Math is relative.

It's 3 am. Perfect time to blog, right? With the baby sleeping through the night, I can't sleep anyway.

I want to write about work, probably not for the last time. I'm currently a burn and trauma visiting research fellow in Lilongwe, Malawi, for the upcoming academic year. Kamuzu Central Hospital, one of the country's 4 central hospitals conceived of as tertiary care referral centers, is a half hour's walk or 5-30 minute drive from our house, depending on traffic. This, taken from the hospital website, is what you see entering the visitor parking lot:

According to dictionary.com, a "hospital" is "an institution in which sick or injured persons are given medical or surgical treatment." But that's the factual definition; the cultural load of a word is where stories lie, and where misunderstandings arise. For example, if I free-associate on the word "hospital" for 2 seconds, I come up with: "white, clean, nurse, love, drugs, pain, death, friends, disinfectant, recovery, fear, babies, surgery, pager, large building, cockroach, elevator, work, hope, despair, emergency room" etc. Your list will be different. The list of a patient will be different from that of a doctor; the list of a woman who delivered a healthy baby different from a son who's just put his mother in palliative care, the list of a Malawian patient different from that of a Malawian doctor, of a Polish patient from an American one, etc, etc, etc. Language operates on an agreement about the factual underpinnings of itself (that is, word definitions), or else all speech would be a subjective hodgepodge of un-translateable experience and we couldn't communicate at all. One of the things I love about traveling is that it forces you to reinterpret and question those factual underpinnings of words and concepts which we take for granted in our own culture.

Hospitals are frequently described in terms of the number of beds and operating rooms they contain. Those numbers help to illustrate a hospital's volume of patients, its importance and function. And they should be easy enough to get, right? Count the beds per unit, add up the units, and voila. Ditto for ORs. But KCH is variously described as having anywhere from 700-1200 beds, depending on the source. How can that be? Math, after all, is supposedly universal. Does 1 bed magically become 2 beds, or half a bed, depending on who's doing the counting? Can Malawians not count? Are they so bad at keeping records that they don't even know how many beds one of their flagship hospitals contains?

The answer, of course, isn't that simple. For starters, the definition of a "functional" bed may include the one placed in the outdoor hallway that connects the rooms, which aren't technically part of the hospital census but which are routinely used to increase the treatment space of a hospital that was built for a much smaller population. Like this, taken from the Malawi Project website:

Next, "functional" beds aren't, when they're in a unit that's under construction. For example, all the main operating rooms at KCH are currently closed for renovation. If you need your leg pinned with orthopedics, it will happen in the dental operating room; if your baby needs a stoma because of her imperforate anus, she will receive it in the burn OR because the main ORs are just, simply, closed until further notice. So I can't really tell you how many ORs there are at KCH at this time, nor when the main ones will be available again.

Finally, I bet that in your free association on the word "hospital" you did not picture a bed containing more than the patient, and neither did I. At KCH, they do. In the privileged wards, like the burn unit, it's because the whole family might sleep in the same bed with the patient. In the most overcrowded wards--the pediatric ones, for example--it's because there are multiple patients per bed. So depending on how you count, one bed does become two, or three, or maybe even 4.

The thing is, you don't need your own bed to heal. We expect it, because that's our cultural and socioeconomic norm, but your healing isn't contingent on private sleeping quarters. OK, maybe if the patient next to you has tuberculosis or leprosy, that may not be too conducive to health, but in general, a single bed occupancy could be thought of as a luxury; especially when you consider all the other things we take for granted. Like a trained surgeon, or morphine for dressing changes, hot water, air conditioning, blankets, food. But more on those in another post. I do have to get up in 3 hours.

This entry was also cross-published with minor changes on my travel blog, malawijo.blogspot.com