Where Laughter Turns To Tears

18 Aug 2015 15:10pm
By Anna Tervahartiala

WINDHOEK, 18 AUG (NAMPA) - Evening fell hours ago. People have returned to their homes and turned off their lights in anticipation of a good night’s sleep. As streetlights in the northern end of the capital form a necklace of illumination, one building stands out above the others; the lights of the casualty ward of the Katutura State Hospital in Windhoek are never switched off. They are on all night, every night.
A regular night shift at the casualty ward starts at 19h00 and ends 07h00 the next morning. On any given night, there are eight nurses and two to four doctors on duty. A nurse works four nights in a row and then has three days off, that’s if he or she is not called in to work overtime. Nursing is not for a sissy and while illness and emergency do not look at the time of day, work at casualty is a mirror of the life outside. This mirror only tends to show the sides one rarely cares to see.
“It is a disaster,” a nurse on duty says. She is not talking about her work in general but about the night shifts at weekends during the end of the month, when most people get paid in Namibia’s capital city.
When she speaks, she laughs but is not joking - when the celebration outside ends, work in the casualty ward begins.
“The cases we mostly handle are not natural illnesses,” Malioh Phares, a nurse who has worked at the Katutura hospital for four years begins describing the month-end situation.
“Alcohol is the main contributor,” the supervisor of the ground floor of the hospital, Geraldine Tjiramba, adds. Assaults, stab wounds and motor vehicle accidents are the typical cases those on duty see as the new month starts.
Looking at the daily statistics about trauma cases treated at casualty from January to June 2015, it is difficult to draw a conclusion about the busiest weekends of the month. The numbers of trauma cases recorded during weekends vary from 189 to 529 and some days have no records at all.
When calculating the overall number of trauma cases at weekends from the duration of half a year, one can see that out of six months, four months had the busiest weekends after the second half of the month: January (378), February (432), April (436) and May (529).
Even though the statistics support the staff members’ statements, Dr Innocent Zulu is quick to remind that statistics do not tell the whole truth.
“We cannot write everything down. The one who has the time does the recording. We have to prioritise treating the patients over counting them,” Zulu explains.
Even though the three staff members of casualty experience month-end from a slightly different perspective, what they all agree on is that when they have a month-end weekend shift, best is to come to work mentally prepared.
“You know it is going to be a busy night,” Phares says.
The hands of the clock are making their determined way towards midnight. The medical equipment is humming steadily and patients are queuing quietly. It is cold and late. Nobody wants to be here.
A man wearing a long jacket with a cloth wrapped around his head is helped in. He is supported by a friend and is pointed to a stretcher onto which he collapses. He lies on the bed limp and the back of his jacket is of a different colour than the rest, as if it was wet and drenched in the heavy drops of a typical Windhoek storm. But it has not been raining. The jacket is glued to his skin by blood. Blood has also stained the flowery pattern on the cloth around his head.
After inspection, the man is pushed to the brightly lit operation room in the back of the ward. He has a deep cut on the top of his skull. His friend says he was hit with a stone that was aimed at someone else. An evening that was supposed to be a night of celebration ended in a fight. Both men are visibly inebriated.
“Am I going to die today?” the man asks while looking at the blood stained bedding.
The nurse is focused and doesn’t answer while she cleans the wound and starts dressing the cut. Her hand is swift and she does not hesitate. She has done this before. In an hour, the man is out of the doors again.
“I might reach up to 50,” another nurse busy in the dressing room estimates when asked how many people she will stitch during her shift.
“Blood bath, war zone, slaughterhouse and mayhem.” These are the terms the staff of the casualty ward use to describe the month-end; a situation nothing new to them - this is the way it has been for years. When asked whether there has been any change, some say it has worsened. No one has clear answers why but many suspect the reason being the growth of the capital, the permanently high percentage of unemployment and the abundant availability of alcohol.
“Our mission is not to solve the issues outside. We nurses cannot focus on the number of shebeens out there. It is not our profession. Our job is to be concerned about the delivery of our healthcare services,” a nurse on duty comments.
What goes on out there is out of the hands of those treating the consequences.
Both nurse Phares and Dr Zulu agree that the casualty ward is understaffed and thus unable to meet the demand for treatment. The supervisor of the ground floor is also quick to note that it is not only the staff members who are overworked.
“Our equipment is on 24 hours a day. It also gets worn out, old and tired,” Tjiramba states.
What also worries the staff members is the lack of order and organisation of patients in the ward. Even though the casualty ward is supposed to serve emergency cases, people who should be seeking treatment at their local clinics opt to get treated at the hospital. Treating patients who are not in the need of immediate care costs time and attention away from the handling of emergencies. Queues are long and sometimes, crucial time is lost.
“This is a hospital, a referral unit and supposed to handle emergency cases or life threatening illnesses. We are not supposed to treat headaches and issues that do not demand immediate care. Those belong to the clinics, but what we are told is that the clinics are already full and we cannot turn people away,” Dr Zulu elaborates.
“Here is not first come first serve. The one who is closest to death is treated first,” he continues.
Windhoek has an annual population growth rate of approximately 3,5 per cent and the casualty ward of the Katutura hospital remains the sole public emergency room open around the clock.
Sitting in the queue of patients, it is clear to see that even on month-end weekends, not everyone has come to the ward because of cases rooted in alcohol abuse. The washed out green curtains do not muffle the sound of a weeping child, nor do they conceal the tears in the corner of the eyes of the family who has brought their mother for treatment. Not all have been out drinking. Some were simply in the wrong place at the wrong time.
Aside from the patients, the ground floor is patrolled by security guards and police officers. Some have brought patients in but most are there to keep trouble out and maintain order.
“We are not safe,” Tjiramba says, referring to the conditions staff has to work under.
Both nurse Phares and Dr Zulu speak of cases where patients have been found carrying weapons all the way up to treatment. Threats and even violence towards the staff is nothing unheard of.
“If they are fighting outside, they will bring the fight inside,” Phares describes.
“There is no respect,” Zulu sums up the way personnel is treated by patients who are not thinking clearly.
Looking towards the future, all three staff members wish to see a casualty ward where professionals are able to work in peace and safety. Proper security measures limiting public access to the treatment areas and more staff are all measures that the three mention as issues with room for improvement. These improvements do not only apply to the casualty ward at the Katutura hospital but are matters to be addressed throughout the national hospital and clinic network.
“When someone comes to the hospital in pain and leaves walking on his own feet feeling better, even though he or she might not say thank you at the time, those moments make this job worth doing,” Phares says.
“It is the real emergencies, the people who are just victims, who keep us going,” Zulu adds.