Friday night in the ER

Friday evening I got a call about 6:30 from Thini saying Nonjabulo was very sick and weak. So I went to pick up Thini, Nonjabulo and Nonnhlanhla (the mom) and take them to the emergency clinic at RFM (the hospital in Manzini.) Nonjabulo was very hot and very, very lethargic. She looked like she was barely breathing. Thini wrapped a real thick, heavy blanket around Nonjabulo before she got the car. Unlike in the States, they keep babies wrapped in these real thick heavy blankets no matter how warm it is outside. Friday night was very hot and muggy. I told her to not put the blanket around the baby because her fever was too high. I was amazed she immediately took the blanket off of the baby. (The baby still had on the long sleeve footed one piece terry cloth sleeper and a light receiving blanket around her.) We got to RFM about 7:30. Nonhlanhla took the baby to get in the que to see the Doctor and Thini and I went to get in the que to pay and get her chart. They couldn’t find her chart because the accounting office had it, so finally they made her up a temporary chart. Because the baby has TB, there was no fee for the visit.

It was some after 8:30 before a Doctor showed up. Thini and I had to wait outside because they would only allow the mom into the emergency room with the baby. Waiting brought back so many memories of taking my Christopher to emergency when he was a baby. He would get ear infections and spike a high temperature and of course it was always at night. I thought of how scared Nonhlanhla must be for her child and how blessed we were that my mom could come into the treatment room with Christopher and I. I thought of one particular time when they rushed us into a treatment room because Christopher’s temperature was so high. And they had us take off his clothes and continually sponge him down with cool water until the Doctor could check him. Christopher hated that and so did I but knew it was the right thing to do. I knew nothing like that was happening inside the emergency treatment room here. It drove me crazy to not be able to go in and ask the Doctor all kinds of questions and tell him everything I knew about the baby. I was especially worried because she didn’t have the chart that gave the history of illnesses and treatment that this little baby has been through in her brief little life. This was one of those times I had to just pray for patience and that the Lord would give the Doctor wisdom in treating this baby. About 10:30 they came out. I was surprised the Doctor didn’t admit her. Nonhlanhla didn’t know the diagnosis, only that they were supposed to get the medications prescribed filled and bring her back on Tuesday for a check up. I tried to glance at the medications, but couldn’t read what was written. I would have had to ask the pharmacist but instead I had to run and get the car because a thunderstorm had rolled through it was raining.

It is now Sunday morning. Thini says the baby is doing much better, but still not eating a lot. I don’t know how much she is drinking. So just when we got her weight up so she could come home from the hospital Thursday afternoon, she got sick on Friday afternoon and she has probably lost at least some of that precious weight gain.

Oh Lord, PLEASE heal this tiny, precious child of yours. Amen

The emergency room on a Friday night was much like what we would expect in our emergency rooms on a Friday or Saturday night except the basic facilities and resources are much, much worse. There was a group of people who had had too much to drink and were fighting with each other. Mainly one main was trying to go after two young women who had something to do with his friend who was lying on the floor while they waited to get the chart and pay the fee. A security guard finally came in. Security guards are usually pretty small people and they don’t carry weapons. I’m not exactly sure what anyone thought he would do but I guess at least his presence calmed things down a it. I told Thini that we had security guards or policemen in our emergency rooms as well, but ours carry phones and weapons including guns to back up their authority.

Here, when you wait in line to get your chart or see the Doctor, you sit on a bench at the “end of the que.” Every time someone is helped and leaves, the entire que stands up and moves up one position. It’s really kind of comical. I want to ask them if they have ever heard of giving people numbers, but I know that wouldn’t help. In Pediatrics, during the day, the patients first wait in the line to get their chart and then they go wait in another room for the child’s vitals to be taken and then they are given a number to go see the Doctor. The nurse at the Doctor’s door comes out and takes a half a dozen or so numbers out of the people’s hand at one time. She doesn’t take their name or keep the charts in any order so I’m not real sure what good the numbers are.

The waiting area for emergency is outside in the courtyards surrounding the emergency room. The emergency room is just a big room maybe about 1200 – 1400 square feet with a few beds sectioned off with curtains. Babies are kept in one section with as many babies sharing one bed as can fit on it. There are usually at least two or three babies on one bed. If the babies are smaller, there are more. The moms stand by them and move out of the way when the Doctor comes. If they are severely malnourished an IV will be started right there. They don’t group them by illness and there is no privacy. The nurses and Doctors try their best to be sterile, but there is no way they can keep up sterile conditions with all the people who come through there and the small cramped quarters. There isn’t air conditioning, so you can imagine how hot, stuffy and smelly it can get.

The US may have a lot of problems with medical care, and certainly not all clinics and hospitals are at the same level, but we have so much to be thankful for. Things could be much, much worse.

I mentioned earlier that there is no charge for treatment if the person has TB. That is because TB is so rampant in Swaziland. It is one of the more common opportunistic diseases as a result of HIV/AIDS. It also spreads very quickly because transmission is airborne. In an attempt to contain the spread of TB and to lesson the treatment time, they have made medical care free for TB patients. That is great. However, the cost of transport to get to the Doctor is still a huge issue. Most people, especially in the rural areas can’t afford the transport fee. And if they can, they crowd onto a bus or kombie (a van that is like a mini-bus making more frequent stops) thereby exposing everyone that is sitting around them to TB. Doctor visits and treatment for those who are HIV+ is also free. But the same issue of transport is still there. And then we have the issue of malnutrition which is huge in this country, not necessarily because of the lack of food, but because many live on a diet rich in maize (corn) and very low in protein, dairy products and vitamins from vegetables. It’s a complex problem with a complex solution. Conditions aren’t going to change any time soon. It will take years, if not generations, for changes of the magnitude that is needed to happen. But we can’t give up hope and our faith in the Lord to guide us day after day, and to help one person or child at a time.