Saturday, 6 December 2008
When I started on Monday, the intern clinical officer was also new so we had fun and games trying to do the ward round whilst trying to remember all the drug doses the senior clinical officer had reeled off before he headed to theatre. The good thing is most children come in very sick and over a day or two they’re back to what seems like their usual selves. The hardest part is, not surprisingly the deaths. 6 weeks on paediatrics at home and I witnessed no deaths, 1 day here and I witness 2, both of which would probably not have happened at home. Life’s crap. The first one was a little boy of almost a year, who had been on the ward for about a week in respiratory distress and appeared to have a pneumonia resistant to a whole host of antibiotics (I’m still getting to grips with what they use here-not that I really know what they use at home if I think about it. According to the BNF, chloramphenicol is only to be used as a last resort due to severe haematological side effects but here they use it left, right and centre and sing it’s praises so I never quite know what’s going on). Just as they were considering starting TB treatment and as I was attempting to sort a clogged up drip in the next bed, his mother shouted and when I went over he was unresponsive, pulse gone, not breathing. I don’t think I’ve ever felt so clueless and useless. We dug out the bag and mask and started chest compressions but I guess it was never going to work. He passed away. The second was a tiny 1 year old weighing 5 kg who had a oxygen saturation of 30% at 8.50am and at 9am she gave up the ghost. Just too much work for one little soul. Survival of the fittest without a doubt but when you weigh less then half of what you’re supposed to the odds are stacked against you.
Discharging home lots of happy healthy children was a relief after that morning. Unfortunately, the time when malnutrition becomes most apparent is beginning and with malaria season too it’s tough for these kiddos. They all have little books called health passports where everything is recorded so we plot their growth, check on vaccinations, vitamin A and mosquito nets. Apparently, lots of people use their free mosquito net for catching birds or fishing. And the men are reluctant to sleep under a net for fear of decreasing their fertility. I guess the later is difficult to prove either way. (I’ve just killed three mosquitos whilst I’m typing this-so strangely satisfying.)
Putting up drips is another thing which takes up a large part of the time on the ward. As all malaria cases get IV quinine to start with. Yesterday, I had a day of spurting body fluids. First one kiddo yanked out their cannula followed by a shot of blood, then I over enthusiastically flushed a cannula which was blocked and landed up with a polka dot white coat for the rest of the day. Lastly, as nappies are either non exsistent or chitenges it was only going to be a matter of time before I encountered a wet puddle forming at my feet. Delightful. Today was more successful on the body fluid front.
So I think I’ll be on paediatrics for the next 3 weeks or so then perhaps a little bit of general medicine before I head back. In one day, I go from thinking I’d love to work in Malawi to being so frustrated at what I’d never be able to do, I just want to leave. (usually when I’m stuck to a child by elastoplast that sticks to everything you don't want it to as I try to put in a cannula without pulling it out again, wishing I could have those nice peel-off-the-back venflon plasters. The small things I guess.) The usual indecisiveness, nothing new there.
Tuesday, 2 December 2008
Well, that’s another week almost gone. I spent most of it in the
They operate here on Tuesday’s and Thursday’s for elective lists doing prostatectomies, tubal ligations as part of family planning (these are free for women, so they do them only under local anaesthetic in the skin where they make the incision. It must be far from comfortable.), laparotomies, hernia repairs and Vesico-vaginal fistula repairs. I’ve only seen general anaesthetic being used once with the super laid back practically horizontal anaesthetist who remains totally unconcerned even if the patient oxygen sats keep dropping to below 80%, the patient is waking up in the middle of surgery or if I’ve given a bit too much ketamine. I think when he’s worried then we’re all doomed. Otherwise they use local anaesthetic-spinals for the most part. Patient’s are very uncomplaining and ladies in labour are mostly silent. In fact they’re told to be quiet. I’d be giving the doctors a good whack if they told me to keep quiet in the throws of labour thank you very much. Though things are in short supply there are always plenty of gloves and sterile needles etc but they use much less disposable things. For example gowns, drapes, suction machines are all washed and reused. The best part of theatre here are the stunning, very flattering scrub dresses which women wear. There are trousers but to avoid exposing those thighs which would imply all sorts of associations with promiscuity dresses are a must. Also needed is a petticoat. I should have known better. I thought they were pretty darn opaque these dresses but the theatre sister discretely told me to take one with me next time. Who’d of thought legs could cause so much trouble. Mind you no one cares what so ever about your top half. So I hope now I’m not offending anyone with my scandalous dressing. My thighs are safely tucked away.
As you can tell from the total lack of posts the internet is a bit fickle here. The room is only open during the week a for a couple of hours in the morning then closes for lunch then opens for another couple of hours in the afternoon, then between the internet not working at all, being v slow and the power out it’s tricky.
Hmm, ok I think that’s enough for just now. It hasn’t rained yet so I’m going to chance it and make a dash for the market-I’m loving the mangos but after having beans 3 nights on the trot I think a break is in order.