Mbabane Government Hospital

I spent the day on Ward 8, the Pediatric Unit, of the Mbabane Government Hospital today. What an amazing experience, eye opening and very sad. I saw a very different style of medicine than the medicine that is practiced within the walls of the Baylor COE clinic. This hospital has limited access to resources, food for the patients and basic medical supplies that should be abundant at a hospital.

The pediatric ward is four large rooms with numerous cribs/beds in each room, approximately 80 beds. Two cribs will be right next to each other and the parents are seated by their child's bed. The parents must stay with the children at all times as there are only about 2-3 nurses for all the pediatric patients. The parents are responsible for giving all of the oral medications and food to the kids. This hospital does not provide the antiretroviral medications that patients with AIDS need and the parents must leave the hospital to bring their children to our clinic to receive refills on medications. Leaving the hospital means they could miss any IV medications they are supposed to receive or miss the calorie rich formula they bring up to the ward a few times a day for the malnourished patients (all of them).

I noticed a few things on arrival to this hospital that quickly made me realize I am working in a developing country. One of the rooms on Ward 8 is the pediatric intensive care unit, it is called the intensive care unit because they have oxygen available in that room. No ventilators, no medical equipment to care for critically ill children, only oxygen. Next I saw a young child about 1 year old in a crib that had several bars missing on the side, if this child moved around he could easily have fit through the hole (I could have fit through the hole, it was large). As we rounded on the children there was a child with advanced stage AIDS who was extremely malnourished in the crib next to a boy with a pneumonia who was coughing right towards her. There is no such things as infection control at a hospital in the developing world. I saw bed sores that were not being cared for properly with appropriate dressings. Another patient last had her blood drawn on April 2nd at which point her hemoglobin was extremely low at 4.8. She has not had another blood draw since that point, and she has been vomiting blood for the past couple of days.

The patients here were extremely sick and many are admitted for malnutrition which requires a rigorours re-feeding program. The hospital is supposed to proved the appropriate formulas for the patients, but unfortunately this is not the case (they were out of milk when I was there). These children are losing more weight while they are in the hospital! And it can take well over a month for them to finally gain enough to go home. This is the hospital in town, a place where children are supposed to heal and thrive. There has to be a better way to care for these kids, a safer, more sanitary way where the kids could at least have enough formula and access to medications. It is one of the many challenges of practicing medicine in the developing world that I had only heard about in medical school, now I am experiencing it first hand.

Leah