It was back to
Kitona Referral Hospital today, for the first full day of the medical
engagement of Operation Lion Rouge. It was exactly as I remembered it—the good
and the bad (but mostly the bad).
I started the day
by going by the lab to talk to them about the MEDRETE back in June. The lab
supervisor is the same as then, so he was able to reiterate some of the points
that LTC Cannon had made during their two weeks working together.
Unfortunately, they really don’t have the money to mitigate any of the big
deficiencies that were pointed out, such as not getting their equipment
properly calibrated in the ten years they had had it. They also have some
pretty big issues with electricity (as the entire country has), which puts a
damper on the things they do and the things they can do. Dr. Olivier from
PEPFAR wants to increase the capacity of the lab, especially in terms of HIV
diagnostics and monitoring, but in order to do that, they need to have reliable
enough electricity to keep and air conditioner going (because the machines run
hot) as well as a refrigerator for the reagents. Currently, the hospital only
has one generator, and it goes to the high-impact areas (the operating theater)
when city electricity is down. In order to do the changes Dr. Olivier wants,
the lab area would have to have its own generator.
They have made
some positive changes, though. One thing I noticed is that they have the
instructions for each of the lab tests printed out and taped to the wall, above
the machine that runs that test. I don’t know if they had that before, but the
paper looks new enough that I’d believe that they didn’t. I’m going to choose
to count that as a win.
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| Lab instructions |
The second area I
went to was the blood bank. Unfortunately, the blood bank has a new supervisor
since June. I’ll have to ask why the old one left. Since he’s new, he wasn’t
able to explain what positive changes they had made since LTC Cannon was there.
One thing that he noticed, however, was that they would draw a donor’s blood
before they did the questionnaire and screening, which meant that if the tests
or questionnaire led them to be excluded, that they had wasted that tubing and
donor bag. Little things, but in a hospital that broke, every little bit helps.
Well, when I talked to them today, I’m pretty sure they said that they do the
questionnaire and testing first, then do the donation. If that is indeed the
case, that’s a positive impact of the MEDRETE.
My last stop
before I saw patients one-on-one with Dr. Patrick was the adult wards. For each
of the patients admitted with malaria, I asked if they had a positive blood
smear, and the answer was always yes (yay!). However, Dr. Patrick explained
that even when the test is negative, they still treat, which is exactly what
they did before (sigh). I guess we couldn’t have expected to change the way
they do things with one lecture about diseases that look like malaria but
aren’t, but I was a little hopeful. Oh, well. Anyway, they had a couple of
malaria patients, a couple of hypertension/diabetes patients (yes, that’s a
problem in DRC as well), and a couple of TB patients. They don’t have isolation
rooms or even a separate ward for the TB patients; they’re just in the ward
with other patients, a hypertensive and a malaria, in this case. I guess the bright
side is that they didn’t put either of the TB patients in the same room as the
patient with HIV and Pneumocystis pneumonia.
We ended up
finishing early (MAJ Lang was doing an environmental/sanitary assessment of the
base while I was at the hospital), and then headed back to the hotel to write
our reports. I still need to see pediatrics tomorrow, which could be
interesting. MAJ Mann found a lot of mistakes with the antibiotic selections
while she was there, so I guess that’s what I’ll focus on.
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