In the few weeks I've been at the Rugazi Health Centre IV I seen some appalling conditions. A HCIV is supposed to be a step below a hospital but the facilities and equipment are sorely lacking. The site is short on basic medical supplies like gauze, sutures, and even medical tape for bandages. Drugs are on short supply so patients are often required to purchase their medical supplies and medication out of pocket outside the centre. I have not been in the IV storage room where the NS (normal saline) and blood are kept.
Once a patient is admitted, they are placed in one of the three wards; paediatric, male, or female (or the fourth, maternity). In all but the paediatric ward, people are supposed to bring their own beds, all are required to bring their own bedding. Food is not supplied and as mentioned earlier, they often have to pay for their own supplies and medication.
There is no full time physician at the centre; we do have a clinical physician (some diploma program that reflects a LPN in Canada) but no physician. The senior medical students conduct ward rounds; we have three. I'm told that the visiting physicians or students conduct rounds, not nurses meaning that if we were not here the patients would not be seen. Nurses give our medication on ward and dispense for out patients.
I would not say that the IV usage is safe. The staff is reluctant to use disinfectants because of the short supply and there is no sterile compounding area whatsoever. Sterile prep amounts to opening ampules, withdrawing without a filter needle, and injecting into the hard plastic IV bag (no injection site... just directly into the bag) or direct bolus dose without the use of a filter needle when withdrawing a preparation. No Y-site injection. No laminar air hood. No disinfecting. At least the needles are sterile in package. It is very unnerving to see the IV bag with an uncovered needle sticking out.
There is not enough blood for transfusion. One night last week there were four patients that came in with severe anemia in dire need of transfusion. There was only one bag of B+ blood in storage and none of the patients could receive it. One child died while the other three were rushed Ishaka (the nearest hospital). The person in charge of stocking the blood did not do his job; he claimed that the distance to get the blood was too far and that we should like the patients die.
In truth, some of the patients would not have benefited from a transfusion; their levels were so low that they would have died anyway. Still, it is very depressing that one could get to a state like that in the first place. Some patients come in like skeletons from malnutrition (the patient I have in mind was also HIV positive) and resemble some of the people I've seen in history textbooks about severe famine during wartime.
My experiences haven't been all bad. There are many times when I think I've learned a great deal about tropical medicine. I am just merely unloading some of my shock and experience from the past 3 weeks. I've seen some more grotesque problems but they are best left for another day (preferably in-person).