Jennifer Davis’ Blog

on patient mortality at Macha:

I was having some serious anxiety about reporting for duty at the hospital at the beginning of last week because I was losing so many patients.  In the states, I have taken care of patients that later died, but it is usually one that is in the ICU and you know that it is coming.   Sometimes here it is such a surprise to me. 
 
Last Saturday I saw an elderly woman on the ward who was septic from a diabetic foot ulcer and in much pain and discomfort.  I ordered IV fluids and antibiotics for her and then moved on with my rounds.  On Monday she was not on the ward anymore, and I found out from the nurse that she died at 10am on Saturday.  I had seen her at 9am. 
 
Another patient died on Monday after we saw her on rounds.  She was six months old.  Her mother came with a new page of medical records even though the child was born at macha.  The baby’s pupils were dilated from an atropine/ belladonna type herb used by traditional healers and she was in respiratory distress.  Dr. Thuma told us that something was not meshing right with the mother’s account of the illness and the child’s appearance, and that there was not much he could do when they waited so long to come to the hospital and had seen the traditional healer first.  He figured out the best plan of treatment he could with what information we had, but the baby died within 15 minutes before any medicine could be given. 
 
You can always know when a patient has died in the hospital because wailing is a sign of a woman’s grief here.  We only allow one visitor at a time during the day, so she will start the mourning process at the time of death.  The nurses place a moveable divider around the cot of the patient until a stretcher can be brought in.  Other family members soon find out about the death and join the first family member as the body is transported to the morgue.  Then all of the family that is at the hospital (which can become an impressively large group as word spreads) come to the morgue and stand outside while preparations are made.  All of the women that are present usually wail, and this can go on for several hours.  Finally, the body is released to the family and they transport it home for burial. 
 
The whole process is difficult to witness.  The sounds of sorrow pierce your heart, but you have other patients that need attention and the work must go on.  I am struggling with overcoming a morbid desire to know if it was one of my patients that died whenever I hear a family at the morgue.  When I pass through the wards, I always look at the cots of the patients that gave me a bad feeling during rounds to see if the divider is up or if the bed is empty.  In hospitals in the states, many patients are sequestered away in ICUs when they pass and it is not such a public thing.  Here it is so glaringly obvious that it’s hard to not know when we lose a patient. 

 The glass-half full answer to how to deal with the pain of these losses is to think about the patients we save.  With HAART therapy, maternal transmission of HIV has decreased from 40-50% (in an untreated population) to 2%.  The pediatrics ward is full of children who are dehydrated from rotavirus and are dying just by providing ORS (oral rehydration solution) through an NG tube.  Men in the ward who are skeletally thin come walking out of the AIDS clinic sleek and fat after they start their ARVs.  Praise God for the lives being saved at Macha.  And pray that they have a chance to learn to call on the Lord as Saviour and live in obedience to him for the rest of that life.