The adult male and female wards are in separate buildings and each has about a dozen beds. Green curtains are available for privacy and are tossed over metal rods when not in use. Blue mosquito nets hang over every bed. Below is a view of half of the women's ward.
Most patients have a family member or friend nearby. The hospital provides meals - usually some variation of "rice and beans"
Lucy was one of the first patients that I met. She is 82 years old and suffers from heart failure, intestinal bleeding and has an abnormal chest X-ray suggestive of an upper chest mass - a CT at an outside hospital questioned thyroid cancer. ..... Lucy's family wondered about transfer to a higher level facility for more testing and treatment. I had a family conference with 10-12 folks including children, grandchildren, nieces, and nephews. Together, we decided not to pursue transfer and to just give supportive/palliative care. She remains on oxygen and is mostly bedbound. The family does not feel comfortable taking her home and does not have the financial means for home oxygen so Lucy will stay in the hospital for now. .....it is a joy to visit Lucy each day and see her sweet smile!
Yvonne is a 15 year old schoolgirl who came in about 10 days ago and went home yesterday. She presented nearly unconscious, breathing rapidly, and had a blood sugar of about 450. Her urine showed "ketones", which are toxins that build up when a person does not have enough insulin to handle their glucose. She had a new diagnosis of Type 1 diabetes and DKA or "diabetic ketoacidosis", a life-threatening condition. Yvonne was given several liters of saline intravenously as well as short-acting insulin injections every 1-2 hours for several days. As her blood sugar declined and the ketones were cleared from her body, she regained full consciousness and was switched to every 6 hour insulin injections. Finally, she was switched to just 2 insulin shots daily before breakfast and before dinner. We taught her and her mother how to poke her finger to get a sample to measure her blood sugar with a glucometer and how to draw up and inject her insulin. This picture is Yvonne at discharge, along with nurse Kerich and me. Yvonne lives several hours away - her mom will either text or email me blood sugar data every few days so that her insulin dosage can be adjusted. After we leave Kapsowar, one of the resident doctors will monitor her. .......in the US, Yvonne would have been treated initially with an insulin drip infusion and may well have been considered for a continuous insulin pump to best control her disease; these are not available here.
This is a surgery patient who was outside getting some sunshine while recovering. He is wearing several colorful Shukas, which are traditional acrylic blankets or coverings worn by the Masai people of East Africa.
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