Edward Francis Small Teaching Hospital

One of the items in my bucket list while in the Gambia was to visit the main hospital in Banjul, Edward Francis Small Teaching Hospital formerly known as the Royal Victoria Teaching Hospital (RVTH). It is public knowledge that the hospital is in shambles, but I wanted to see it myself.

We have all heard of the horror stories and chances are you or your family members have a dreadful story to tell about RVTH.

Luckily for me, I was invited for a private tour of the hospital by one of the doctors there. After exchanging a few text messages to try to coordinate a date and time convenient for both of us, we finally met at the main entrance of the hospital building on 8th January 2018.

While we were exchanging pleasantries at the main lobby area, I could not help but be distracted by the pile of junk sitting there all dusty. Then I looked up and saw the terrible condition the ceiling was in – water stains, hanging and missing pieces of the ceiling. The ramp in the lobby area looked jaw-droopingly filthy and the walls looked tired and the paint chipping away.

As we made our way up the ramp headed upstairs, I took the opportunity to express my reproachful feelings about the lobby area to the doctor and asked what was being done about it. He looked at me and said: “Guess what? The First Lady just left about half an hour ago prior to your arrival.” Apparently, the First Lady (bu hess) has been frequently going to RVTH with her entourage and making endless promises. I didn’t see her there that day, but I can imagine her in the middle of her entourage sporting her Prada sunglasses inside the hospital wards.

After we landed on the upstairs balcony, I took a quick minute to take it all in. I moved close to the balcony railing for a bird’s eye view of the hospital grounds. I don’t remember the last time I visited the hospital, but I do have vivid memories of sliding down the ramp in the lobby as a boy for fun; it was squeaky clean and had a sensitized smell then. To my immediate right, there was a group of people congregating by the fence and there were two other separate groups further down. So out of curiosity, I asked the doctor what the deal was with all the different groups of people assembling around the hospital grounds.

As it turned out, they were all there to pick up the corpse of their loved ones to take back for burial. The doctor did not mention, but I assumed they were from far away and huddled up to figure out how they were going to transport their corpse back home for a burial. I could not help but wonder how many other people were there on that day to pick up the corpse of a loved one. I knew right there and then, that I had to emotionally prepare myself for what lies ahead for the tour.

Since most people who go to the hospital were probably there to visit a sick friend or family member, they are usually emotionally preoccupied and focused on the situation of that particular patient, but my case was different. I was not there to see any particular patient and didn’t have the luxury to be emotionally preoccupied, and that left me more emotionally vulnerable compared to those there to see a certain patient.

We first walked into the women’s ward. There were only a few beds scattered around and almost all of them looked like they were on their last leg. They appeared old and tired and some looked like they had been doctored many times before. Everything in that ward was old and murky.

As I try to make sense out of the scene, I overheard sounds of discomfort (moaning and groaning) towards the end of the ward. I looked over and saw a naked woman lying on her side on the last bed next to the back door. One of her legs was amputated at the shin, the other right above the knee, and her back was burnt. My heart sank and I was hit by a tsunami of emotions. I felt an urgent need to leave the ward immediately, I was getting overwhelmed. So I started gravitating towards the back door, which led to an open hallway. That was my way of signaling my “guide doctor” that I wanted out of there, as I got emotionally consumed. On our way through the back of the ward onto the open hallway, we went past the bathrooms. The sight was horrific and the smell hazardously poignant.

Through that open hallway we made our way to the “On Call” room for doctors, which was located in the next block. There are two “On Call” rooms and they are right across from each other – one for the male doctors and the other for the female doctors. When doctors are on call, the rooms are used for waiting and relaxing. It makes good sense of proximity – right there in the hospital.

At a closer look at the doors, you can tell the locks have been changed multiple times; you can see the numerous holes where nails once held in padlock brackets. There, we found the doctor on call on his laptop; I got introduced to him by my “guide doctor”. He told me that he studied in Venezuela and we spoke a little Spanish (I had to jump on the chance). The room was tiny and had two small beds right next to each with little space in between them. The bed sheets were thin and appeared to be the wrong size. Our conversation centered on the massive challenges they face there at the hospital and the lack of responsiveness from the current and former administrations. To me, it sounded like they were being asked to make water flow uphill. Impossible!

From there we went to a couple of other wards and briefly stopped by at the sluice prior to heading to the ICU. The sluice room is where used disposables such as incontinence pads and bedpans are dealt with, and medical and surgical instruments are sterilized and disinfected. The room looked like a disaster! The entire room was layered with dust, there was a broken table with broken chairs on one side of the room, and the sink was soiled.

As I stood there listening to the doctor explain the condition of that room to me, I was paralyzed by a feeling of deep concern and could not help but think of the infinite possibilities of infections. With unsanitary conditions being a major cause of infection even in advanced countries during surgery, I could only imagine what the rate of infection would be with the condition of the sluice I saw at the RVTH. The risk of surgical complications increases dramatically when doctors work in unsanitary conditions. We then ventured into the ICU where I was met with the shock of my life! They had no monitors or the most basic material to work with.

The used incubators that were donated to the hospital by diaspora Gambians were all destroyed due to the erratic electricity situation, and the two I saw there were barely working. The story was the same with the oxygen concentrators. The ICU hardly had any equipment in it, and most of what was left there was purely for decoration so that the room wouldn’t look empty, but they serve no other purpose.

A hospital with not a single X-Ray Machine, a Radiant heater for new born babies, or a ventilator, is appalling! I was also taken into a room where a woman with cervical cancer was sitting by herself. According to the doctor, it could be treated either with radical hysterectomy or chemotherapy and the drugs are not available in the country, only in Senegal or Europe. “Cervical cancer can often be found early and sometimes even prevented entirely, by having regular Pap-smear tests. If detected early, cervical cancer is one of the most successfully treatable cancers.” I found this on the American Cancer Society’s website, but I wonder what the chances for survival are for that woman.

Not long before my visit, I was told that the Permanent Secretary visited the ICU with Momodou Malcom Jallow, a Gambian origin and a Swedish law marker, who was very much angry with them regarding the situation of the ICU because they lack the most basic material to work with, yet they are busy traveling, attending endless workshops, and driving luxury vehicles while leaving ordinary citizens who put them into office to die.

The tour took me to so many places in the hospital that I could not even keep track. By the time we got to our final destination, the Accident and Emergency (A&E) ward of the hospital, my head was almost saturated with information; I had been trying to retain and compartmentalize the vital materials from the visit for future reference. I thought I had seen it all prior to walking into the A&E, but what I saw was even more shocking. Actually, it’s more like what I didn’t see there left me even more stunned.

The ward was bare and there were no equipment in sight! I was introduced to the doctor on duty, and of course, a conversation about the hospital and the enormous challenges they face ensued. Hearing from the doctors was tough because you can sense the frustration and desperation, and that can potentially affect the quality of their work. I could only imagine how they felt as doctors working in such impractical conditions. The hospital had no medicine and people have to buy their own medicine from private pharmacies. In certain cases, if a patient couldn’t afford to buy the medicine they needed for them to perform a critical procedure, the doctors called outside private pharmacies to guarantee the patient for a purchase on credit, and if they default, then the doctors are on the hook for it. What a tough situation for a doctor to be in!

Although I have been in emergency rooms before and have an idea of what they do in there, I still wanted to look it up and here is what I found. “An emergency department (ED), also known as an accident & emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior appointment; either by their own means or by that of an ambulance. The emergency department is usually found in a hospital or other primary care center.” The tour ended, but our conversation did not.

My “guide doctor” walked me to the car and we stood there and talked for another half hour, dissecting and analyzing the hospital’s condition and the predicament of the doctors and patients. My final question to him was this “with all I have seen here today and everything you have told me, why are you still here?” And he answered “when I see patients I have treated in the streets or at gatherings and they thank me and show appreciation – that’s what is keeping me here.” Ndeysan, suma yaram daw sisassi! I could not help but think to myself – only if he had everything he needed to be able to better exercise his passion for healing the sick – passionate but disabled!

Finally, I was in the car and driving back with all the hospital images circulating in my head. It was like a flash flood, the kind that consumes everything, choking the life out of anything in its relentless path of destruction. The visit had been emotionally draining and very discouraging, but I was glad I chose to go. Too often, I hear dreadful stories about the hospital, so it was good for me to see for myself and get firsthand information.

Later that evening, after retiring into my silent corner, I could not help but ask myself whether RVTH was a hospital or a hospice, given what I saw and the information I gathered, to me, a hospital is a health care institution where patients go to seek treatment, and a hospice is where chronically ill, terminally ill or seriously ill patients go to live in the last months and days of their lives. With the number of families going to RVTH on a daily basis to pick up the corpse of their loved ones, one could easily argue that the RVTH is more of a hospice than a hospital, without the comfort of attending to the emotional and spiritual needs of patients, which is the essence of a hospice.

Now this brings me to my landing point – the GARD strike. We are all aware of the explosive accusations of theft of medicine and equipment by the doctors, from the Minister of Health in the presence of other doctors from the region, which I believe was the straw that broke the camel’s back. The minister said “When we talk about corruption in the health system, we all know how it is. These young doctors will just go and practice pharmaceuticals and some of them will open pharmacies with the resources that we have. I am very sure of what I am saying because I was the PS.” That statement coupled with the frustrations of their working conditions, some of which are highlighted in this piece, led the doctors on strike.

As a Permanent secretary, the Minister claims she knew but did nothing about it? And now as a Minister, she was making a public accusation without providing a single documented case – it begs the question. Furthermore, why would the ministry even issue licenses to doctors working at the hospital to open pharmacies? That’s a huge conflict of interest! Maybe the ministry should revisit their pharmacy licensing policy? I would suggest for them to give all the pharmacies a ninety-day-notice prior to revoking their licenses and have them re-apply, this will be a good way to screen applicants and avoid the conflict of interest, in an effort to correct the system.

Regardless of your status or financial health, as long as you live in or frequent the Gambia, you are a potential victim of “A Dead Health Care System”. If you suffer a major medical emergency there, they might not be able to stabilize you prior to flying you out, and that may significantly diminish your survival chances. So it is incumbent on all Gambians to demand from the government the healthcare we deserve. No country can succeed without a healthy population, and the recent death rate is alarming.

By Momodou Ndow