Mpika Urban Hospital

The last few days, I have been recovering from a bout of bacterial dysentery.  A freeloader named diplococci and thousands of his friends have wreaked havoc on my intestines, keeping me shackled by an invisible tether to the nearest porcelain throne.

The worst of it transpired during the first night and tapered off through the following day.  A day and a half after the onset of symptoms, I was feeling as though I was on the upswing, but I decided to go to the clinic to check if it was a parasite.  On my colleague’s suggestion, I had intended to go to the nearby private clinic so that I could be seen quickly and maybe get some work done in the afternoon.  Through miscommunication with the people at the guest house and the taxi driver, I ended up at the Mpika Urban Hospital, a government facility.  But I’m glad I ended up there.  It was an eye-opening experience, filled with shocking contradictions.

I waited for almost three hours to be seen, which didn’t strike me as particularly bad considering the number of people waiting.  There didn’t seem to be a clear order in which people went in to the see the clinic officer, and it was hard to tell who was waiting to be seen and who were accompanying family members.  I was beginning to feel that I was being skipped, and that people who showed up after me were being attended to first.  At least I wasn’t getting special treatment, but I also didn’t want to be missed because I wasn’t pushy enough. 

Finally, the doctor called me in.  He was tall and professional looking, sporting a typical white lab coat.    “I assumed you had accompanied someone.  I didn’t realize you were waiting to be treated,” he said.  I wonder how many white patients he sees at this facility – I got the feeling I was a rarity.  After listening to my symptoms, checking my blood pressure and palpating my abdomen, he ordered a blood test and a stool sample. 

“Sounds like dysentery.  Let’s find out,” he said.  His demeanor and approach exuded confidence and competence.  I was comfortable that I was going to get appropriate treatment.

“Ok, thanks doctor,” I said as I stood up.

“Oh I’m not a doctor.  I’m just a clinic officer.  We only have one doctor in this area, she’s out in the field.  You see, our problem in Africa is manpower.”

I went to the laboratory, a nearby building within the same compound.  As I sat down to have blood drawn, I watched carefully as the young woman in another immaculate lab coat took a new syringe out of a box labelled “STERILE.”  She took off the cap and drew blood smoothly from my left arm.  Promptly afterwards, she dropped the syringe in a sharps container.  Again, it was professional and I felt very comfortable.  But that was about to change.

She handed me a little plastic container.  The lid had what looked like the spoon-end of a slurpee straw protruding from the inside face.  “Please collect a stool sample for me.”  Oh fun…

I’m going to get a little graphic now, but with purpose.  Be forewarned, read on of your own accord…

The only washroom I could find was at the end of a men’s sick ward, holding about a dozen beds.  When I saw this washroom, I left to make sure it was truly what I was expected to use.  It was.  There was only one dirty looking toilet with no seat, and which at the moment would not flush.  The bowl was crammed with crumpled newspaper; I looked around to see that there was no toilet paper.  In the end I would use a page torn out of the notebook I had brought to be used as my chart.  The stool sample had to be scraped from the top of the newspaper in the toilet.  Thank goodness for that little slurpee-straw-lid contraption.

Finished, and happy to be through with that business, I walked out of the washroom.  I expected to see a plastic tub of water with a spout coming out of the bottom nearby.  You find these most places in lieu of a sink and tap connected to the unreliable water supply.  But this hand-washing station was not nearby.  It was at the entrance to the ward.  I had to walk the length of the sick ward with dirty hands and a stool sample to wash my hands.  And I couldn’t find any soap; this I had to borrow from one of the patients.  Afterwards, I did find the provided soap, but it was a sorry, filthy chunk tucked away on a corner of the stand.

I was outraged.  After seeing two clearly educated professionals in this process, I could not believe that the washroom had been so neglected.  And how was it that no one thought to put the hand-washing station outside of the washroom?  There may have been a lack of manpower, but there was not a lack of education.  And even if the situation couldn’t be improved to Canadian standards with available resources, it could be drastically improved with some common sense and minimal effort.

I returned the stool sample, and went outside to wait a couple hours for the results.  Only two hours for results – pretty good by Canadian standards.  This process would have taken me days at home, as I would have had to go to a lab, who would process the results and then send them to my doctor, who would discuss them with me in a follow-up appointment.

I got the results, talked to the clinic officer again and got a prescription for Cipro.  He had to hurry out to help someone.  I didn’t get to tell him about the bathroom, so I went back to the lab to mention it.  I found a young man there this time.

I explained the situation calmly.  “Are you aware of this problem?”

“That’s a management problem,” he said flatly.

“That’s a health problem,” I retorted, my calm starting to desert me.  My goodness, you’re a health professional, I thought.

“Yeah, I know.”

“All it would take to make it better would be to move the washing station the 15 metre length of the ward.  Or better yet, get another washing station.”  This struck me as something he could simply do out of professional conscience.  Just move the damn washing station!  And to give you a sense, this laboratory was not set up as an independent entity.  It was part of the facility.  The ward was just a small building maybe 30 metres away from the lab, but it had no nurses or other staff.  Patients were being attended by their family members.  I really felt that one of these people I had met should have taken responsibility for this sanitation issue.

“Yep, it’s a problem,” he said.  But apparently not his problem.  I wanted to scream.  I wanted to take his starchy white lab coat and wipe the bathroom floor with it, and maybe another fleshy surface that had been neglected in the wiping department.

Grinding my teeth, I turned around and left.  I collected my Cipro and a few other supplements free of charge, and went back to the guest house.

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