I spent five weeks in this 600-bed United Bulawayo hospital (UBH). Government care is heavily subsidised. There is one ‘private’ hospital in Bulawayo run at a standard comparable to hospitals in the developed world.
THE DEPARTMENT OF SURGERY
I was attached to Mr Cotton’s team. He is an English consultant general surgeon of British training.
The firm was busy with a 1 in 2 on-call commitment and a rapid turnover of patients. There is a long operating list once a week with 6 – 7 ‘big’ cases (requiring general anaesthesia) and 3 – 4 minor cases in the 8-hour scheduled list time.
A patient could be seen in today’s outpatient session and admitted for tomorrow’s operating list! A significant proportion of patients on the list travel for hours to get to the hospital.
RESOURCES AND DIAGNOSTICS
Articles often taken for granted in western hospitals were used economically. Some drugs needed in the hospital were often in short supply or were absent from the hospital’s formulary. Many operations are carried out under intravenous anaesthetic ketamine.
Most basic blood investigations are available for half the working day. Urgent blood investigations have to be carried by Mpilo, the other UBH hospital.
The hospital has a reasonably well equipped radiology department with facilities for ultrasound as well as x-rays. CT scanning is available in Mpilo.
HOSPITAL IN-PATIENT CARE
Nursing care was generally delivered with great professionalism. At times though, the nurses seemed to just do their jobs and spent very little time talking patients. Doctors “gave orders” and the nurses carried them out, sometimes with little display of initiative. The doctor-patient relationship follows a similar format. Patients were very uncomplaining – they were quite stoical and seemed to accept any negative outcome as fate.
OUTPATIENT DEPARTMENT
The patient walks in carrying his own notes. The whole encounter is usually over in about 5 minutes but much is decided in this time. The surgeon books the patient directly on to his surgical list diary before writing a very brief summary into the patient notes which they carry with them to the junior resident on admission.
Patients present quite late in the natural history of their disease. They often consult their local traditional healer or witchdoctor before approaching conventional medicine as a last resort. Healed scars and tattoos are evidence of such consultations.
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