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July 9, 2011 / calebdresser

Group Hospital

Today, I had the opportunity to see the other side of Hargeisa’s healthcare system. Dr Robert, an American physician who has spent the past twenty years in Africa, invited me to join him at the Group Hospital for the day and I gladly accepted. He donates his time three days every week to teach interns and act as an attending physician, although he often gets dragged into patient care because nobody else is available.

Group, as it is known here, has acquired something of a reputation among the staff at Edna’s. Thanks to its rock-bottom prices and rock-bottom standard of care, a fair number of women go to Group to deliver, don’t get proper medical attention, develop complications, and eventually head over to Edna’s hospital with a well developed haemorrhage, convulsions, or a dead fetus in obstructed labour. Edna’s staff often has to fix the mistakes made at Group, or deal with patients that should never have been allowed to progress to the conditions that finally force them to come through our doors. I was curious to see the place.

The Group Hospital consists of a rough assemblage of single-story buildings just west of downtown on the main road. From the outside, it hardly looks like a hospital; it is separated from the street by a sorry-looking stone wall and an open area covered in piles of windblown garbage. Inside, it is a government-run catastrophe.

We spent most of our time on the male and female medical wards. Each ward consists of a single long room with rows of beds along each wall. The rusting metal beds don’t have any sheets, so most of the patients bring their own bedding. Infection control consists of bright blue mosquito nets over the beds and a stained sink without any soap at one end of the ward. The infrastructure is basic. Partway though the morning, I heard mewing and looked up to find a confused kitten peering down at me through a gap in the ceiling tiles.

The patients don’t help the situation, though that could probably be said of any hospital. Most of them pay $2 for their chart and can stay indefinitely once they are admitted, so a certain proportion are perfectly healthy but don’t want to go home. One of the first people we examined was a muscular young man who said that he occasionally felt shortness of breath. He’d had a full workup that showed everything was normal and had been released two days earlier, but still hadn’t bothered to leave the hospital. His friends had decided to join him for the day – most of the young men in Hargeisa are unemployed – and his section of the ward had turned into the latest hangout spot.

The staff members are not much better. While Dr Robert took the time to do things like take histories, perform physical exams, and talk to families about their needs, it was evident from the notes that many of the patients had received nothing but symptomatic treatment, and that little effort had been made to diagnose their actual problems. We had to go fetch one of the nurses who had wandered off to drink tea under a tree with her friends when it came time to see her patients, and we played an endless game of find-the-chart on both wards throughout the day. My personal favourite was a file folder that had inexplicably been stuffed underneath a patient while they were sleeping.

As might be imagined, many of the patients were seriously ill. We saw a diabetic coma, liver cirrhosis, an array of gastric bleeds in need of repeated blood transfusions, and a teenage girl who had mysteriously lost motor control in her arms and legs but was alert enough to be terrified. For most of these people, definitive care is not available in Somaliland. Many conditions that would be treated surgically in the United States are treated medically because the surgeries cannot even be attempted here.

Despite the chaos and inadequacies, there were some happy moments. I left the hospital with a smile on my face after meeting the gentleman in the following photograph. While he still has tuberculosis in both lungs, his condition is improving, and he was chatty and friendly throughout our visit. Afterward, we talked about his family and he invited me to sit with him for a picture. All is not lost at Group Hospital, and while it may be true that everything moveable has been stolen, for at least one man the crumbling buildings still provide some hope.

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2 Comments

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  1. minstrelm3 / Jul 11 2011 1:58 pm

    We had completed our hike on Mount Katahdin when Winslow, whose phone lets him read your blog, told us a little about this post. There is such a lot in this world that I wish were excellent for every person, every creature. I am awfully glad that the gentleman in the photo with you finds himself improving. My experience, having surgery in January, radiation in spring, and climbing the Saddle Trail and Hamlin Peak in July, had seemed like an amazing accomplishment among my surgeons & colleagues, my family & friends, and my own gumption. Now I remember, too, that it is also an amazing thing in the perspective of global health options. I am incredibly fortunate. I wish everyone were. Count on me to continue trying to do worthwhile things, so that my is life worth all that has been given to it.

  2. Becky / Jul 13 2011 3:24 pm

    Is it safe to be so close to TB?

    And ceiling kittens….. oh boy! Maybe it’s the hospital’s pet therapy?

    -Becky

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