I have previously posted about my time working in a leprosarium. Working in a leprosarium 1968-74 I mentioned there the other side of the work carried out on the same station. As leprosy only rarely has acute problems I spent most of my time in the non-leprosy part of the program. I only regularly spent 2 half days/week with the leprosy program, besides seeing the occasional emergency in the leprosy department.
Other work for the general community – this post will only discuss the second non- leprosy medical work. There were several other aspects for another day!
There was an (officially) 30 bed hospital with an added 12 bed TB ward and an attached outpatient clinic.
It was the only hospital covering a large area and several million people. Through the country there were scattered clinics run by dressers (they were not to nurse standard but with some training, and had permission to prescribe a few simple medications) and a few mission clinics but the nearest hospital south was about 80 km away; north 200 km; west 150 km; east several hundred km, and this in a heavily populated, very fertile, part of Ethiopia. We were at the cross roads which led in all 4 directions. At that time cars were few and far between and public transport was limited. As loaded trucks often carried many people on top of their loads we often had mass emergencies if there were major accidents. And there often were!
It really wasn’t beds for just 30 patients. We used to put smaller children one at the head and one at the foot of the bed. In times of great overload we used to sometimes put patients on mattresses under or between the beds. There were verandas on the east and west sides of the main building and we would spread mattresses on them. Sometimes in the rainy season there would be a rush to change the ‘veranda’ patients to the other side away from the rain slanting in from one direction or the other. Most people chose to go to the clinics or to natural healers before a percentage came to us. We could never have survived if all those who should have, had come!
This general hospital had a small ‘operating room’ which was mainly used for obstetrical deliveries which needed forceps deliveries. More major cases, obstetric or other general cases, were taken to the OR in the leprosy hospital. We had few normal deliveries apart from the wealthier women from the nearby moderately large town. For a normal delivery they were charged about ten times as much as a poor person with a complicated pregnancy – something about robbing Peter to pay Paul. Unless there were problems after delivery these ladies were allowed to stay about half an hour.
The room was also used to reduce simple fractures and for suturing. The leaded room with the X-Ray machine was attached to the hospital. The machine was an old WW2 field one. A local young man was trained to take the simpler X-rays. See an example of one of the chest X-rays below.
In addition to the 30 beds there was a 12 bed TB complex. TB was very common. Only the very weak or those with complications, like lung collapse or paralysis from TB of the spine, were admitted. Another national worker was trained to aspirate chests and put in chest drains.
The outpatient department was in a separate building. It included our small pathology department. We treated about 100+ cases a day. Apart from acute emergencies, who were sent directly to the emergency room in the hospital, all were seen initially by a dresser. If they couldn’t make a diagnosis, or if the patient returned with the same problem, they were referred to the nurse. If the problem still remained the nurse arranged for them to see the doctor sometime. I, or if there were 2 one of us, tried to visit outpatients just before I/we went to lunch.
Emergencies were common. I remember one day when 3 ladies with ruptured uterus came within 5 minutes of each other! As well as daytime surgeries, planned or emergency ones, many emergencies arrived out of normal hours, so we operated most nights as well on emergencies.
The 4 nurses had the following duties: One was in charge of the general hospital; one of the leprosy hospital including the OR; one in the leprosy outpatients; one in general outpatients. If we had 5, the fifth was on night duty for all the work – if there were only 4 they rotated around taking responsibility for both parts of the work at night. They were very competent and really acted as junior surgical registrars.
Below the more line is a picture of a chest X-ray of a TB patient.