Last Week in Stone Town
In our last week in Zanzibar, we spent most of our time writing reports on our findings. We did manage to find time for a few more lab visits, as well as squeeze in two last minute interviews.
We toured the laboratory facilities at MMH, and also were able to visit the lab at the new private hospital that just opened a few months ago. The difference was striking. Though MMH labs were clean and most were air conditioned, the clinical chemistry lab at MMH had two machines that had been out of order since March and April due to the need for replacement parts or reagents. One just needed a new light bulb. The lab usually stops taking new samples for testing around midday, so if lab work is needed for a patient in the evening or overnight, it often has to be sent to a private hospital.
The private hospital had brand new, state of the art equipment. A six month supply of reagents were kept in stock to avoid running out of something that may be needed. Blood tests were also done manually to double check results. The pricing at the new hospital was, not surprisingly, much more expensive. MMH charges 3,000 TSH for renal testing (urea and creatinine testing are 1,500 TSH each) and liver function tests are 9,000 TSH. At the private hospital the price is typically 40,000 TSH for renal and liver function, but at the new hospital costs can be even higher.
We had two great conversations with Natasha, a resident in the gynecology department, and Lauren, a medical student from the UK. Natasha described what providers look for to indicate severe pre-eclampsia, giving us more insight into why kidney and liver function tests are important. Elevated liver enzymes are one indicator of pre-eclampsia, and magnesium sulfate, the drug given for eclampsia, can be toxic to the kidneys. Currently pre-eclampsia is diagnosed with blood pressure measurements and urine dipstick tests, but Natasha told us that the BP machines don’t work, all give different readings, and the staff has never been trained to calibrate them. She also mentioned that measurement of fetal heart rate and the mother’s contractions do not happen often enough, which can result in missed detection of fetal distress and ultimately a stillbirth.
Lauren did an extra rotation in obstetrics in her studies in the UK, but some of the students she is working with at MMH were delivering babies with no prior delivery experience. She also brought up the fact that the fetal heart rate is not measured often enough. The biggest thing she has noticed is the lack of urgency in the hospital. When the decision is made that a woman needs an emergency cesarean at MMH, it may take 45 minutes to get her to the operating theater. In the UK, she said the woman should be on the table under 10 minutes.
