly and easy and the weather has been marvelous for the past few days. Thyolo Hospital is set in a beautiful part of Malawi, in the rolling hills amidst tea plantations on red earth, scattered houses, mount Mulanji towering 3000 meters high in the distance.

All well, wasn’t it for the fact that it’s a hospital, not the kind of place that can thrive on smiles and beauty. Physically, the hospital is in rather good shape, thanks to the fact that is was  built only four years ago and is equipped by Medicins Sans Frontiers, who run a large AIDS program here. The current president is from this area and rewarded his people with a nicely designed district hospital shortly after he came to power, and he wasn’t skimpy on the (EU) money. Reality bites when it comes to the work being done in this lovely place. Any western doctor gets his or her heart broken at least once a day, no matter how long you’ve been here. People die and suffer unnecessarily, the lofty ideal of Hippocrates’ thou-shalt-not-do-harm is taken lightly.

One part insufficient education, one part demoralization in a slow and difficult system, and one part - forgive me my cultural arrogance - pure and utter disinterest make for appalling patient care. Two young and very dedicated Dutch doctors are employed by the Malawian Ministry of Health as the only full time physicians, working with a large group of clinical officers. Even after a year in this place, they relentlessly press the staff to improve their performance, provide good care, learn and teach. With the ever looming culture clash of the white folks treading on local ground, no matter their intentions, it’s a delicate business. What to say if once again a man shows up at the emergency department with a very painful belly, is seen by a clinical officer in training, is admitted to the ward without a diagnosis, nor a plan, nor a senior clinician being involved, only to be found 36 hours later by a nurse, hours before he dies of a cause that could have been operated on at time of admission?

Is it that life is not worth as much here? Why are people who decide to work as health care workers not dedicated to saving lifes? Still a lot for me to figure out.

Not a good day, today. I should write you again on another day when I come out of the hospital smiling, happy that we could do some good things for a patient, found the right diagnosis. Yesterday, when at the end of the day I went to see the woman who had been admitted with a pneumonia, but then it turned out she didn’t have a pneumonia at all and I could relieve her shortness of breath with a very simple intervention - wonderful, at least for that brief moment things made sense. But even then, one can’t look too far ahead, or one would see that the quick victory of the day will be overshadowed by the unstoppable progression of her advanced AIDS……..

Okay, enough already, I don’t think the lightness of being will be flowing into this keyboard today.