Monday, 5 January 2009

what's in a name?

Here each vowel is prounced independently so a name like George becomes Georgee. Then if the name doesn't have a vowel at the end, well why not add one so for example becomes Josephe. I shout Josephy and he's nowhere to be seen and then if I yell Jospehy, he appears. It sounds like everyone has an ee at the end of their name. Spellings also vary lots which makes patient files a bit confusing, George was spelled as Joji on his health passport book and I didn't think of "George" till one of the nurses decided that Joji was meant to be George. Yesterday, I was searching for Richardee's file thinking it would be under R . Oh no, after a good half hour one of the clinical officers asked if I'd tried looking under L. Well, no I hadn't in fact. And low and behold for sure we had a Litchard under L. L's R's they're the same thing. I should've remembered.

So the paeds ward is still busy. One little boy passed away yesterday just as the nurse was about to put up blood for him. Strangely, another wee one, Lewis, needed a transfusion but his mother wasn't a match (here, there's no blood bank so if you need transfused a relative has to donate and be a match), luckily his blood group matched that of the boy who had just passed away and strange though it felt we were able to use the blood for this second little boy who is now doing grand on the ward. A gentle reminder, I guess,that things carry on. With so many kiddo's with high fever's, convulsions are fairly common and as a little one was in the throws of a seizure and his oxygen staurations were plumeting I once again felt like I was way way out of my depth then there was diazepam, not for me you inderstand though I could have done with some too, but for the wee one and wonders it did do. He settled, his saturations came right back up and we were back on land again. I was so happy to see him off oxygen and breathing well for himself this morning. What a relief. Somtimes, I pop to the outpatients department to see what's going on there. Usually just to sit in with the doctor or clinical officer who's on duty. Patient's seem to wait much longer before coming to the hospital here than at home. One elderly man had been having pains in his foot with reduced sensation for the past thirty years apparently, I'm still not sure why he'd chosen to come today, but it was decided that he needed to get bigger shoes and perhaps try some amytryptilline for the pain too. We also saw a little boy with tetralogy of fallot: he'd caught chicken pox and possibly had endocarditis too as he had black, gangrenous fingers on one hand. He was very ill but getting by just. On Monday, during the morning report, we were told he'd passed away. Lumbar puncture packs are scarce and I seem to find myself wandering round the hospital trying to find a pack most days. Today now that the rainy season has started, all the leaks and cracks in the hospital are becoming apparent as well as the paths which are not covered over so, duly, I got soaked as I went to the surgical ward to try and find a LP pack. One of those days I guess. As I type the heavens have opened again. Fingers crossed it'll go off before I need to walk home. It's not so much fun when everything goes all muddy and you forget your umbrella or coat. Bring back the baking sun I say. (but it is good for all the people who've just started planting for the coming year.) The rains also mean that drapes for sterile packs and surgery don't dry as quickly which means surgery nad procedures are just postponed. rain has a lot to answer for as it also means that whoever is on call can't come in to see any patients as well, it's raining of course and well, it's just not possible to go out in the rain. I wonder if that would work at home. I think it's worth a try, no? This week the x ray machine was also broken so fractures were guess work and stethescopes came into their own though it would have been a big help if my stethescope skills were up to scratch. They also regularly run out of testing kits in the lab so often tests which you send come back as out of stock. They've also run out of ceftriaxone, a fairly commonly prescribed antibiotic. But somehow, things still go on, things still get done and patients do get better sometimes against all odds. And usually they're still smiling. I can imagine I,for one, would not be.
I need to go to the market for the usual cabbage, tomatoes and onions but I'm not sure I won't melt in the rain so I think I'll stay in hiding till it goes off. I'm still keeping well stocked with mangoes and am hopefully not turning strange shades of yellow with mass consumption. I heard today that children who eat lots of mangoes are prone to twisting of the bowel and obstruction so I'm hoping the same doesn't apply to adults.
The hospital is forever short of things from paper and prescription charts to sterile packs and money. The staff who've worked overtime this month have had their pay delayed til next month and I guess understandably, staff get fed up of this and hence the shortage of nurses in the hospital. Apparently, governement hospitals are the place to be in Malawi as you get paid better, more training and paid for overtime. So the intern clinical officers all want to apply for government positions after they complete their mandatory year here. Again somehow things work out and there does alawys seem to be just enough staff at any one time but it's a bit like living on a knife edge. It still doesn't really feel close to Christmas here apart from the Christmas songs on the radio which just feel a bit out of place. I think I'm going to one of the staff from the eye department house's for Christmas day-they're have a barbecue and some friends over. Otherwise I'll be in the hospital for the rest of the week. Just in the process of working out whether or not to change my flight to give myself a few days before I disappear off to Wishaw. The only thing is if I change now I have to spend a night in Addis Abbaba so I'm not sure it's worth it.
I still have to make it to Blantyre so i've yet to see the kiddle winkle woos form Yamikani. It does feel strange to be going back to them now but will be interesting none the less.