Hospital Transport

I always thought that, whenever given the chance, I would readily swap public transport for an alternative, any alternative. That was indeed until this week, when I realised the full meaning of hitching a ride along a hospital vehicle. It was a perfectly legitimate behaviour from me as well, since I was on hospital business. Just to set the scene quickly here, let me explain to you what hospital transport is actually used for. There are two types of vehicles. One is your familiar chauffeur driven car for the hospital executives, when they need to go to meetings or other official (and sometimes private) business. The same vehicle also picks them up from home in the morning and drops them back in the evening- irrespective of the walking distance: 3 minutes, if I crawl, in the case of Ntcheu. It is a status-laden priviledge that comes with an otherwise poorly rewarded job and I guess the guys don’t see why they should pass it up. The second type of vehicle is your patient transport/ hospital business one. It runs whenever there is a need to deliver or pick equipment for the hospital and when patients need to be transferred to tertiary referral centres (Lilongwe and Blantyre). The way it normally works is that a trip is scheduled for such and such official business. The word is out straight away that there’s a vehicle going that side. The transport manager checks his list for patients needing transferring ‘that side’ and contacts the ward to send the patient/s along. In reality, it takes a little more coaxing from the referring clinician (me) to make sure the vehicle doesn’t leave without the patient. As the 4x4 fills up with its destined cargo, you have a number of hospital staff tagging along for a free ride and filling up the last remaining places.

It soon became clear that by giving a wide berth to public transport in favour of hospital transport (twice) this week, I was actually jumping from the pan into the fire. The obvious appeal of avoiding the long painful wait in a bus depot for the bus to fill up is quickly overcome by a string of new inconveniences. The decibel level, for one, is on a par with the public transport counterpart. I keep asking myself: Am I the only one in this country who reacts to loud (gospel – remember Michael Bolton? He’s still alive and kicking in here, along with Celine Dion, Mariah Carey and their local equivalents who all sing the exact same tune, with slight variations in the lyrics- and rap) music being played for 3 hours on end while I’m trying to snooze/read/work during a journey? Of course, if it could be drowned by my own music through earphones, things might improve a little, but I’m talking decibels that are refractory to such remedial action! As for the waiting, there’s how it goes- apparent time saved versus real time saved (or not).

The first of my two journeys was aboard the executive type vehicle to go the capital for the collection of a shipment that had arrived at the central post office. I had ordered some orthopaedic equipment from India, through a competitive grant I had secured from my NGO. That was one of my early successes some five months back, and the fact that it only turned up now says a lot about the hurdles involved in the procurement process- dealing with London office, multiple invoice changes to meet their standards, dodgy pricing mistakes, ship freight and now customs. The arrangement was to set off early with the DMO, 7am at the hospital gate with the aim of coming back early or at least allow plenty of time in the event customs proved to be difficult. At 7.15, I saw the driver come in unhurriedly and only then set off to go and pick up the DMO. When he came back at around 7.45, the DHO and another person were also in the vehicle. They had some business in Lilongwe too. We finally set off and reached Lilongwe around 10.15. Since we had more than 1 businesses to attend to, ours was naturally left last on the list. We first went to the ministry of health building, which actually is a well hidden gem in the Lilongwe architectural landscape. It sits along with the other ministries along ‘Capital Hill’ and is one of the numerous legacies of this country’s most famous and revered politician, Hastings Kamuzu Banda. It has become almost normal for me to expect to hear his name mentioned in connection with any development I see in this country. We eventually made it to the post office at around 11.15. My dreaded interaction with customs went smoother than I could ever have imagined. We managed to convince them that hospital equipment counted among items exempt from whatever hefty duty. It’s only later on that I realised there had been some butter doused on those palms behind the counter, that obviously took place in fast and discreet Chichewa. Once we got past the official businesses, the next stage was to sort out any personal business that could only be done in Lilongwe, since we were already there and had no chance of getting back in time for work. That’s when it got tricky as everyone had business in different parts of town, which gets very congested with traffic around that time- and I’m told the reason for this is that most people get in their cars to drive home for lunch. That partly explains the 2-3hour lunch break all of a sudden: 30-60min for transport, 30-60min for cooking, 30-60min for eating! It can’t save much money considering the price of fuel here, compared with the dirt cheap cost of a (simple) meal. By the time we’d sorted the mobile phone contract of my colleague out (around 4.30pm), the vehicle had managed a tyre puncture, which further accrued the delay in departing. Just as we thought that was it then, the team decided to stop at a supermarket for some special supplies not available in Ntcheu and just as we’d done that and got ready to go, someone decided we ought to stop in another part of town to buy something else. Thankfully we all figured out that would be perfunctory since the shop would already be closed by now. Thence we made our way to Ntcheu, getting there at the grand hour of 8pm, me half deaf and completely battered, but happy nonetheless to have come back with the goods I set out to collect!

As if that were not a lesson enough, the very next day, I joined the second type of vehicle to go that other city, Blantyre, again on hospital business. What I didn’t know was that I would have to share this vehicle with no fewer than 10 patients/guardians all referred to QECH hospital. One was semi-conscious and lying on a mattress laid down in the back. People were huddled against each other until the last pocket of air was filled. In addition to that, there was their luggage and the transfusion box, which gets filled every Friday. Some people had to be left behind for pure lack of space. You’ll be pleased to hear I secured a seat in the front, squeezed only by another staff member heading south. Once in Blantyre, we unloaded the patients and I made arrangements with the driver to meet up later on so I can go and obtain some more orthopaedic supplies from the stockists there. By the time I’d finished my business in CURE, QECH and the medical stores (nothing useful in stock by the way), it was already around 5pm and my driver had acquired 2 more passengers (including my colleague, whom I had handed over the ward jobs to in the morning thinking he was around!) Again, just as I thought it was time to go, so I could return to Ntcheu in one piece, we incurred delay after delay. We first picked up a parcel from an ex-hospital staff for their relatives in Ntcheu, then went to collect the blood transfusion box, then went to pick up a staff member and all her luggage to move back to Ntcheu and... the straw that broke the camel’s back... we had more patients to pick. The ones from last week, who simply had no means of getting back to Ntcheu of their own. It’s a saddening example indeed of how often people miss out on essential medical care, for the simple reason that they cannot afford transport. The glimmer of hope that I saw in that patient’s eyes as she approached the vehicle, enquiring if we were the Ntcheu transport for her and her convalescing son was, in itself, a thesis on the hardships endured by the poor class of Malawi. I don’t know how long she’d been waiting there for and even worse, I don’t how long more her friends whom we couldn’t fit in the vehicle will have more to wait. Only after that did we manage to unequivocally set off for Ntcheu. It was sunset already and I was shattered and desperate to reach home in the shortest possible time. But as a final dent into my barely standing bodily frame, that also was notbe and the reason being that our driver happened to have some sight impairment. He was completely blinded by on-coming vehicles and would slow his vehicle down to 40Kmph or less everytime one went by. Furthermore, the front seat, despite being away from the sweaty patient crowd in the back, had 1 significant drawback which possibly made it even sweatier. It sat right atop the overworked engine which was radiating constantly like a burning stove. The 2 hour drive back thus took a solid 3 ¼ and I had by then lost all will to live. Thankfully it was Friday night and happiness was just a meal, a shower and a few beers away.
Hop on board!