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Brenda’s Travel Diary

Friday, 15 Feb 2013

Location: Kahama Hospital, Tanzania

MapPene's Hospital Experience

Hi All!
Brenda asked me to do a Planet Ranger posting of the nursing experience at Kahama District Hospital… so here it is!
Each morning work at Kahama Hospital begins with ‘Grand Rounds’ where doctors and nurses meet to discuss unusual cases that occurred in the last 24 hours. These cases are varied from pediatrics, obstetrics, to outpatients—and can be described as lively, frank, honest and fascinating---all done with the purpose of improving patient care and outcome. Once the meeting is complete—the day begins! For Anna and myself, our experience began in Labour and Delivery—an area where we both have some comfort. Well, comfort is not what we felt 30 minutes after beginning! Literally, babies were being born every time we turned around--and by noon we both felt we had put in equivalent to a week’s work at home!! On average, Kahama Hospital has approximately 25-35 babies a day! And to make it a little more interesting, young 20 year old nursing students are responsible for the complete delivery and postpartum care—often unassisted and unsupervised by medical staff!
Having a baby in Kahama is very different experience than having a baby in Canada. Typically, the mother arrives on the step of the L&D (equivalent to a large school portable) in active labour and is assigned to a very small tiled ‘cubicle’— similar to a large shower stall. In the cubical there is an old stretcher with a very thin, old, black plastic mattress.
The mother then proceeds to make her own bed by throwing down a large sheet of plastic followed by a large piece of fabric which she has brought from home. Here the mom remains flat on the stretcher, unsupported by family members, and minimally supported by medical staff (due to the workload) until the delivery of her baby. Following the delivery, the mother is up, dressed, and discharged to the next “station” (post-partum ward) within 20 minutes or so of delivery. Should there be no room in the postpartum ward the mom will wait outside in the courtyard, often sitting on hard cement, or in the grass/dirt until being discharged home within 2-4 hours post-delivery. If a mother has a cesarean section, she will be transported from the OR to a higher risk post-partum ward where she and her baby will be assigned to a single bed that she would very likely share with another mother and baby! Here she would stay for 3 days-- similar to Canada.
Although this is a very brief and general description, the consensus is that the Kahama nurses have amazing skills. Most nurses have two years education and rotate through the hospital to a different ward every 6 months. The six month assignments are determined by the Head Matron. In other words all nurses are expected to work in all areas and specialties in the hospital. What is clearly evident is that nurses are lacking equipment that make the nursing job easier and assessments more accurate. For example, IV poles that will elevate to appropriate heights and stand without falling over, doptones to listen to fetal hearts, neonatal stethoscopes for small babies, digital thermometers to quickly do temperatures.
As far as the mothers of Kahama--- we are all in complete amazement and admiration of the stoic, accepting, non-demanding and non-sense of entitlement behaviour these women display. Clearly, as much as we can offer from Canada, we are learning and receiving from this amazing community and hospital in Africa.