Mosquitos: 2 smcm: 0

Trip Start Aug 26, 2007
Trip End Dec 16, 2007

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Flag of Gambia  ,
Monday, October 8, 2007

I planned on being able to write a journal entry about trips to Brikama and Banjul I wanted to take this weekend. But instead I'm forced to write it about a West African hospital, where I spent most of my weekend staying with my good friend Bryan, who became the second member of our group to fall prey to the mosquitoes. Somehow, though we've all been keeping up with our anti-malarial medication, we've managed to triple the number of SMCM students who've gotten Malaria here. I guess there's no telling in West Africa. And there is especially no telling in a hospital here. Bryan was in pain, feverish and a little out of it during his stay, but he was fortunately well enough to still be able to laugh about the experiences with the health care. I'm a little afraid what would have happened if he wasn't. Here's a quick description of medical care in The Gambia, in one of the better clinics.
We faced the typical several hour wait in a crowded, hot waiting room, the typical chaos and confusion and lack of communication with nurses, and the typical fear that you might simply be lost in the disorganized mess of sickness and inefficiency of West African health care. But we finally made it to what I gathered is the only doctor, who informed us nonchalantly that Bryan did in fact have malaria, and would have to stay in the hospital for the weekend for observation and to get the necessary shots.
The room he was staying in didn't quite live up to its possibilities for ridiculousness. Sure, the thin, ripped sheets on the bed looked questionable, the mattresses were even worse, and the lack of soap in the bathroom worried us a bit about the standards of sanitation, but there was AC, and it was a good size. But Bryan's first encounter with the nurse made up for any lost ridiculousness and kept us laughing nervously for a while. She said almost nothing, thrust five pills in Bryans hands without telling him what they were, and burst his vein while hooking him up to an IV, sending a spray of blood over him, his bed, and the IV. A mumbled apology was the only effort to remedy this situation, the blood remained to add some color to the otherwise gray room, and Bryan was left with a very sore hand. Actually, the unfortunate irony was that the shots and the fact that we caught the malaria early meant that for a bit the hand was the only pain he suffered too much of. The afternoon and evening passed by in monotony in the hospital room as similarly non-verbal nurses entered periodically and night fell. The longer we were in the room the more it tended to feel like a prison, and it became worse as I tried to get comfortable enough to sleep on the single, stained, too-small sheet. I felt very much at the mercy of those strangely quiet nurses, able to enter through the swinging doors of the room at any point, no longer under any illusion of privacy. The whole thing took on an even eerier, surreal tone when I had to find a nurse at 3am because Bryans IV ran out. The white walls were lowly lit, a soft buzzing noise filled the halls, and there wasn't a soul anywhere. I wandered around, knocking on random office doors, past open operating rooms, and finally nearly collided with a very disgruntled, tired looking nurse (scaring myself, and probably the nurse half to death) who I'd apparently woken with my knocking. That was resolved, though, and morning slowly came, interrupted by more random entrances by nurses. One nurse arrived at 9am who was surprisingly vocal. This ended up being a very, very fortunate surprise. Bryan seized on the opportunity to ask exactly what was being injected into his body. The nurse explained that they were chloraquine shots, seven to be administered every 6 hours, and that he had already had three shots, was about to get his fourth. This was troublesome to us, however, because Bryan had had four shots, not three. Bryan spent about five minutes in a very frustrating, circular conversation trying to explain this fact to the nurse, who simply kept pointing out that no one had marked down giving him the fourth shot, and so he had to give it. Bryan, after finally bluntly refusing to accept the shot, was able to convince the nurse. We found out later that if he had gotten the shot at 9am it would have had a FATAL REACTION with the dose he'd had just over an hour earlier. We also found out later that this was the nurse's first day when he used it as an explanation for why he didn't feel confident enough to try to get the TV in the waiting room to work. Apparently being the only nurse in the entire hospital that morning and holding Bryan's life in his hands was one thing, touching a TV was another.
If only we had known what was to come the next night, we would have been grateful for this one doctor. The next day was a slow painful one (especially without the TV), though one of the few successful ways we found to distract Bryan from the pain and pass the time was laughing about the medical care, so I guess we can't be too critical of it. When the doctor decided to grace us quickly with his presence again we convinced him to let Bryan go home between shots and even to remove the bloody IV from his hand. But it was back to the hospital that evening. When 3am, the time for Bryan's final shot, rolled around the nurses were not punctual. And when Shane, who had taken over hospital duty because he didn't have class until 3pm the next day, went to go find the nurse he made the slightly terrifying discovery that there were none. The entire hospital was empty. He retreated back to the glorified cell and went back to sleep, sure that some nurses would arrive early in the morning to give him his shot. But when they did finally arrive they had no shot. They assured Bryan and Shane every time they asked that someone would be coming soon, very soon. "Ndanka, Ndanka," they told themselves, all the way up until 3pm when Bryan finally received his final shot, 12 hours late. We assume, kind of out of necessity, that this won't have too much of an effect on his recovery. Shane had to leave already, Bryan's phone had died by this time so he couldn't call for a ride, the chloraquine was kicking in and making him a little loopy, and Bryan was generally desperate to leave. But, because this is West Africa, there had to be another complication: the health insurance had not contacted the hospital. Bryan received the most consistent, vocal attention from the hospital yet at this point, as they questioned and lectured him until they finally made some sort of arrangement and let him wander, now alone and loopy, out of the hospital. He then had to arrange three different taxi rides until he finally stumbled back into happy camp.

In the end, It's kind of hard to know whether he should be more proud of surviving Malaria or the hospital. EIther way, though, it was one hell of a weekend.
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