Gareth in Malawi

First attempt at a ward round today. I arrived on the ward, M1, and was once again immediately approached by throngs of patients proffering their hands for shaking or greeting me with manic shouts. By now I am getting used to it and feel more comfortable wandering out into the courtyard and along the concrete floors, stepping over patients, greeting informally but without committing to a full conversation. The courtyard and corridors are filled with many white-uniformed bodies, milling around in groups talking uneasily to each other, and sometimes engaging with a patient. My initial reassurance at this apparent surplus of staff turned to mild frustration when I saw that they were all nursing students, very few of whom were interacting with patients, some listening to iPods. In the smallish office there is apparent chaos, two patients sitting with torn clothes on the floor, shouting at a fellow patient outside, various white-clad nursing students flipping idly through patient notes, and the nurse Monday writing furiously while telling a patient to get out and a student to come in. He flashes a brief smile when he sees me and I ask him if he’d like to do a ward round. There is a brief ripple of his temple muscles as he contemplates the further chaos this will cause now. “Of course, you know, we can do a round.” I check again, “What would be good for you Monday? I can see things are busy here.” I feel helpless, not speaking the language, not yet knowing how patients are admitted, or even how many there are on the ward today. I don’t want to cause more work for anyone. Monday is sure though, “No, we can do a round. Let me call the patient.”
Read the rest of this entry »