Working in a small, rural, African hospital is, in one sense, so completely different from any sort of medical practice we’ve experienced in Australia, Canada, or US; but there is now a sort of familiarity and nonchalance about it as we progress past the six-month mark of our arrival to Gabon.
Some of you, dear readers, are already intimately familiar with the challenges of medical work in a bush hospital; for others of you, even your local hospital might feel foreign. For all of you, here are some answers to perhaps a few questions you’ve been harbouring about being physicians in Gabon.
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How is Bongolo Hospital different from a western-style hospital?
Oh, how to count the ways!
There is noticeably less staff here. For instance, there might be only one nurse and a nurse’s aide for anywhere from 10-40 inpatients. Thus, all inpatients must be accompanied by a “guardian,” that is, a friend or family member who will provide meals and basic hygienic necessities.
On the outpatient side, patients aren’t given appointment times – just appointment dates. A patient will just show up in the morning and may wait all day before being seen by a nurse or doctor. This works out surprisingly better than one might think, because the taxis from various outlying towns arrive at the hospital in the morning and then depart in the late afternoon. There isn’t much vehicular traffic in-between.
From a physical plant standpoint, the lack of pavement is noticeable. The majority of the roads in and around the hospital are dirt. The operating room, the medication storage room, and some of the outpatient offices have air conditioners, but otherwise the pervasive heat and humidity penetrate to all other areas of the hospital.
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This courtyard roughly divides the hospital buildings in half: medicine and pediatrics on the left, surgery and maternity on the right.
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How is Bongolo Hospital different from other African hospitals?
We should qualify that, outside of Gabon, our knowledge is limited to only a few other miʂȿίon hospitals; so take what we say with a grain of salt. However, we have noticed some differences.
On the outpatient side, all patients are first seen by a nurse before being seen by a physician. The nurses, all of whom trained at Bongolo’s own nursing school, act as primary care providers in many scenarios, especially in internal medicine and pediatrics, leaving the physicians to see only more complicated cases, or the cases requiring operations.
On the inpatient side, the patient rooms are, for the most part, semi-private (as opposed to a large, open ward). The inpatient buildings tend to be long, rectangular structures with 5-10 doors on each side, with each door leading directly to a patient room.
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Internal medicine inpatient ward. Each red door leads to a small patient room with two beds.
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Have your expectations of African medicine been met?
We suppose? That is, to be honest, things just don’t work as well – but we knew that going in. For instance, the surgical instruments are often less than pristine: the clamps don’t clamp, and the scissors don’t cut, the tweezers don’t tweeze, the cautery doesn’t buzz, etc.
From an anesthetic standpoint, there is halothane and isoflurane, but no sevoflurane. There are local anesthetic agents, but they don’t always work very well, depending on the batch. (This anesthetic roulette definitely causes the patients some pain, no pun intended.)
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Inside one of three operating rooms at Bongolo. Two residents and a scrub nurse work on a facial reconstruction case.
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Medication shortages are frequent. For instance, we recently diagnosed candidal esophagitis on an upper endoscopy – only to learn that the hospital ran out of antifungal agents to treat it. The entire country nearly ran out of HIV medications until the Democratic Republic of Congo decided to give us some. (Vraiment.)
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Is there anything that’s taken you by surprise?
Insurance paperwork. We thought we might escape the mountains of insurance paperwork after leaving the US nearly three years ago. But alas, there’s a form of national insurance that roughly mimics the US-based Medicare – but not nearly as efficient or effective, unfortunately. And with the insurance come reams and reams of paperwork. Several hospital employees are dedicated just to claim submission and reimbursement files.
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This pile of insurance claims is actually rather small. They can get multiple times bigger.
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On the plus side, the laboratory is better equipped than most other hospitals in the nation. Not only can we get basic hematology, chemistry, and liver function panels, but even certain immunoassays are available (e.g., TSH, prolactin, PSA — though sometimes the lab runs out of reagent to perform the tests).
Finally, our work-life balance has been a pleasant surprise. It may have to do with the remoteness of the hospital, the relative dearth of vehicular and motorcycle traffic, or the generally low population density of southern Gabon. But most days we’re able to walk up the hill home for lunch, and we almost always share dinner together as a family as the sun sets outside out window.
And that’s nice.
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And now...for some family pictures!
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It took us six months, but we found the Chinese supermarket in the capital city, Libreville!
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We recently spent a day with our friends in Addis Ababa, Ethiopia. We enjoyed a Korean restaurant, gelato, and (most memorable for the kids) a large trampoline.
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We went on to visit friends in Burundi. This included a few days relaxing near Lake Tanganyika, where the kids discovered a carousel on the beach.
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Left: Nolan and Toby saying goodbye in France after language school.
Right: The boys are reunited nine months later in Burundi!
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