Hospital Sanitation and Obstetrician Headspin

Hmmm...yeah there isn't any sanitation really.  I was actually appalled the first time I stepped in the men's general medicine wards.  It was dank and dark, absolutely no air conditioning anywhere (and it gets 90+ degrees here during the day).  Oh, by the way, there is no air conditioning in the hospital, period, no matter the department.  At least in general medicine, there was only 1 patient per bed, but the sanitation is scary.  No infection control.  The room is filled with maybe 30 patients, and at least one of them I know is suspected of having tuberculosis, yeah no infection control whatsoever.  They may have a sink here and there, but no soap, no towels.  We foreigners bring our own hand sanitizer and try to make do with that, but after several alcohol washings, the film build up on the hands is pretty gross, and I feel like I need a good scrub with old fashioned soap and water.  While general med is rather dingy, obstetrics is in a new edition to the hospital, so it is relatively more modernized (still no central air) but at least its brighter and whiter.  Same sanitation laws apply, sinks with running water, but no soap anywhere to be found.  It's incredible, especially in an environment where I'm up to my elbows in maternal blood, fecal matter, amniotic fluid, and baby poop, that after every delivery, the best we can do is clean our hands with some alcohol sanitizer that we've brought along.  Still, given the circumstances, I think the staff do a pretty good job keeping things clean.  And we do use sterile gloves and personal protective equipment, eye shields, gowns (that we have to bring for ourselves!)  This hospital has very limited resources.  I guess it is to be expected, but actually living it out is quite hard.  I mean, we don't even have clean drinking water at this place.  There is no cafeteria to provide any kind of patient nutrition (or staff lunches).  The patients provide most things for themselves.    

Since I've been working in obstetrics for almost 2 weeks, I'll give you a better idea of the obstetrics system at Mt. Meru Regional Hospital.  The woman may have had 1 or 2 (or no) prenatal visits before getting admitted to the hospital in latent phase of labor.  When they are approximately 5cm dilated, they come down from the antenatal holding area (where there are 2 or 3 mothers or more) to a single bed.  Then they come to labor and delivery until they deliver.  After the delivery they will literally no sooner pop out the placenta then we are rushing them out to make way for the next woman. They gave birth literally 5 min ago and already are standing up, getting themselves dressed, and gathering their items to move over to the postnatal ward, where again there are 3 or more mothers to any given bed.  There is no such thing as local anesthesia (no epidurals).  We do give lidocaine if we have to conduct episiotomies.  These women even need to bring along their own suture in case they lacerate and tear during childbirth.  I have seen the nurses sew with and without the use of local anesthesia.  They bring their own congas (birthing clothes) as well b/c there are no linens on the beds.  And that is how they can tell which baby is theirs, no name tags needed.  They recognize the conga cloth that their babe is wrapped in!  In ALL of these wards, including labor ward, there are 12-20 beds per room.  It's only in labor ward that I've seen only 1 patient per bed.  This is a public hospital, so from my understanding, the conditions are much nicer in private hospital.  Still, even in public systems in America, the things done here would NEVER ever happen.  It's quite horrific at times.  Today we had 15-20 babies born in about 5 hours.  It was literal chaos, exciting, but chaotic.  I never had enough equipment to do what I needed to do, very frustrating!!!  And several of the babies needed resuscitative measures (suction and oxygen) and probably intubated, but we don't have the resources for that here.  It is amazing to me that the children can be in respiratory distress, and the nurses in L & D attend to the child, but after they do what they can do and the child is still pale and limp, they go back to attending to the mother's and doing their job without even a care.  From my viewpoint, the child is not at all well, but their feeling is Akuna Mitata (no worries).  To give them credit, the nurses are very busy people, and I guess in obstetrics the mother's should be the priority when there are so many of them birthing one right after the other, but still, CRAZINESS.  TIA...this is Africa.