Healthcare News and Policy

Despite being on the top of a hill, the hospital was remarkably unimposing and unimpressive: just one floor high and composed largely of corrugated iron and brick. It consisted of a handful of wards, an A and E “department” and a few small rooms to see outpatients in. It contained several courtyards. Outdoor corridors connected the different wards. The courtyards and corridors were lined by people, patients, families and extended families. Mothers breastfed, children ran around playing games, other adults dished out food or did their washing in a nearby sink in the grounds, whilst some simply sat. By contrast the hospital wards were quite empty—only a few inpatients in each of the four specialities (pediatrics, general medicine, general surgery, and obstetrics and gynaecology). Many of the rooms in the wards were empty. Faded, once-colourful, patterned curtains hang limply. Paint flaked, and biblical quotes peeled off the dirt-washed walls. In the stifling heat even the ceiling fans seemed to be taking a siesta. The hospital was basic to say the least: there were no computers, no observation machines and I had little confidence in when the bed sheets were last changed. Instead a manual blood pressure cuff lay dusty in the corner of the cupboard, adult oxygen saturation probes were clamped onto children’s feet and thermometers were used from patient to patient without cleaning. Inhaler spacers were replaced by plastic bottles with a hole cut in the bottom. Ventilators were replaced by a dedicated doctor bagging the patient throughout the whole operation. Intensive care simply did not exist.

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