We got caught in the rain on the way back from lunch
The shouts of “Morning!” (whatever time of day it is) and “How are you?!” from small smiling children greet us on most of our trips out and about. We are quite a novelty. Although it turns out the little ones that come to the hospital from the villages far afield are less sure of us – often never having seen Kawajas before.
Emergency Medical Ward
This week on the EMW started dramatically. If you don’t mind, there’s a bit of a medical case history here – a bit involved but paints a picture of some of the patients here.
Shortly after arriving on the ward, one of the excellent nurses Sister Anna pointed out a very sick man who had arrived the previous day. 31 years old, he had rapidly progressing fever and reduced level of consciousness. Treatment for malaria and widespread infection of unknown origin had been started.
From the start, it was clear this man was very unwell. He was all but unresponsive and the snoring noise heard from the end of the bed indicated he was not maintaining his airway which was becoming blocked. He was breathing at 50-60 breaths per minute (very abnormal) and was incredibly hot to the touch (there was no thermometer available to take his temperature). It is important to remember this man had been completely well just over a day before.
James put his anaesthetic skills to good use and maintained this patient’s airway while I searched for an oropharyngeal airway (basically a plastic tube used to allow someone with a blocked throat to breathe). A single one was found on the other side of the hospital. With the help of the medical ward doctors we gave this man treatment for this widespread infection with antibiotics, anti malarials and fluid resuscitation. There was no oxygen available to give and no further blood tests or imaging that could be done. There is no intensive care unit, nowhere in which to escalate treatment.
Despite being given all the care and treatment available he was too unwell to recover and died early yesterday evening. His case was more severe than many patients in Juba but not uncommon.
Some of the patients here come to hospital after a difficult and long journey from the villages outside the city. The standards of nutrition, drinking water and basic sanitation can be very poor and people are often very sick before they can make it to hospital for treatment. Malaria and typhoid fever, often severe and life threatening is seen and treated here every day.
This week on the EMW started dramatically. If you don’t mind, there’s a bit of a medical case history here – a bit involved but paints a picture of some of the patients here.
Shortly after arriving on the ward, one of the excellent nurses Sister Anna pointed out a very sick man who had arrived the previous day. 31 years old, he had rapidly progressing fever and reduced level of consciousness. Treatment for malaria and widespread infection of unknown origin had been started.
From the start, it was clear this man was very unwell. He was all but unresponsive and the snoring noise heard from the end of the bed indicated he was not maintaining his airway which was becoming blocked. He was breathing at 50-60 breaths per minute (very abnormal) and was incredibly hot to the touch (there was no thermometer available to take his temperature). It is important to remember this man had been completely well just over a day before.
James put his anaesthetic skills to good use and maintained this patient’s airway while I searched for an oropharyngeal airway (basically a plastic tube used to allow someone with a blocked throat to breathe). A single one was found on the other side of the hospital. With the help of the medical ward doctors we gave this man treatment for this widespread infection with antibiotics, anti malarials and fluid resuscitation. There was no oxygen available to give and no further blood tests or imaging that could be done. There is no intensive care unit, nowhere in which to escalate treatment.
Despite being given all the care and treatment available he was too unwell to recover and died early yesterday evening. His case was more severe than many patients in Juba but not uncommon.
Some of the patients here come to hospital after a difficult and long journey from the villages outside the city. The standards of nutrition, drinking water and basic sanitation can be very poor and people are often very sick before they can make it to hospital for treatment. Malaria and typhoid fever, often severe and life threatening is seen and treated here every day.
The Emergency Medical Ward (EMW) in action
Despite this we have seen patients make impressively quick recoveries with appropriate treatment. They are often much younger than many of the patients I would see in the UK or New Zealand and their physiology can take much more of a battering.
The efforts of the nurses and doctors on the wards and the other JTH staff are Herculean. They work in very difficult conditions with very limited resources. Sometimes the hospital runs out of the most basic medicines, fluids and equipment. For many reasons I am merely beginning to appreciate (not least of which the destruction of this country’s infrastructure by many years of war) many of the therapies, imaging and blood tests that are taken for granted in the Western World are unavailable.
Despite these difficulties and the bewildering array of pathology seen, staff remain focussed and in good humour while working long and difficult shifts. Two of the doctors on the EMW have worked every single day that James and I have been in Juba, including weekends and several night shifts.
The efforts of the nurses and doctors on the wards and the other JTH staff are Herculean. They work in very difficult conditions with very limited resources. Sometimes the hospital runs out of the most basic medicines, fluids and equipment. For many reasons I am merely beginning to appreciate (not least of which the destruction of this country’s infrastructure by many years of war) many of the therapies, imaging and blood tests that are taken for granted in the Western World are unavailable.
Despite these difficulties and the bewildering array of pathology seen, staff remain focussed and in good humour while working long and difficult shifts. Two of the doctors on the EMW have worked every single day that James and I have been in Juba, including weekends and several night shifts.
Matt & Dr Dobol, a very hard-working medical officer (SHO)
A Note On Hand Shaking
It’s a simple thing, shaking hands. A greeting, an affirmation of trust or of friendship through physical contact. Simple and quite wonderful. It is the culture here to shake hands with colleagues and friends on each meeting – sometimes several times per conversation for emphasis! Being stopped several times on each walk across the hospital makes for slow progress at times but is one of the many pleasures of living and working with the people in Juba.
James and Dr Maker. Note: James is 6 ft tall and has size 11 feet.
These guys are built on a different scale!
These guys are built on a different scale!
So that’s my first attempt at blogging, hopefully not too wordy for you all... We spend our days working on the wards, meeting and getting to know the doctors, nurses and pharmacists here. We have a preliminary plan for some research into the medicines and fluids prescribed and their availability – the JTH pharmacies often run out of vital items and patients’ relatives (if they have any) have to take a prescription to an outside pharmacy to get treatment. Patients without relatives are not so fortunate. We are working closely with the staff here as we want to initiate research/audit that is:
1. Wanted by staff
2. Useful and important in improving patient care
3. Replicable (we are only here for 3 ½ months)
4. Feasible for James and I to undertake.
All the best from Juba
Matt (& James)
Matt (& James)
PS If you're reading this as a Facebook note you might like to consider visiting the blog direct at http://onedoc.blogspot.com
This is a really interesting blog guys. Keep up the good work, You are headed for great things by the looks of it.
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