Emergency Room Care at Kamuzu Central Hospital

Melanie K. Sion, M.D.

Fellow in Surgical Critical Care at Brigham & Women’s Hospital

PGY-8

Emergency Room Care at Kamuzu Central Hospital

I’ve been visiting this hospital once or twice a year for five years and have become familiar with many of the practices here.  Although I've spent a fair amount of time integrated in day-to-day clinical work, I am often still learning new details and nuances about how exactly each clinical process is accomplished.  My formal project for this trip is to gather a basic understanding of preliminary patient and clinician flow data about emergency room.  I thought I understood the general intake process having taken call numerous times at this hospital however this opportunity has sparked new clinical questions and I'm grateful to be deepening my understanding and learning new facets of this place.  

My previous assumption was that a nurse from the emergency room area triaged incoming patients or that they passed by the doctor’s desk before they went to the waiting room.  I've learned this assumption is incorrect.  There is a cohort of 12 "clerks" who function as medical assistants and take on this role.  These individuals have an office next to the ER (two of whom are featured in the attached photo) and are the first to measure a patient’s vital signs and write down their chief complaint.  I know the clerks well because I spent my research year during residency at this hospital and they are the data collectors for a number of projects.  I’m surprised I’ve worked with them for so long and didn’t realize they played such an essential role to the functioning of the emergency room.

I’ve given out a number of surveys to the clerks, emergency room nurses, and to the medical interns that staff the emergency room. I’ve also spent a few days doing direction observation of emergency room activities.  It has been a challenge to try to be solely an observer and have fielded questions when appropriate as the level of training of the emergency room doctors are interns on their surgery rotation.  As expected, I’ve learned that there are 360 degree shortages of most supplies, staffing, and infrastructure and it is these challenges that make staff worry about patients and the quality of care that they can provide. 

I would like to extend my interviews to patients during a future trip, I do wonder what their expectation is of this emergency room and hospital.  I’ve heard and observed distrust from some patients on the wards, having observed that they turned to local healers on numerous occasion until their problem was intolerable.  I wonder how this emergency room and the care here appears in the eyes of the patients, i.e. are they surprised by the capabilities of care and infrastructure in any way, good or bad by their experience in the emergency room?

Photos of the emergency room are attached.  This is the major, tertiary teaching hospital for the capital city and the emergency room is just that – a single room with a row of stretchers.  In time, I would like to help improve the set up and capabilities here so that it is better for clinicians as well as patients and their families.  Major endeavors take deep pockets and time but as I gather more information hopefully I can find some small logical ways to improve this environment.