Frah, teaching, and hospitals galore

It has been a crazy couple of days. I've already seen so much and it hasn't even been a week.

On Saturday night, I finally got to see my first delivery! It was becoming a big joke because I kept missing all the births...the first night I missed two because I was sleeping (jet lag), then I missed one the next day while I was on rounds, and somehow I missed another two in the afternoon. So, I finally got to see one last night! There were actually two women...one vaginal and one c-section going on simultaneously. I stayed with the vaginal most of the time, and she had a beautiful baby girl...named Frah. The c-section also went well, although it took quite a bit of convincing for the woman to agree to have one. Everyone is terrified of surgery here, including c-sections.

Sherri and I have also begun helping out with some of the classes. The Nursing/Midwifery students have to take an entrance exam in English in September into a new program at the Hargeisa University. If they pass the exam and choose to continue in the program, they will receive a BSC (basically like a BS in the states) in Midwifery. This is a pilot program through the Hargeisa hospital, and Edna is hoping that many of her students will apply and get into it. As part of this program, the girls will have to do research/write a thesis (also similar to in the states). However, most of the girls have very little experience with research, and so Edna would like Sherri and I to help them through a mini research project. We basically have a month to try to help them complete a written report (intro, methods, data, analysis, and conclusions) based on a research survey they will conduct on varying topics (FGM, antenatal care, breastfeeding). We only have about three weeks to work with them now before the classes switch (the nursing students doing practicals in the hospital switch with the nursing students taking classes). It should be interesting. This is also completely optional, which is probably a good thing so that we are actually only working with students who will progress on to the University program. However, it has been a bit of a whirlwind as Sherri and I try to figure out what the most important basics are for them to understand, coordinate with their schedules, and try to make them understand everything in English.

We are also helping with English classes. The entrance exam for the nurses is in English, and all the classes at the hospital are also taught in English, as well as all courses at Hargeisa University. There are two or three professors who teach the classes, but Sherri and I will also be working with smaller groups to help review grammar, some of the topics on their entrance exams, and also help them practice speaking. Tonight we had to actually substitute teach for a class though....interesting. English is hard! I really think any other language is easier...we have way too many exceptions to the rules. We've never formally taught English, so we basically just did some more minor practice. Some people seem completely clueless, but there are a few girls who know quite a bit. So prepping, helping, and teaching classes has been sucking up my time...but in a good way.

Today, Sherri and I also to the Hargeisa Group Hospital (HGH), which is the government run hospital. This hospital is much larger than Edna’s and also much more in disrepair. Binke and Sinead (the two British pharmacists) have been working there in the pharmacy, so Sinead showed us around. We toured the orthopedics ward….mostly broken legs due to car accidents. For traction, they use paint buckets filled with rocks. Compared to Edna’s hospital, the beds, floors, etc. are in much poorer condition. More patients go to HGH because the beds are free (although we did see some separate private rooms for higher pay), but all the patients must pay for the medicine or other necessary equipment for care. There is a huge trash pile and incinerator, but really there is trash throughout most of the complex. Most of the wards are stone buildings that are falling apart. It appears some of them are no longer used, but instead they are just filled with junk and have broken windows. There are goats running around within the complex, and lots of goat poo everywhere.



We went to the mental ward, which has a female and male side. Coming from Sinead’s perspective as a pharmacist, there are lots of problems with the system here. There are some trained nurses who diagnose and medicate the mental patients. They have some training, but they do not know the uses nor how to administer drugs outside of an essential list they learned during training. When donations of some drugs are made that the nurses are unfamiliar with there is no easy way for them to be used. And if there is a medication available, there is often a problem with maintaining a continuous supply of it. Apparently, the mental patients used to all be locked up, but now they use medication to try to limit the mobility of the patients. Seems sort of sad.

We walked by the FGM trauma center, but did not get to go in. The FGM trauma center basically takes anyone with a botched FGM, or women who have had complications (urinary tract infections are also common) due to their FGM. More on FGM in a future post....


We went to the depot, which Sinead calls the “black hole.” Inside are piles of expired drugs, broken or unused equipment, and other unsorted supplies. There are lots of donations to the hospital, but there is no management system in place to ensure the correct supplies is available and in-use. When organizations make donations of supplies, many of the health care workers do not know how to utilize these newer technologies or medications. Donations of random supplies are not helpful if there is no education on how to use it. I saw several Westernized patient monitors sitting unopened because there is not the understanding at the hospital of how to use them. The drugs often become expired because when they arrive there is no single system to categorize and dispense all the drugs. Depending on which organization supplies the medications, there are varying rules as to who can use these drugs, etc. and so there are many different systems. Having worked at the hospital for the past few weeks, Sinead and Binke are now providing recommendations to the hospital. Their many recommendations include implementing a better management system and creating a unified system for organizing, categorizing, and dispensing various medications and supplies. Seems like it is all a bit of a mess really.

Boxes upon boxes of expired Calamine lotion.
(Sinead: "I mean, how much Calamine can you need")



Binke and Sinead in the re-organized pharmacy.

All and all, an interesting day. Another funny tidbit, Edna loves to watch "America's Got Talent." Cracked me up the first night she told us it is her little sin...that she loves this show!