After telling you all about my first impressions of Axum it’s now time to tell you about the hospital where I will be working for the next year. I’ve spent two weeks working at Axum St Mary hospital so far, mainly shadowing the two Masters in Paediatric staff who run the paediatric department. The hospital consists of a number of concrete buildings spread out over grounds filled with dusty tracks, concrete pathways, trees and grass borders. There is a large outpatient area, medical ward, surgical ward with attached operating room, ophthalmology outpatients out the back, gynaecology ward, and finally the paediatric ward (that was one of the residences for junior doctors once upon a time). There is an emergency department but this is mainly where people are seen out of hours and consists of a room with 3 trolleys in it. The tests available are FBC, blood film, screening for some tropical diseases, biochemistry (apart from the fact that the machine is broken), microscopy of urine, stool and CSF but no cultures and also X-rays and ultrasound scans. Compared to some places this is actually quite a lot of tests.
The routine of the hospital is slower paced than the UK. The day starts at about 8am, lunch is from 12-12.30 until 2pm and then the day finishes at 5pm. Out of hours the whole hospital is staffed by 1 or 2 junior doctors. On Monday, Wednesday and Friday the day starts with ‘morning meeting’ in the medical directors office where all of the admissions are discussed. The day then splits for paediatrics with one person going into the OPD (outpatient department) and the other going to the paediatric ward to do rounds and see new admissions. In the OPD patients come after being seen in triage which seems to just consist of a respiratory rate being done! As there are no GP’s the children seen range from a baby with a dipper rash to sepsis, malnutrition and severe pneumonia.
If a decision is made to admit a child they make their way to the paediatric ward. The ward is a series of interconnecting rooms: one for the neonates and one for children with malnutrition who also spill over into other rooms, the rest of the children are spread out between four rooms. The sickest children seem to be in the room furthest away from the staff room. Flies buzz around the children and the curtains in the neonatal room seem to be crawling with mosquitoes. Some of the beds have mosquito nets but not all of them. After admission or after the morning ward round parents are sent off with prescriptions and requests for tests to get the various things needed and also to pay for them. The commonest things children are admitted with are malnutrition, pneumonia and neonatal sepsis. Some of the more unusual cases I’ve seen, from my point of view at least, are visceral lishmaniasis and cutaneous anthrax.
Everyone that I have met from the doctors to the nurses have been friendly and helpful. The nurses especially have fabulous including making fun of my language skills and trying to teach me Tigrinya. So far I have learnt greetings and some medical terms. Their aim they have told me is to make me fluent in Tigrinya by the end of the year!