Debi's entry Hospitalization

I have permission from Bob to tell this story. Just as the reunion was winding down and Byrna was catching a flight home the next day, Bob developed a nosebleed on Saturday night that would not stop. He is on Coumadin and was scheduled for a blood test on Monday.  On Sunday morning Don was called to take him to urgent care while Byrna continued to pack. 

Don works at Selian Medical Center which is more rural, however Don took Bob to ALMC (Arusha Lutheran Medical Center) in the middle of Arusha because it is much more modern and has much better capabilities including the blood testing to check the coumadin effect. Urgent Care was not busy on Sunday morning so Bob was seen promptly. The bleeding could not be stopped so they decided to admit him. Poor Byrna had to decide whether to stay or go as planned. She decided to go because Bob has recovered from this before and there were lots of relatives to provide oversight and TLC. I was able to spend time at the bedside with Bob on Sunday and Monday because I don't work, I did not need to pack or run last minute errands like Carol who left on Monday, I was eager to observe care at the bedside for my potential work in the future AND I could play cribbage with Bob to help pass the time!

So ALMC is a building that is new since we visited in 2005. The medical record is partially computerized!  It is quite modern by Tanzanian standards. It is built around a beautiful courtyard so there is light coming in lots of windows. Here are a few things I observed:

*A private room with private bath. (He was probably considered a VIP as Mark Jacobson, Medical Center Director, paid him a visit after church)
*Lots of light from large windows and cloth curtains for privacy
*Bed sheets and a bedspread!
*The bed could have the head raised. 
*No towels or wash cloths provided (We brought some in)
* No kleenex or anything to help with nosebleed besides gauze ( we brought some)
*When we asked for an ice pack, one ice cube arrived wrapped in plastic wrap. 
*No toilet paper until we asked for it. 
* No drinking water provided ( we could buy a bottle of water from the canteen)
* Food service was supposedly provided ( at Selian there is NO food service...so families have to bring in food or patients don't eat. Don saw a man with no family who only ate because other patients shared with him), however the first time food was offered to Bob was late on Sunday after Carol and Erik and Bernice brought us all pizza. So he declined.  The next morning a very large food tray with a large insulated lid arrived for breakfast and a thermos bottle of chai. When he opened the lid, it contained two slices of white bread with no butter or jam!  We had brought some food and snacks so he was OK. 
*No pillow ( we brought)
*When the nurse came in to draw blood she brought a basin with a syringe, a laboratory tube, gauze, some solution to disinfect skin , a regular glove that she used as a tourniquet and a package of sterile gloves!  The first thing she did was apply the sterile gloves with perfect surgical technique and then proceeded to touch everything else. I held my breath when she transferred the blood from the syringe to the test tube as that is how needle sticks happen. 
*The doctors seemed competent. They asked good questions and left to do additional research to see if Bob's anti malaria pills for the trip could be contributing to his high INR (Coumadin blood test). 
*Before leaving we had to pay the bill. Thank goodness Bernice was there!  In general you pay for things in advance. Don had paid for his inpatient stay which was about $45.00 but Bob had to pay for a couple of additional things so we had to go to the discharge window. This is a big glass window with two round holes to talk through and two slots at the bottom for exchanging money. Already there were about 20 people all crowded around the window clamoring to be helped. Bernice recognized someone she knew inside and somehow the crowd parted for her. They would NOT take cash!  They only wanted credit cards or bank cards. The day before the machine was not working so they had taken Don's cash but there was some question about the receipt so it took awhile to straighten things out and pay. I have no idea why they do not ask people to stand in line. Just some tape on the floor or a ticket with number would reduce chaos. 

The good news is Bob is fine! I found it fascinating, although I am daunted as to how I might help. Opportunities for improvement abound, but the culture is still too foreign to me. I guess in the end if the patient gets well, the number one goal is met. Oh yes, cribbage was fun and we all ( Don included) took turns winning!