Katutura State Hospital

I have been struggling to write this blog for the past few days. I am not sure how to approach this content without it sounding sensationalized or pitiful. I'm not entirely sure if it's possible, but I gave it my best shot. Here goes:

Christa and I spent last Friday morning at Katutura State Hospital, one of the public hospitals serving residents of Windhoek and surrounding areas. Christa practiced as a nurse at Katutura State for 27 years before resigning to commit all of her time to Mount Sinai Centre. Visiting the hospital was quite surreal and in many ways not what I expected. From what I understand the resources and manpower at private health facilities are significantly greater compared to public health facilities. The private health facilities are essentially serving a limited number of people, likely upper-class individuals such as high-ranking government officials and expatriates. Their financial resources already afford them better health than the vast majority of Namibians. Public health services are available to everyone else who does not have the financial resources for private health care. And their health needs are signifcant. Additionally, many doctors and nurses don't want to practice in the public sector because they are significantly underpaid and under-supported. Working in a private practice or private hospital means better pay, meaning they can pay off their student loans while earning income to support their families. However, they are not reaching the individuals with the greatest health needs. Those who work in the public sector must do so out of sheer compassion and committment to the well-being of their communities. One interesting thing I learned is that the public hospitals have flats (apartments) on their property for their doctors and nurses. Doctors and nurses can live their for reduced prices in order to assist them as they pay off student loans.

In retrospect, I think my visit to Katutura State was not what I expected because Windhoek is more of a westernized city with restaurants, movie theaters, running water, wi-fi, etc. We're not in the middle of nowhere with no resources and a government that has run amok. But on the other hand, Windhoek is also a city of disparities. I have heard that national independence was supposed to alleviate some of these disparities by providing more jobs and better wages. That didn't happen. This disparity is very clear in their public sector health facilities.

We were greeted at the security gate by a guard with a large rifle across his lap. Although I don't see all of the security guards with big rifles it is not uncommon. My boss' son said that many of them don't know how to properly use the rifles and end up shooting themselves in the foot. Good thing he's nearby the hospital. Christa and I walked up to the main entrance and there are people sitting alongside the wall, many with casts on their legs and crutches. We walk inside the hospital and there are no decorations or chairs, and really horrible lighting. It looked completely desolate. There's a security guard standing inside, a line at the reception window, and the casualty unit is on the immediate right. We went first to the pediatric clinic. They don't take appointments so people just come and hope to get in to see the doctor. We went back through the rooms of the pediatric clinic a bit. I felt a bit awkward about this as you could see the patients (there were no doors on the rooms, only walls on the sides to separate them from the next room). Christa would stop to talk to the nurse while the patient was sitting there. I guess patient privacy is different here! I talked to a couple of the nurses working in the pediatric clinic to hear their thoughts about working in the public sector, government support, etc. It was clear that they didn't have all of the necessary resources and supplies. The nurses are not very well-supported either, often working alone for extended periods of time. The nurses that I spoke with also expressed concern that the people who are making the decisions and policies do not know what is going on at the ground-level. They just make decisions based on what they think is best or whatever the trend might be.

Next we went to the ARV (antiretroviral therapy) clinic where people who are HIV-positive or at risk of becoming HIV-positive can go to receive services (i.e. testing, counseling with the social worker, etc.). The ARV clinic is divided into two sections, one for adults and another for children. We visited the children's ARV clinic where we saw some of the Mount Sinai Centre kids there for follow-up appointments. Up until 18 months of age, babies are tested for HIV with the DNA PCR virologic test. Blood is drawn from a spot on their heel and placed in five different spots on a paper which is then sent to the lab for testing. It was amazing how quietly the kids sat in the waiting area, while there was nothing to do, no toys to play with, pictures to look at. And they were all there for the same reason: HIV/AIDS, something I think that majority of the kids don't grasp. I asked one of the nurses in this department at what age they start explaining to the kids their HIV status. She said age 10. I didn't get around to asking what kind of counseling support they have for kids. Do they tell the kid, "hey you're HIV-positive" and then send them on their way? We also visited the maternity ward. I know that for some HIV-positive women, a c-section may be recommended to reduce the transmission of HIV from mother to child during birth. Christa informed me that the hospital does not have the resources to perform c-sections. They cannot afford the anesthesiology or instruments necessary for a c-section.

One thing that really struck me as we visited the various clinics was that there were a lot of staff sitting around, not doing much of anything. I know that this is not the case, but it was very startling to see the nurses sitting around with newspapers while patients waited for care. Perhaps it was because they were waiting on a doctor for a consultation. It just struck me as odd given the sheer need for health services and yet the nurses seemed so laxadasical about work. I know that what I perceive may not be the case. There is definitely a cultural context around work and work ethic here that I have not entirely put my finger on.

I also have to say that it was hard to visit the hospital. I think that, as a white person, and a white woman, I receive many looks of skepticism. I can respect this as they don't know what my intentions are, they don't know me, and what not, but it doesn't make it any more comfortable. I was glad to be with Christa. I think that gives me some sort of validation, especially as she knew all of the staff at the hospital.

I will end this on a positive note. Visits to the hospital are relatively cheap, approximately $1.50 - $2.00 USD. However, this is still a significant cost to many of the families who visit the public hospitals, especially if they have to go regularly for care. Despite the limited resources at the hospital, they never turn a patient away from care or treatment because of their inability to pay.