Dr. Lowell Schnipper and I visited St. Albert’s in late July and early August 2016, mainly to learn more about the needs of the hospital’s cervical-cancer prevention program. Dr. Schnipper is an oncologist with Beth Israel Deaconess Medical Center and Harvard Medical School. Joining us was Ms. Megan Jukich, who manages a clinical laboratory at The Ohio State University Comprehensive Cancer Center – James Cancer Hospital and Solove Research Institute, where I also work. Megan provided the following account of her visit to the hospital.
We arrived at St. Albert’s at 1 a.m. on a Friday morning after nearly two days of travel (and a few hiccups) from Columbus, Ohio. I walked into the guest cottage and happily collapsed into bed, relieved that I could fully recline and sleep. Despite my exhaustion, I awoke early and, after enjoying a lovely breakfast with my companions, Darrell Ward and Dr. Lowell Schnipper, we headed up the path that led to the hospital.
We crossed through the gate onto the hospital grounds where we met Dr. Julia Musariri for a tour of the hospital. Back in Ohio, I work at a state-of-the-art cancer hospital. We treat patients every day with life-saving drugs, and, when those fail, we treat them with experimental drugs in an effort to both prolong their life and learn how to treat future patients. I oversee a laboratory that has protocols and processes that we follow to ensure that we comply with or exceed standards. We follow safety precautions when handling patient specimens, just as anyone caring for these patients would in any other part of the hospital. But this was my first visit to a hospital in a developing country, and during my time at St. Albert’s, I saw things that I struggled to comprehend.
Long before we arrived, the region had been suffering through a severe drought. The hospital water system provides water to the entire mission of 3,000 people. It includes the 140-bed hospital, the parish, the primary and secondary schools, school staff and the relatives that live with them. The secondary school has 900 students. The primary school has a total 1,200 students. The rest are mission staff with their domestic workers and other dependent relatives. By the time we arrived, the hospital was rationing water to the entire community.
Prolonged drought led to water rationing at St Albert’s in 2016. It meant that one nurse had to pour water from a pitcher over the hands of another nurse for hand washing.
It’s hard to imagine how a hospital can function without running water, yet St. Albert’s was forced to. There was no alternative. This meant that we had to flush toilets in the hospital using buckets of water and that a surgeon scrubbing for surgery used water poured over his hands by a nurse from a bucket of water. There was rarely soap and certainly no hot water. Without these basic things, the chance for disease and infection to spread is so much higher and it’s nearly impossible to thoroughly clean things like surgical instruments, work surfaces, and floors of operating theaters. Having to carry in water requires extra labor for an already overworked staff. And what would happen if the buckets of water ran low at a critical moment?
Walking through the male and female wards, I noticed that patient beds were different sizes and and models, a result of what was available or donated. Some beds had mosquito netting above them, but some did not. Signs posted around the hospital encouraged the opening of doors and windows to help stop the spread of tuberculosis. The reason for many hospitalizations, according to Dr. Julia, was diarrhea, respiratory infections and pneumonia. Since most households have limited access to clean water and the inability to practice hand hygiene because they cannot afford soap, it’s easy to understand how sickness can spread quickly. In addition, most dwellings house a large number of people in a small space, so it’s no wonder that infections spread easily from person to person.
In the maternity ward, I saw three expectant mothers sitting on a bench, eating sadza (a cornmeal mush that is a dietary staple in southern Africa) and beans – hardly a
nutritionally-balanced meal, yet it’s what the hospital can provide. There is also a post-natal wing, and across from that is a small room for premature babies. They are looked after by the nurses at St. Albert’s with no help from life-sustaining machines such as ventilators or incubators. I learned of a baby born with twisted arms and legs that survived only a few hours. The only help that could be offered was to cast his limbs in plaster in the hopes of straightening them.
In the male ward was a man whose foot had been run over by an ox cart, a fairly common injury in rural Zimbabwe. Another patient, an epileptic, had a seizure and fell into a fire. His foot was burned so badly that his toes had to be amputated. These are the real risks of everyday life in rural Zimbabwe. If someone is lucky enough to have a mode of transport aside from walking or a bus, it’s often an ox cart. Being bounced around or leaning too far over the side can easily lead to falling out and being run over. Burns are common because a large fire for cooking is found inside (or outside) nearly every home, often the only way to boil water or prepare sadza.
Our visit to the hospital pharmacy revealed mostly empty shelves. Zimbabwe’s National Pharmacy has no medications to supply to the nation’s hospitals. In the rehabilitation department, the staff helps patients as best as they can using hand-me-down crutches, walkers and exercise equipment; a pile of recycled casts and mismatched braces for arms and legs is piled in a corner.
In the hospital kitchen, food is prepared for patients and staff using biofuel from an underground biogas generator buried nearby. The laundry includes a sewing room where we meet the woman who makes surgical pads used during operations by hand because buying them pre-made is too costly. The counseling offices are located near the administration block. HIV testing is offered there, along with suicide, domestic violence and grief counseling. It was here, with the social workers and counselors, I would spend most of my time in the coming week.
I had the privilege of observing several counseling sessions throughout the week, always with the permission of the person seeking help. The sessions were in Shona, but the counselors translated for me so I could understand the problem. Each session left me feeling numb and drained.
I knew that Zimbabwe was not immune from issues such as suicide and domestic violence, but as I began my visit, I suppose I anticipated other, perhaps more stereotypical problems, such as AIDS and HIV infection. As I observed the counseling sessions, I was struck by the dire circumstances facing each individual.
In one case, a 21-year old woman spoke of her husband abusing her. It was the ninth time it had happened in their three year marriage. She sat slumped in the chair, hat pulled down to cover her eyes. Everything about her signaled defeat and despair. She came for HIV testing because although she was faithful, she wasn’t sure that her husband was. Her test results came back negative, and although she said she wanted to use protection with her husband in the future, the reality was that he likely would not agree to it, leaving her continually at risk if he is unfaithful. In another case, I sat silently as a man talked of ingesting pesticide, an increasingly common way to attempt suicide. Although I couldn’t understand what he was saying, his voice shook as he spoke and he often seemed on the verge of tears. I’ve been in that same vulnerable state, and it was all I could do to keep from reaching out and taking his hand, a tiny gesture from one human to another who has been where he was.
I was also fortunate enough to venture out for a day with the Community Home-Based Care team. It was a continuation of a launch of a sanitation and hygiene initiative sponsored by CAFOD, a Catholic international development charity based in England and Wales. We visited a local primary school, rural health clinic, secondary school and village – all were participants in the pilot project because of their vulnerability to disease outbreaks. Centenary itself had experienced an outbreak of typhoid just two weeks earlier. I was shocked to see that there was only one toilet for boys and one for girls at the primary school, which served over 500 students. Upon arriving at the secondary school, a group of students told us that the toilets had no water, leaving no way to flush the waste or for students to wash their hands. In all of the toilets, waste was overflowing and we were told it was cleared away only twice per week. The smell inside the boys’ toilet was overpowering.
I couldn’t comprehend how these students, many of whom overcome many challenges to even attend school in the first place, dealt with the obstacle of not having access to a working toilet every day, all day. I was facing my own challenge that day – the start of my menstrual cycle. After going all day without access to a toilet, I was grateful when we stopped at a shop. I was close to tears when I discovered the bathroom consisted of a toilet bowl with no seat, toilet tissue or running water and more than a few flies. Later that night, I realized that what I had to deal with that day was ugly and uncomfortable, but this is what the community around St. Albert’s faces every day. An overwhelming majority of women and girls cannot afford a luxury such as tampons or sanitary pads. The reality is that school attendance by girls drops around the time that they begin menstruating. Not only is it a challenge, but it has a significant negative impact on their education.
In the weeks leading up to my arrival at St. Albert’s, I thought about what I might experience while there, but I had no expectations. Every day, I marveled that this hospital continued to function – not only function, but thrive – under the most challenging of circumstances. Moreover, the staff continue to keep their heads up, continue to smile, continue to persevere. It would be so easy for compassion fatigue to set in, seeing these things day in and day out, and perhaps it does, but I never witnessed it. In the short time I was there, the times I had to catch my breath or fight back tears became too numerous to count. In the evenings, I found peace in taking walks through the nearby hills, watching a glorious sunset, or sitting under the stars marveling at their brightness and the clarity of the Milky Way, neither of which pictures can do justice.
Yet, I woke up every morning grateful for a chance to do it all over again. I laced up my sneakers and walked the dirt path up to the hospital. Day in and day out, my heart felt fuller as the layers of dirt continued to coat my shoes. I never expected to love this community as much as I do, especially within such a short time . I never expected to be so sad when I left, worried about how they would continue to get what they need to do their work. I certainly never expected to return home filled with the notion that I could make a difference, but that is what I intend to do.
To this day, I put on those sneakers, now a deep brown instead of their usual grey, and think about the path that I walked and where it’s leading me. I can’t bring myself to wash away the dirt – it’s a daily reminder of those I left behind, and I’m looking forward to the day l I can return to them.