I thought I’d follow James’ advice and do a little bit of blogging a bit more often...
Yesterday we went our separate ways for a time – James spent time in the operating theatre and I went to the Emergency Medical Ward with Dr Andrew. Fascinating in very different ways. James was in theatre with Dario – one of the senior surgical consultants here. He’s a true general surgeon and his work demands experience in all aspects of general surgery and orthopaedics. Along with the other surgeons he regularly manages everything from gunshot wounds and fractures and plastics (skin grafts) to hernia repairs and major abdominal surgery, and when the emergency need arises to open a chest or skull. He’s also a thoroughly nice guy and has been very supportive of us throughout – he’s the man who has requested we look into the records of gunshot wound surgery at JTH and formulate a report.
Amongst other things, James saw a lumbar hernia repair yesterday (something I’ve never seen in the UK or NZ), and was impressed with the surgical skill displayed in performing a mesh repair on this rather large abnormality.
Yesterday we went our separate ways for a time – James spent time in the operating theatre and I went to the Emergency Medical Ward with Dr Andrew. Fascinating in very different ways. James was in theatre with Dario – one of the senior surgical consultants here. He’s a true general surgeon and his work demands experience in all aspects of general surgery and orthopaedics. Along with the other surgeons he regularly manages everything from gunshot wounds and fractures and plastics (skin grafts) to hernia repairs and major abdominal surgery, and when the emergency need arises to open a chest or skull. He’s also a thoroughly nice guy and has been very supportive of us throughout – he’s the man who has requested we look into the records of gunshot wound surgery at JTH and formulate a report.
Amongst other things, James saw a lumbar hernia repair yesterday (something I’ve never seen in the UK or NZ), and was impressed with the surgical skill displayed in performing a mesh repair on this rather large abnormality.
The EMW was pretty full yesterday (as it is most days). Many of the patients were admitted for treatment of malaria. It has a huge variety of presenting signs and symptoms. One of the most striking appearances is that of a patient with cerebral (brain) malaria. We have seen them present with anything from abnormal behaviour to confusion to outright coma.
One of the patients on the ward yesterday had the malarial symptoms of body aches, fever and nausea with additional signs of cerebral involvement. Progressively stilted, odd movements and slow, uncoordinated movements together with limited speech and confusion all point to this clinical picture.
Cerebral malaria has a poor prognosis even in well resourced Intensive Care Units and is a major cause of morbidity and mortality worldwide. But despite this I have seen people make startling recoveries over a short space of time with good ward based care.
At Dave’s wedding earlier this year Dr Hakim (a UK based medical consultant and originally from Juba) told me of my upcoming trip to Sudan “You will see things you have only read about in textbooks”. And of course he was right. For example, nearly every ward round I go on here reveals patients with massive splenomegaly (an abnormally enlarged spleen due malaria, typhoid, certain anaemias and a multitude of other causes). I can think of very few times when I treated patients at home who had such findings.
Liver cysts, signs of liver failure, the neurological signs of cerebral malaria, numerous skin lesions associated with infection or with HIV/ AIDS, the sunken eyes and cardiovascular findings of profound dehydration are common to name just a few. The patients here have such a burden of advanced illness yet as I’ve said before, patients, their relatives and staff approach these difficult situations with grace, pragmatism and intelligence. People deal with great pain and suffering with very minimal complaint – very humbling to witness.
One of the patients on the ward yesterday had the malarial symptoms of body aches, fever and nausea with additional signs of cerebral involvement. Progressively stilted, odd movements and slow, uncoordinated movements together with limited speech and confusion all point to this clinical picture.
Cerebral malaria has a poor prognosis even in well resourced Intensive Care Units and is a major cause of morbidity and mortality worldwide. But despite this I have seen people make startling recoveries over a short space of time with good ward based care.
At Dave’s wedding earlier this year Dr Hakim (a UK based medical consultant and originally from Juba) told me of my upcoming trip to Sudan “You will see things you have only read about in textbooks”. And of course he was right. For example, nearly every ward round I go on here reveals patients with massive splenomegaly (an abnormally enlarged spleen due malaria, typhoid, certain anaemias and a multitude of other causes). I can think of very few times when I treated patients at home who had such findings.
Liver cysts, signs of liver failure, the neurological signs of cerebral malaria, numerous skin lesions associated with infection or with HIV/ AIDS, the sunken eyes and cardiovascular findings of profound dehydration are common to name just a few. The patients here have such a burden of advanced illness yet as I’ve said before, patients, their relatives and staff approach these difficult situations with grace, pragmatism and intelligence. People deal with great pain and suffering with very minimal complaint – very humbling to witness.
We took a trip to a church outside the city with father Jo last Sunday. The President of South Sudan Salva Kiir was present (the second time we’ve seen him in the last month or so). Along with the Archbishop of Juba, the president gave a rousing speech to the congregation including an encouragement to register to vote in next year’s general election. The next few years will be a time of great change for this country for many reasons perhaps best left to those in politics to comment on. The massive importance of the election in 2010 and subsequently in the referendum of 2011 to the political situation here really struck me. Whether people vote or not will have a direct influence over the future of this long troubled country.
The US Envoy to South Sudan was also present – this combination lead to an impressive security force and a motorcade of several hundred soldiers with too many AK47s to count. Being in a bit of a hurry to get home after the service for a well deserved lunch (he had been up behind the altar with the other priests for the last 4 hours) Jo pulled out just a bit behind the president’s motorcade and we drove just in front of a pick-up with what looked like an anti-tank gun anchored on top. An interesting weekend. I also crossed the White Nile for the first time – deep, wide and fast flowing at Juba even several hundred miles before it joins the Blue Nile in Khartoum.
And finally... Snakes! Or a single snake in fact. “Oh look, there’s a snake” said James in a rather matter-of-fact manner yesterday evening as we sat in our office. And indeed there was a green fellow just over a foot long and half an inch thick calmly making his way along the floor – probably having slipped under the door. Not exactly a maneater but pretty disconcerting.
Being both practical and deep-thinking men we rapidly discussed our options (from the safety of standing up on the sofa). You must bear in mind we’re not experts in snake behaviour, venomous or otherwise in South Sudan and happen to know the only anti-venom is kept by the UN in their compound which is some way away.
1. Ignore him - he might be harmless? No, as we work in this office nearly every day and don’t fancy the prospect of sharing it with a potentially lethal interloper.
2. Capture or otherwise detain it? A swift scan of the room revealed a distinct lack of reptile-proof containers and anyway what would we do with an imprisoned and probably angry serpent?
3. Kill it? Yes, we decided. But what with? How tough are they? Unsure of the answers we thought perhaps a heavy object dropped from above might work – but again the standard office set up doesn’t include accurately droppable snake killing objects.
So I went for an old fashioned approach of beating it soundly about the head with my shoe. It took quite a few hits and finally lay somewhat dead on the floor. We paused for James to take a picture (with ruler for guidance) of the offending beast and then threw him out the window. Sorry snake, we aren’t men of violence but given the situation, you had to go.
Sister Anna had a look at our picture today and told us most snakes here are venomous and we probably did the right thing. Disaster averted we went on with our evening and watched an episode of Band of Brothers to put our snake problems in perspective.
All otherwise is well here. We have five weeks left in Juba, are getting on well with the gunshot wound research with plans going well for teaching sessions for clinical officers and nurses. The rainy season is coming to an end – the previously daily rainstorms now come less than once a week and the roads are dusty and red. And it sure is hot. We are both still happy and healthy and finding time to indulge our common interest in Tolkien.
Matt (and James)
All otherwise is well here. We have five weeks left in Juba, are getting on well with the gunshot wound research with plans going well for teaching sessions for clinical officers and nurses. The rainy season is coming to an end – the previously daily rainstorms now come less than once a week and the roads are dusty and red. And it sure is hot. We are both still happy and healthy and finding time to indulge our common interest in Tolkien.
Matt (and James)
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