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The Okavango River Moves Slowly

28 August 2019

Phoenix Multidisciplinary Acute Care in Rundu

The Okavango river moves slowly. Near Rundu it forms the border between Namibia and Angola. A leisurely boat trip at dusk shows you kids playing football and herding cows in Angola to the north, farms, scrub-land and hotels in Namibia to the south and, if you’re lucky, the occasional crocodile, of unknown nationality.

From 5th to the 20th of July this year myself, Professor Judith Hall, Dr. Brian Jenkins, Dr. Najia Hasan (both Anaesthesia) and Dr. Ilona Johnson (Pubic Health Dentistry) went severally to different parts of Namibia as part of the latest research, education and outreach programmes of the Phoenix Project collaboration with University of Namibia (UNAM). Professor Hall and I visited the District Hospital in the small, dusty town of Rundu, to observe conditions for staff in the hospital. We also wanted to see what life was like for nurses working in outlying clinics, providing care for people in the ”Informal settlements” which have sprung up nearby. Later, we visited Windhoek, to compare conditions with those in Rundu.

In Rundu Hospital we were enthusiastically hosted by Mr Daniel Ashipala, Head of Nursing at Rundu Campus UNAM, there we saw ”High Care” and Accident and Emergency (A&E). In High Care (Intensive Care ICU/High Dependency HDU), 2-4 nurses would have to look after up to 16 patients, a nurse-patient ratio of up to 1:8 (in the UK the ratio would be 1:1 for ICU and 1:2 for HDU). A&E was similarly under-staffed. Both areas were overrun with student nurses with nothing to do as the regular staff had no time to teach them. There were no specialised doctors, just general medics who had to be summoned by nurses phoning around the wards until they found one able to attend. Sometimes each unit had warning of a critical patient approaching by ambulance; sometimes they did not. The clinics, staffed usually by 3-5 nurses who’d been there for years and saw about 400 patients a day, dealt mainly with Malaria and HIV programmes. They were unequipped for dealing with a patient who might stumble through the door having had a cardiac event, a stroke or a snakebite. They had no oxygen cylinders; their drug trolleys were empty. Any CPR training they’d once had had been forgotten years before (let’s face it, we all forget unless we update regularly).

Katutura hospital, in Windhoek, was the same, just bigger. A faded 1960s pre-independence building, crumbling concrete, cracked windows and an air of neglect. Yet here, as in Rundu, the nurses and doctors were doing what they do all over the world – working hard, doing their best… managing. “We don’t want the latest equipment, that gets broken and thrown out, we cann’t service it. What we want is training”, they said. All of them, clinic, A&E and ICU nurses said the same thing: we want education and training. So that’s is what we’ll try and start to provide. We’re returning to Rundu to start delivery of this training in October 2019.

After all, the Phoenix Project is a listening project.

Authors: Mr Tim Davies RGN Phoenix Emergency Care and the Bill Mapleson Education Centre and Professor Judith Hall MD Phoenix Project Lead.