Now I used to work at an A&E department when a busy day was 140 admissions. On my first day I went to the outpatients department and was greeted by this:
The day carried on in a similarly unusual manner as James has alluded to on his correspondence. Suffice to say my first day was a culture shock. However, many lessons were learned including the importance of coming to the hospital with toilet roll on your person.
Being of a medical persuasion, I find this place fascinating. It is literally alive with pathology and I have seen things that I have never seen before. Cerebral malaria, TB, HIV, more ascites than you can shake a stick at, splenomegaly, hepatomegly, and proximal myopathy. Yesterday I diagnosed my first ever diastolic murmur possible caused by mitral stenosis and today I saw a case of tetanus- just like in the textbooks! (sorry about this paragraph, all of you non-medics)
Sad things are seen here too. A 22 year old man came in with cerebral malaria and despite our best efforts we couldn't stabilise him. He presented too late and died later on that day. In St Mary's he would have been for full escalation of treatment and would have been ventilated on intensive care. He was a student at Juba University, no older than the medical students we have here with us from Southampton.
Sometimes the problems here seem so big that if you think about them all at once everything seems so impossible. However, the Southern Sudanese are the most inspirational people. After a war lasting 40 years, they remain optimistic and are working hard to re-build their country. Juba has already changed since I visited in March. The main roads in Juba are now all tarmacked and there are pavements, too. New housing is being constructed and buildings are constantly going up.
Things have changed in the hospital, too. It now has power 24 hours a day and has a new health resource centre with 8 wireless computers and a load of laptops. On my first day there was a computer course and they were being taught how to use Microsoft Access!
These people are truly remarkable. They are tenacious and optimistic in life and they are very industrious. They have interesting mannerisms that I am still learning. Everyone shakes hands here. If you see someone you know, you shake hands. If you see someone you know well, you slap your hand into another person’s hand before shaking it vigorously. It is common for men that are good friends (in the platonic sense) to hold hands whilst walking. This happened to me once which was... novel.
The staff here are very optimistic about the St Mary’s Juba Link. Yesterday we had a Link Committee meeting and they were so kind, complimentary and accommodating- it is this and their hard-working attitude to life that gives myself and James the desire to keep working alongside them. I only hope that we live up to their expectations.
I don’t want to tell you everything. I think little instalments are much better than one long email. So I shall sign off for now and tell you a bit about the culture in my next update because this in itself is fascinating. I leave you with a photo of me and James beavering in his room and another photo that we took for teaching this Saturday, where we try and demonstrate how scary it could be to take care of the sick patient if you know nothing!
All the best, team. Bye for now.David
Sounds very challenging guys. I know its the culture but James you dont have to hold Daves hand! Rob
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