_____ One Doc's Blog ____

So here we are at the end of week four, and I don’t think we’ve been looking forward to a weekend break this much for a while.... Work’s going well but we’re upping our level of responsibility clinically on the Emergency Medical Ward. We’ve tended to employ a rather deliberate strategy of hanging back for the first few weeks whilst we observe and figure out the place (and the pathology) but now our role is naturally growing and evolving (certainly in terms of pure clinical service-provision for the hospital) rather well.

On Thursday, for example, for some reason there were no doctors on the ward, so we did the whole round ourselves with nurse translators. This went pretty well, and I think was an important milestone. Still, it was about 50 patients and took all day. Language slows things down, and on average people are far sicker than in the UK, and they take time. However it’s nice to feel useful and just do pure doctor stuff. These days we’re very familiar with managing malaria, typhoid and acute diarrhoeas these days which is most of the tropical medicine we see routinely. There’s actually far more interesting medicine here if you look for it - much is more familiar territory... Diabetes, GI bleeds, strokes, cardiac arrhythmias, heart failure, liver failure, renal failure, anaemias of varying causes, epilepsy, chest infections, meningitis, asthma, deliberate self-harm (overdose), cancers...even “collapse ?cause” :o)

It’s a challenging environment to work in though; physically, it’s hot, humid and sweaty (and often a little smelly) on the ward. Clinically it’s challenging not only to know what correct management is or should be, but also a whole other level of clinical problem-solving comes into play i.e. what can be done with the limited resources we have here? (This of course applies to investigations as well as treatment.) Emotionally, it can be draining to handle the incongruence between those two particularly when most days people young people die of acute diseases who almost certainly wouldn’t have in the UK.

You may think from the above that it’s a struggle to get up to go to work in the morning, but you’d be wrong. There’s a really special sense of teamwork (not to mention humour) here amongst doctors and nurses, not to mention the satisfaction derived from patients that are successfully treated here – and that’s the majority. I’ve seen young folks literally comatose (GCS 3) from cerebral malaria one day and walking and talking the next. Quinine may well be my favourite drug. I said it was challenging, which it is, but probably more rewarding for that. It’s no holiday, sure, but who really cares?

Having said the above, it’s important to have a bit of emotional insight and get some good relaxing in too. Fortunately Matt and I share many of the same relaxation pursuits. (Many is the evening discussion we’ve had along the lines of “Those Orcs aren’t going to slaughter themselves...” :o) And there’s healthy amounts of guitar playing and film watching and coffee drinking and pizza eating all happening. So it’s good.

Personally, I’m continuing my experimentation with Catholicism and spending a lot of my Sundays hanging out with my Comboni chums from last year. Last Sunday we went over the river to a new monastery-type outfit that had just been built for its official opening by the Bishop. The Mass was really fun actually, lots of great African singing and dancing. The children in particular made me smile an awful lot. The chap at the door mistook me at first for a priest and tried to seat me on the stage (a little embarrassing as none of the other Priests had come in yet and I would’ve been on my own) but luckily the Comboni Sisters (nuns) were all sitting in the front block and understood my dilemma (with much amusement I may add) and let me sit with all the ladies. It was all in good humour though so no problems. All followed by a delicious Sudanese lunch. So that was that. I’m going to the cathedral tomorrow so that’ll also be an adventure.

Two final notes:

Firstly, one of the stray hospital dogs has adopted us and follows us everywhere now. We don’t know why and certainly haven’t encouraged it in anyway. We try and kick it away but neither of us really has the heart to actually harm any animal particularly, particularly one so mournful looking. (The attempted kick becomes reminiscent of The Simpsons’ Mr Burns’ “I’m giving you the thrashing of a lifetime...!”) I found that a splashing of cold water quite effective, but then we saw it getting all picked on by another stray pack and felt bizarrely sorry for the wretched beast. We’ll see what happens.

Secondly, at breakfast the other day we beheld a man using a modified bicycle to drive a grindstone to sharpen blades. Personally I thought it was one of the most awesome things I’ve seen for a while, so we had to take a photo. It reminded me so strongly of something one would find in the back garden/work-yard of Kitchener Road that I felt a bizarre sense of kindred. Anyway, there it is.