A post not for the faint of heart.

This post is a bit different from the rest of what I have been writing.  Instead of freely writing what I am thinking and experiencing, I have decided to post a portion of my clinical log that I have written for my class.  This is the log with follows my observations and reactions to everything I have seen in the past three weeks at one government run clinic alone.  I personally don't feel like it is too graphic but I will say that some of the things which I have seen are unbelievable and quite honestly, disturbing.  I apologize if anyone is offended or just grossed out but I think it is important for me to share these things as I am here in Botswana to study public health.  Please keep in mind this is not proof read nor finished so don't fault me for any mistakes!! :-)

Also, as a side note:

I will be traveling to Mochudi in the following week which is a village outside of Gaborone.  I will be staying with a host family and therefore will not have any internet access from the 12th to the 20th.  I will definitely have lots of stories when I return from there!!

Clinical Log #1:

In order to fully understand the aspects of public health which come into play in places such a Gaborone, it is necessary to have hands on experience.  The past three weeks, I have spent my Tuesday mornings observing at a clinic in Gaborone.  My initial impressions were ones which questioned how well any health professional could actually consult and treat patients in such a small and confined space.  The observations which I have collected in the past few weeks have proved to question much more than that initial observation.

My first Tuesday in the clinic was 25 January, 2011.  Upon entering, I found a waiting room approximately half filled with patients waiting to be seen.  The time was close to 8:30 am and patients had yet to be seen.  I had been told by one of the nurses in training that the clinic opens daily at 7:30.  Immediately a queue forms.  Speaking to the nurses that were sitting around, I realized that most of the staff in the clinic are not true nurses but nurses who have yet to graduate their program.  In total, there was one doctor who would not come until the afternoon, two trained nurses, and four nurses in training.  Due to the slow start to the day, I was able to ask a few questions of the nurse I was paired with for the day.  I learned that each patient, if from Botswana, pays P5 per visit.  While speaking with her, I noticed another nurse using a tongue depressor she had pulled form a box of sterile supplies in order to rip paper in straight lines.  After using that and putting it on the table where patients are seen, she continued to place the tongue depressor back into the box of sterile supplies. 

For the first day, I was put into the maternity and family planning section of the clinic.  The women were all asked to lie down on an examination table which was covered with a red plastic material used to protect from infection.  The nurse examined the patient using a glove but did not wash her hands after examination.  The red plastic was not changed despite finding out that the previous patient was infected with HIV.  It was not until one hour and 15 minutes after the nurse began to see patients that she washed her hands with soap and water.  Another issue found in the family planning section of the clinic is the lack of supplies in order to give a proper examination or to give the actual family planning injections.  Several patients had to be turned away and sent to another clinic in order to get the medicines and treatments they were requesting.  In the event that the clinic could provide the injections needed, the nurse did not take the time to clean the skin before injecting the patient nor did she take precautions to protect herself from any contaminations as she grabbed the needles bare-handed after use.  The final major observation made in the first day was the lack of privacy in the examination rooms.  Many times, multiple patients were found in the same room and people were able to walk in on pregnant women who were on the examination table in the middle of being checked. 

The second day at the clinic was spent in the dressing, injection, and bleeding room.  The three of those procedures are all preformed in the same room.  All patients seen were in for re-bandaging.  Each patients was told to undress wounds themselves and were given soap that the nurse had brought from home in order to wash hands.  Patients were forced to stand in uncomfortable positions for prolonged periods of time while the nurse was distracted from re-dressing the wound by a passer-by talking of the malaria outbreak.  New gloves were used for each patient seen and the nurses washed their hands after each patient, however, there were two patients in the room at a time at one point.  At the registration table, there was only one blood pressure machine working and the battery died quite frequently.  In the event of a dead battery, a hand machine was used with a faulty hose causing the nurse to take the blood pressure several times in order to get a semi-accurate reading.  One patient complained of waiting for three hours before even being registered while another patient had waited that period of time before having discovered she had a blood pressure of 192/160.  In this case, she was immediately seen and took precedence over the other patients. 

My third visit to the clinic was spent with the visiting doctor who was sent by the government.  He immediately seemed more focused and motivated to see patients and quickly yet efficiently treat them.  The doctor only spoke a bit of Setswana however thus needing to call in a nurse to interpret once in awhile.  One patient he saw could not be prescribed medicines because there was no way to transfer records from one doctor to another, a flaw in using the hand written record keeping system.  Each time the doctor touched the patient, he washed his hands with soap and water.  He mentioned he would be quick with patients to keep the queue moving, however, in the event of a person needing more attention such as a nicotine addicted patient, he was more relaxed and took the time to suggest solutions.  The same problem with the red plastic covering for the bed existed, however, as a patient who had experienced a miscarriage and was now bleeding laid on the bed followed by a patient who the doctor suspected of having an STI all without cleaning or changing the plastic.  The doctor was very careful to explain to a patient the importance of going to get further tests but was frustrated when the clinic did not have the supplies needed in order to perform a simple PAP smear.  When asked, the doctor said he could see any number of patients, usually averaging 100 per day.

The situations which are found at the Broadhurst 2 clinic are unbelievable.  At no time is it acceptable for a patient to be put at unnecessary risk for contracting a disease or illness.  The attitude of the nurses as they slowly move through the registration process and the consultations makes the atmosphere anything but pleasurable.  The suffering of each patient in a three hour queue without access to water or a bathroom is not a suitable situation for a person dealing with a so-called “advanced” health care system.  Patients’ privacy is completely ignored and their dignity is stripped as they must endure the constant interruptions during their consultations.  During all that the patients encounter during their attempts at making it through the clinic, they are exposed to countless infections which are completely avoidable.  The standards at which the nurses in the clinic are allowed to work are remarkable as there seems to be no supervision which must be noticeable to patients.  If a doctor comments on how poorly run a clinic is, there must be some changes made in order to provide to services and protections that a clinic is required to provide.