QEII

I want to try to paint a picture. My intention is not to make everyone sad, although that’s likely unavoidable. My hope is to try to highlight just how different life is for a sick child in Lesotho than it is for a sick child in the States.

Piles of garbage lie outside the entrance to the Pediatric Ward of Queen Elizabeth II (QEII) Hospital, the main public hospital for the country. The garbage mostly consists of broken cots and desks and chairs, and it’s unclear how long it has been there, or if it just keeps growing and never gets smaller. The walls of the hallway are freshly painted yellow with multi-colored flowers, directing you to the Children’s Ward. While I can appreciate the attempt at optimism and cheer, the yellow looks more like baby poop and less like sunshine. I hear the crying and smell the dirty diapers before I set foot through the doorway. In the States, hospitals have a smell that people don’t like because of the association with sad memories, but the smell is more like antiseptic and less like sickness.

There is a bench at the entryway, where mothers and grandmothers sit holding their children. These are the babies who have been admitted to the hospital because they are too sick to go home, but there aren’t beds available, so they wait on the bench until a bed opens up. They sit there quietly, and they do not complain.

All of the hospital rooms, which just lead from one to the other like a maze, each hold 4-8 beds, which realistically means 8-16 patients because most beds are shared. Sitting next to the bedside of each child is a mother, or a grandmother, or an aunt, or a neighbor. A child isn’t admitted to the hospital if they don’t have someone to take care of them here. The moms provide most of the nursing care—they are an essential part of the hospital team.

Like the beds, patients who require oxygen often have to share an oxygen concentrator and split the nasal cannula. There are no ventilators here, so intubation isn’t an option. Chest X-rays are read by holding them up to a window or a light and giving it our best interpretation, not in darkened rooms with pristine computer screens and radiology-trained eyes. The medical chart is under the mattress or next to the bed of each patient. It consists of pieces of white paper bound together with string. IV fluids run at the rate that you try to adjust them to by estimating the speed of the droplets, not by a machine that can calculate it to 6.1 mL/hr, or whatever your heart desires.

Standing on rounds, I watched one of the many bugs on the wall crawl into an electric socket to hide out and listen. About a third to a half of the children are admitted for some combination of diarrhea, dehydration, and malnutrition. These children are lethargic, have sunken eyes, sunken fontanelles, increased skin turgor, and remind me of ghosts. There is a lot of variety of illness as well, including meningitis, heart defects, seizures, TB, pneumonia, and sepsis. In the States, by comparison, a more common problem is childhood obesity and the diabetes epidemic occurring in our children, and Asthma is one of our most common hospital admitting diagnoses.

I could write sad stories about babies who died in my short time there, about the crying and yet grateful mothers. I could describe the lack of supplies, and the lack of gauze and angiocaths and alcohol swabs and antibiotics, but I think this is enough for right now.

The picture of a hospital here-- it’s a little different than home.