Fee-Paying Toilets

UTH is the main public hospital in Lusaka and they will accept anyone who is referred or comes to receive care there. With that being said, the hospital is clearly divided into socioeconomic status. There are low cost wards and high cost wards. (There are even fee paying toilets and non-fee paying toilets!) The low cost wards are free to the patients and, as such, are often quite crowded with cots crammed close together and even mattresses on the floor if there are no cots available. With the amount of patients in the low cost wards, it comes as no surprise that there is very little privacy between patients. Privacy is often something I take for granted in the United States. During ward rounds in the morning, patient charts are kept at the foot of the bed of the patient and it is not unlikely that charts get put on the wrong patient’s bed. Also, in Zambia, it is the role of the family and loved ones to act as caregiver to the hospitalized patient.  This caregiver cleans and feeds the patient, comforts them, and sometimes administers home medications (especially antiretroviral therapy); this role is in addition to the nursing staff that already works on the floor. When you add all the caregivers to the already overcrowded rooms, it becomes quite a mess. Even going into the nursing room where medications are stored, pill bottles are left wide open, they are all stored together in the same cabinet, sometimes medications themselves are even mixed together in the same bottle. It is quite chaotic!

Medicine cabinet in nursing room of low cost ward

The high cost ward is strikingly different. It is more similar to what you might picture a hospital stay being when you are in the United States. These patients either have insurance or will pay out of pocket for their care. Each patient has a decent size room with walls and curtains to separate them from the other patients on the ward. There is a sink, refrigerator, and shelf in each of these rooms. It is much quieter in these wards; the nursing room is organized and clean. I have never seen such a staunch difference between living conditions in one hospital!

Entrance to one of the high cost wards

We are currently working with our preceptor to develop research topics to target some of the major problems we have observed in our first few days in the internal medicine ward. We are hoping to find ways for pharmacists to expand their role in these wards and improve patient care.