Dirty rooms, damaged flooring, stained surfaces and bad smells – not what you would expect if you visited your local hospital. For elective students in Africa, Asia and Latin America, it is a daily occurrence. For some it is also the most shocking thing about working in the developing world.
Infection control is a term drummed into western students from day one of their healthcare course. Techniques like hand washing are easily employable and are incredibly effective at preventing infection and maintaining health amongst patients, staff and the public.
Many elective students comment that whilst they were prepared for wide-ranging illnesses, advanced pathologies and a general lack of resource, it is the lack of these simple measures that shock them the most. Radiographer Trish commented that in Nepal “I couldn’t physically wash my hands in between patients even if there was soap, because the sink is in the fluoro room which is usually in use and the next nearest one is in the next department.”
She found that patients all wore the same gown and that there was often contrast media from previous x-rays left on the table. In the end she was contributing to the problem because her role meant she had to manhandle people to get them into position for x-ray.
It’s a similar story in Sri Lanka. Alison found that “infection control was poor, aseptic technique was a concept obviously misunderstood and isolation rooms were scarce. There were 44 beds on the ward and usually over 80 patients. It was also common to see stray dogs and monkeys wandering around the ward!”
Alison spoke to her supervisor and found that part of the problem is that hospitals cannot afford to supply alcohol hand gels or even soap and sinks throughout the wards. Although it may actually prevent further expensive treatments when disease spreads, preventative measures still cannot afford to be taken.
In some cases the problem is bigger than a bar of soap. One student was horrified to see the malaria patients sharing wards with other patients. "They all had mosquito nets but lack of understanding meant that most had removed them because of the heat. Others had holes in. The ward was full of mosquitoes.... it was like watching malaria spread in front of your eyes".
The message about infection control has started to filter through in some places. One Work the World student found herself waiting with her supervisor before ward rounds because they were cleaning the floor. Cleaning took precedent over visits from the doctor!
In other places the doctors have had to work around infection control measures. Medical student Ben was originally shocked when two lumbar puncture kits arrived for the five women showing signs of encephalitis or meningitis. All five had waited a week, so the two kits were used, cleaned and the re-used. “Not ideal but it was the only way these women were going to get the investigations they required. I was very impressed by the way the doctors kept their heads when faced with these very difficult circumstances”.
It is often important to think of the bigger picture when you are working in an overseas hospital, like Ben above, but that doesn't mean hygiene and cleanliness no longer matter. If, as one of our students found, alcohol gel was available on the trolley but the nurses weren't using it, try to set a good example. Claire made a point of using it every day and eventually the nurses she was working with started to follow her example.