Well, that’s another week almost gone. I spent most of it in the Eye Hospital which has turned out to be really interesting. Twice a week they run Mobile Eye Clinics which cover up to 200km away form Nkhoma north and south. So on Wednesday I went along with the group who were heading towards Mangochi, a town on the edge of the lake. We left at 4.30am with the patients who had received surgery on the Monday. These patients were dropped off and then we headed to do the rounds of 4 clinics. Each one was held in a school building, somewhere accessible to large numbers of people (apparently less accessible to a vehicle-down dirt tracks which had nasty steep bits when I was convinced I was going out the windscreen), and each had about 50-60 people waiting to be seen when we arrived there. One of the medical assistants, a nurse and a driver go plus an ophthalmoscope and a box of eye drops and cream. And they work non stop. I was just about dead. There’s lots of allergic eyes, I guess like hayfever, lots of cataracts, glaucoma (sad, as usually in the late stages when the patient has lost much of their vision already), pterygium (I’d never seen these before but they’re common here-growths of the conjunctiva) and uveitis. So anybody they can treat on the spot is treated and anyone who’s a potential candidate for surgery is taken back to Nkhoma in the landrover (it takes about 18 patients plus the staff). After they’ve done the round with the clinics, the next week’s clinics are arranged by speaking with the T/A (traditional authority) for the area who then agrees to the clinic being held, finds a venue and publises in the area. By the time, this was all sorted, it was about 6pm and we were somewhere near the Mozambique border (I’d lost all sense of direction by this time) which meant a long journey back in the dark. Someone also decided to buy fish since we were close to the lake which smelt just great. Cars don’t seem to do the whole dipping headlights thing so just blind everyone in the opposite direction. That’s if they have lights at all. They indicate to the right to let you know here the edge of their vehicle is, kinda good thinking when it’s a whooping great truck taking up most of the road. I was glad I slept most of the way back. At 11pm we arrived back at Nkhoma. I was knackered but it’s all in a days work for the Eye Hospital Staff. Then Thursday we saw all the patients in clinic in the morning and most had surgery that afternoon. Unfortunately some of them are not suitable for surgery and just have to go home empty handed but mostly there seems to be lots of happy seeing patients to go home again on the Saturday.

So tomorrow, I’m going to go off again with them before starting paeds on Monday.

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.