City Hospital Kano

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CITY HOSPITAL KANO by Andy Buhler, CUSO, 69-71

(A composite day in the life of a CUSO lab technologist)

Yawn!

Stretch!

Groan!

Africa and I awake again. Six-fifteen and the sun has been up for a quarter hour. Birds and insects have already begun their daily drama of eating and being eaten.

The steward taps gently upon my door.

“OK world, here I come, ready or not!”

Throw back the sheet, raise the mosquito netting and stumble over to the bathroom for a quick cold shower. There’s nothing like a cold shower in the morning, ABSOLUTELY nothing. A brisk rub-down then into some clothes. “Let’s see, today I’ll wear those PermaPress trousers, sandals, and my black and white Kampala.”

“Chop’s ready, Mas’er,” sounds from the kitchen. Coffee, bacon and eggs with bread and treacle and I begin to feel almost human again.

While the steward clears the table I prepare to go to work. I unlock the front door and roll the Honda 90 out of the living room into the driveway. Mygardi is still asleep by the ashes of his fire near the corner of the house -- some watchman he is! It’s lucky someone doesn’t steal the house during the night! A quick cursory check that everything is where it should be, on with the helmet, and I’m ready to go to the lab. It’s easy to travel the two miles to the hospital now that I have my bike. Formerly the ambulance had to come for me every morning and, if the driver was busy or forgot, then the choice was either walk or wait. Being remarkably adaptable to African time, I usually chose to wait.

From my house to the hospital the roadway writhes like a snake in torment among the mud-walled houses of the old city. This morning, as usual, it is very crowded. “Beep, beep! Goat -- get out of my way!” Oops, mind that pothole and the oncoming car. Cyclists bob and weave before me. Pedestrians do the same, often darting across the road mere feet in front of the bike.

“Baturi! Baturi!” little voices shout from the roadsides. I smile and wave. They smile and wave back.

Slow down! -- a hand-cart laden high with bags of fresh-picked groundnuts straddles the path. Five Africans, lithe, dark, and glistening with sweat, strain to move the load. I veer off the road into the littered gutter-way and pass on the left as another bike bounces by on the right. Kofa Nassarawa, one of several gates leading into the ancient walled city, looms just ahead. Through the gate, and on past the dye pots and several orange vendors, the high stone wall encircling the hospital complex comes into view. City Hospital, Kano, the main hospital for all of Kano State. I ease off the throttle and kick the bike down into first.

“Mota, mota, hankali!” shouts the uniformed gateman. People flow apart to let me pass. Circling, I park the bike in the shade of the wall. Saucer-eyed lizards scurry away then stop to watch me dismount. Across the red earth and laterite courtyard stands the only two-story building on the compound. This building (cinder block and dirty cream like the rest) houses the offices of the pathologist, matron, senior medical officer, chief clerks, liaison officer, male OPD, several consultant specialists, Blood Bank and the laboratory. Behind it are the single-story wards, dispensaries, stores and the mortuary. In front is a canteen which sells everything from a single cigarette to sodas, candies and cookies, scribblers, biros [pens] and even a couple of red lace bras.

It is a large and busy institution here. There are approximately 500 beds but the staff process over 1000 outpatients every day. Like the extras in a Cecil B. DeMille spectacular they come -- patients, relatives, friends, visitors and the idly curious. Great articulating chains of humanity, going to outpatients, going to dispensary, getting cards, stretching out everywhere. They are on benches, sitting on chairs, standing, lying on walkways, seated on dusty curbs -- waiting, hoping to get some relief from their sufferings. Already, as I cross the courtyard, about fifty people are crowded around the lab door. A white-smocked technician is dispensing all manner of small bottles to people and sending them off in various directions to produce the required specimens for analysis. Some patients are also being directed inside to await venipuncture.

“Sannu, Baturi,” greets me as I approach. I reply in my halting Hausa and step inside. “Good morning, Sir. Welcome,” is heard as I set my helmet down on the Biochemistry bench.

I pick up the requisitions and quickly riffle through them -- a BUN, a blood glucose, three bilirubins and four pregnancy tests await our technical attention. My colleague in Biochemistry has already collected the blood specimens because he arrives at work by 7:30 a.m. I’m supposed to show my face at 8:00 a.m. After dusting off the EEL spectrophotometer, I wander over to the oven to see if we have any dry glassware yet. Must be a good day -- even the pipettes are dry.

Turning, I see the nurse from B-Ward Female hurrying in, papers in her hand and a flustered look in her eyes. Today is the third time this week she has been late with the requisitions and it’s only Wednesday. Maybe she’s trying for a perfect record, six days late out of six. Resigned, I smile wanly, and take the requisitions from her nervous hand. “Please try to be a little earlier tomorrow, nurse.” “Sorry, Sir. Yes, Sir,” and she curtsies on one leg and goes hustling back to her ward.

Gathering up a few items for blood collection I set off in the direction of the female compound. B-Ward Female is quite typical of most of the medical wards here, a little less crowded than some but constructed in the same basic design -- dirty cream cinder-block walls with green trim and a corrugated tin roof. On each side of the building arched outer walls support an overhanging roof to form a covered breezeway. The floor of the breezeway is tiled in grey-fleck ceramic and is a multi-purpose area. It helps keep some of the mud and rain from getting directly into the ward proper, serves as extra bed space in times of crowding, and the roof overhang shelters the ward from the direct rays of the sun. Today there are four beds outside. I push aside the curtain draping the central doorway and step inside. A furry yellow kitten looks querulously up at me then continues its stalk of a large green grasshopper under a bed. The room contains about thirty beds in varying states of occupancy, fifteen along each wall. One bed contains three persons at present: a mother, the babe she is breast-feeding, and a youngster she is hand feeding with some watery grey pap. Several other beds have one or two visitors beside them. A few are empty as the patients are probably preparing food or visiting friends.

A pigtailed nurse comes over to offer her assistance. She looks quite efficient and the red belt indicates her senior position. “Good morning, Sir.” “Good morning, Nas. Would you find this patient for me please? She is not in her bed.” Nurse pops her head out the door and calls to a group of women gossiping under a tree. One ancient, bare-breasted lady puts down her multi-colour, multi-purpose bowl and wraps a gaudy blue and orange shawl over her shoulders. Slowly she hobbles in and then sits on top of the bed covers (a thin red wool blanket and sheets washed with Brand X). “Menene sunenki?” [“What is your name?”] I ask, checking the name on the requisition. Quietly she replies, cautiously watching my actions through her one clear eye. I motion her to lie down and I prepare her arm for venipuncture. Today we had no sterile syringes ready so I’ll have to use a Kahn taking set -- a long needle with about an inch of open rubber tubing on the shank. I wait until about ten milliliters of the pale red liquid have slowly dripped into the collecting tube. I then release the tourniquet and remove the needle from her arm. “Na gode.” [“Thank you.”]

Going over to the sink, I rinse out the needle. Nurse comes over and tells me that the other patient has absconded so I return to the lab. After placing the tube into the water bath with the others, I happen to glance over at the distilled water flask. Getting low, pharmacy must be making solutions again. I connect up the hoses and turn on the power to the Elgastat to prepare more. Not much to do now until the blood has clotted fully so I move over to my chair by the window and sit down.

The lab faces the courtyard. It’s a great place from which to people-watch. The gatekeeper directs a steady flow of lorries, cars, motorcycles, bicycles and pedestrians in and out while attempting to prevent the omnipresent goats, sheep and wandering burros from obtaining entrance. People mill about everywhere -- the sound, the blind, the lame and the dying. Almost every third person has a bandage around his shin covering a septic tropical ulcer. A cripple scuffles by beneath the window. Battered sandals clenched in her bony hands to ease the chaffing, she slowly drags herself along the ground, knees and feet swathed in filthy rags. The curse of polio had touched her limbs and wasted them until they look like thin tallow tapers twisted by the sun. Beyond, a beggar boy in tatters leads a blind man dressed the same. The boy stops near a new Mercedes and the blind man chants a short prayer in Arabic from the Koran, hoping for alms to buy food. The driver drops a penny into his bowl and the boy moves on again.

Reds, yellows, greens, blues, stripes, splotches, checks -- a riot of colour mixes and swirls as people move about. The women are especially gay in their cotton scarves and wraps. Each has a baby on her back and perhaps two other little ones in tow. Everyone packs something on his head, a bright fula, a tray of green-skinned oranges, patterned cooking pots, a calabash of water.

The clink of glassware in the sink brings me back to the reality of work awaiting completion. My colleague is busy decanting the golden sera from the tubes of clotted blood. The work is routine and the two of us soon get it completed. Crises seldom occur since the tests and techniques are relatively simple and foolproof. Our only current problem is the shortage of phosphomolybdate reagent ordered three months ago from England. If it doesn’t arrive soon we’ll have to dispense with blood sugar testing. Slowly the clock hands extend themselves to one thirty. Time to start cleaning up.

Wipe off the counters, straighten the racks, drain the accumulated water from the ever-dripping refrigerator, cover up the instruments. Two o’clock and time to close up shop for today. “Sai gobe.” “Right, see you tomorrow.” I put on my helmet and walk towards my bike.

The ride home is very hot and muggy. The air seems to cling like a moist woolly blanket. Even the insects are quiet, resting somewhere in the shade of a moldy leaf.

Groundnut soup and tomato sandwiches await my arrival. I quaff them down with a large pot of hot, sweet tea.

In the secluded comfort of my cushioned easy chair and luxuriating in the breeze of the fan, I feel relaxed and at peace. Remembering yesterday, thinking of today, day-dreaming of tomorrow, I find them all so much the same. Nothing changes. Everything moves onward slowly. Predictably.

Why hurry? Why worry? There’s always tomorrow. Slowly my eyes start to droop.

A short stretch.

A long yawn.

Africa and I relax.

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