Inside a hospital

- Dr cries as child dies because he can't find right drug
- Nurse collapses and there is no equipment to help her

John Moyo is only 25 but he is one of the most sought-after people in this country. Moyo (not his real name) is a doctor. He clearly understands and appreciates the need for more local doctors to work in this country, especially in government hospitals, and is quite aware that between five and 10 doctors are leaving the country each month, but every time you meet him, he complains about the frustration in the profession.

He cannot wait to finish his housemanship and emigrate. And it appears no amount of persuasion will make him change his mind unless there are drastic changes in the country's hospital administration system and the way junior doctors are treated generally.

For Moyo, not only is he overworked and underpaid, he does not have much needed transport or decent accommodation. Worse still he does not see any prospects of getting out of this squalid life unless he leaves this country. He wants to specialise but he believes he will never be given a chance to do so if remains in the government service.

Moreover, because of the present system of hospital administration, he believes it is much better to go and work elsewhere rather than in an institution where people who do not know anything about medicine mess up things yet the only person who gets the blame is the doctor. What hurts him is that it is nurses and doctors who get the blame when a patient dies yet at times they are not to blame.

At times they are denied the tools of their trade by some political appointee who is in charge of buying hospital drugs and equipment but does not know what to buy and does not even care to consult those who know.

Moyo, who is the last born in his family, and has therefore had no experience of looking after babies, wants to become a paediatrician. He says he likes children because they never lie to you about the history of their illness. It was therefore a terrible blow when one of his patients died, right before his eyes, because he could not find the right drug to treat the 18-month-old baby.

"I was called at about 9 pm and told that the child was dying. I was there within five minutes. I was literally flying. The first thing I asked for was an EET tube (Endo tracheal tube) to help keep the child breathing. They didn't have any so I had to send someone to go and get the tube while I watched the child dying.

"They spend about 30 minutes looking for the tube. There was nothing in the casualty emergency cupboard. There were only adult tubes. When they brought the tube the child was still alive. I had been giving him oxygen but it was not enough. I put the tube down the child's trachea and it was then I realised there were no drugs and before the nurses could find any drug the child died.

"I felt that the child should not have died and I started crying. I just couldn't help it. If it was an adult, someone say 50 to 60 or more, I would not have minded that much because, at least, I know he has seen a few things even perhaps his own children.

"If it had been someone with AIDS, especially an adult, I would not have cried because it's of his own making. If it had been someone who had been drinking heavily, for example, and had developed cirrhosis I wouldn't have cared that much because it's of his own making. But not a child especially when you know he is HIV negative.

"A child is so innocent. He has not even been absorbed into the system. Moreover, the child had died not because we couldn't save him but because someone had not ordered the right drugs. This is so boring.

"This was not inefficiency. There are cases where someone can be inefficient. I admit that. If things are there and one cannot use them that is inefficiency but if the things are not there what can one do? You cannot be accused of being inefficient when the things are not there," Moyo said.

Moyo admits that it is the responsibility of the nursing sister to make sure that the emergency trolley is stocked with all the required medicines and such she is to blame. But he quickly adds that the sister may know what is required but when she requests she is told the drugs are not available by those responsible for ordering the drugs and she is usually brushed off with the excuse that there is nothing they can do about it.

"The drugs are supposed to be in the ward all the time. We have an emergency trolley. This trolley should stock the tube I am talking about and the drugs as well but they are never there," Moyo says.

"The problem is that the people who order drugs are not medical professionals. They are just administrators. They do not know what is required. Most of them have never been in the wards. They do not even know what's used."

For example, we had some Rhodesian made drips coming on the market just a few weeks ago. They were useless. They were manufactured before independence. They were made in Smith's time and are definitely out of fashion but they were buying them because they were very cheap. I do not know where they wee buying them from since they have been in hibernation for the past 12 years but everyone knew they were useless.

"This is very frustrating because we are the ones who treat the patients so if a patient dies people say the doctors are shit yet it may be because someone has not bought the right drug because he is looking for something cheap.

"They just buy drugs without consulting the medical persons who use the drugs. Like now they are buying some Chinese needles which are useless. They are blunt. They are buying them because they are cheap but you can't use them. Today I had this patient who is hypertensive, there was no EM dopa. The drug was not there.

"Third World countries are the dumping ground of useless drugs because we look for cheap drugs. Take aspirin, for example, some countries have stopped using it but we are still using it because we are a dumping ground. The person who suffers is the doctor because he is the one who administers the drugs," Moyo says.

But the problem of shortage of drugs does not only seem to affect patients alone. Moyo cites an incident involving a nurse who collapsed in his ward. Moyo says everyone panicked and since he was the only doctor available he rushed to the nurse and placed her in the right position. When one faints, he says, there are three basic things to do: to check the blood pressure, test the sugar level and the haemoglobin (the red colouring matter in the blood that contains iron and carries oxygen).

"You must do this in five minutes otherwise you lose the patient," he says. As he called out to the nurses: "BP machine," he was told it was not there. The machine to test sugar and that to test haemoglobin were not there either. He had to request one of the nurses to go and look for the equipment some 120 metres away and she only came back with the machines 30 minutes later.

The nurse survived, though, and Moyo simply says "it was only through the grace of God" because there was nothing he could do until he had made the necessary tests.

While Moyo's sentiments may be scoffed at as those of a disgruntled young doctor trying to give an excuse to leave the country, the writer had a first hand experience of what Moyo was talking about. The writer took a baby to hospital at 11.a.m a doctor who examined the baby recommended that he be admitted for observation. This simple process took up to 5 p.m.

On admission the child was given an injection and had to spend the whole night coughing without any medication because the ward did not have cough medicine. The child was discharged by a specialist at 10 a.m. on the third day, but only left at 4 pm because the nurses had been looking for the medicine prescribed by the specialist.

Apparently some private doctors who use government hospitals are capitalising on this anomaly to discriminate against "government" patients who are normally the poor or the aged.

This seems to be rife in the eye section where there is a shortage of one of the key drugs, atropine. The drug has been out of stock for almost three months and although it was ordered in November it lasted less than two weeks.

What is however, disturbing is that the specialist is now demanding that before patients can be operated they should buy two month's supply of this drug. This The Insider has been told, is apparently a way of denying treatment to the poor because most of them cannot afford to buy the drug in such quantities. The Insider has been told that only two weeks' supply is really necessary.

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