Malawi Day 6: Privacy and dignity. Challenging myself

I've seen some things during the week in Malawi that have really challenged me and made me think about the concept of privacy and dignity. 

A couple of days ago I spent the afternoon in the resuscitation room. I talked previously about the child with the snake bite. Also in the tiny room at the time were two other patients: a 4 year old child with cerebral malaria and a 12 year old girl carried in by several members of her family. She appeared to be unresponsive and was slumped in their arms, not supporting her own weight. 

There were reports of her having been beaten and whipped by a teenage boy. It became clear that she was not actually unresponsive, but completely shut down emotionally. Not looking at anyone, not talking, closing herself off from the outside world. Examination by the doctor revealed a swollen tummy. Glances were exchanged. The collective concern unspoken. Pregnant? At twelve? Could this really be true? I take myself back to that moment and relive the wave of emotion, the feeling of the stone in my stomach. I think of my twelve year old daughter at home. But I can't draw those parallels, not if I'm going to get through the day. 

The team are trying to get the child to talk, to tell them what happened so that they can help. She remains silent and this is taken to be a response to stress, to emotional trauma. 

I look around the room. The child with the snake bite is desperately unwell and it's critical to be able to measure her fluid balance. To this end, she needs a urinary catheter inserted. The child with malaria has become a bit more aware of his surroundings after some oxygen and IV fluid and is, by turns, screaming inconsolably and looking around. 

My colleague and I decide that our presence is likely to hinder the twelve year old feeling comfortable enough to talk and we leave the room. 

The community area, hospital grounds

As we get outside, I contemplate what I've just witnessed. Three children with highly concerning presentations all together in one room. No privacy. No visual or audio separation. It feels so wrong. It's the opposite of everything we strive for at home. The tears come then for a minute. I'm just unable to feel ok about it. The team rally. We've all had a hard day. Witnessed things we weren't ready for. There's understanding, a bit of reflection at our daily debrief, and then a bit of laughter and silliness over dinner. It's how we cope in healthcare and we're having to pull out all the coping strategies now. 

Later, I reflect (over what's app) on what I have seen with a friend who's spent a lot of time in this part of the world. Gently, he challenges me to think about the fact that I am applying my Western European ideals to an entirely different context.  Maybe this lack of privacy is something that exists in every aspect of life for people here. Maybe it's ok and actually a source of support. 

Over the next few days I notice more about the feeling of community and the support that the mums on the ward give each other. Babies and children often share beds as there just aren't enough of them. Mothers are by their sides constantly. If they need to leave the ward at all, one of the other mothers temporarily takes responsibility. Food is shared, tacit emotional support given. When they witness other children receiving attention, or if one is severely unwell or dying, their looks are of compassion and concern, never nosiness. 

On the odd occasion a whole bed becomes vacant, no one ever asks to take it. There is support and solidarity in the closeness. I think about the difference  between here and home; the clamour for cubicles and the privacy this provides.  Maybe we've got it all wrong. 

Privacy and dignity is often discussed in healthcare in the UK. It's as if one can't exist without the other, as if it's a box to be ticked. It even appears on quality checklists: Is privacy and dignity maintained?  This is a question that always bothers me, and I know it will even more now. 

Here, privacy is in short supply, but dignity is abundant. At home we are all over privacy but can we say the same of dignity?