6.29am. Hear a knock at the door. Greeted by a nursing
student who hands me the chart of a new patient on the maternity ward. ‘Sister sent this
chart for you to see the patient”. Try to establish from the student how unwell
the patient is, whether any vital signs have been recorded and whether I can finish brushing my teeth. Student insists she
is only the messenger and that ‘Sister said you should come’. Decide it’s too early
in the day to give my nursing triage tutorial on the doorstep and head to maternity.
Thankfully, the woman who is 30 weeks pregnant is not too unwell but has been feeling
progressively worse with fevers, ‘generalised body pain’ (a favourite symptom which
features in most patient’s complaints) and headache. I organise our limited panel
of blood tests (blood count and a malaria test), commence her on treatment for
malaria, advise the student to monitor her observations and after examining her,
reassure the expectant mother that her baby’s heart rate is healthy.
8.24am. Drop into lab to check on the progress of the
arrival of HIV tests as since the previous night current stocks have reduced to
zero preventing any testing or blood transfusion.
8.30am. Arrive at the outpatient department and catch up
with the other junior doctor from the UK.
8.43am. Telephone medical superintendant to see if we should
start the ward round without him. Informed that (at short notice) he and the
sole midwife for the hospital have been called to attend a training workshop in
Bo (Sierra Leone’s 2nd city) for 3 days. Advised to start ward round
without him and continue for next 3 days.
8.57am. Maternity ward. Thankfully, no women are currently
in labour and the woman from earlier is starting to look brighter. Good news from a lady who had a caesarean, whose
scar, which was infected, has now fully healed and her baby who weighed a
meagre 1.7Kg at birth has now breached the 2Kg mark and is breast feeding well.
9.40am. Children’s ward. Together with the other doctor, weigh
up our options for a child admitted with sever malaria and anaemia who needs a
blood transfusion. Despite explaining to the family that we cannot offer safe
blood transfusion currently until the HIV tests arrive, they feel there is no
option for them to travel to another hospital. Telephone the lab again. Informed
that someone is picking the tests up from Kenema as we speak. Maintain the child
with fluids and continue treatment in the interim. Continue to see the
remaining patients on the ward and also have to give a lengthy reassurance to a mother whose
child is happily running wild around the ward that, unlike the first child,
her little boy would not benefit from a blood transfusion.
10.32am. Start to get exasperated with patient on Men’s
medical ward, whose sole response to questions in any language is that he has a
hernia. On examination although he does in fact have a small reducible
unproblematic hernia, more worryingly his heart rate is twice as high as
normal, he is incredibly dehydrated, struggling to breath, anaemic and in heart
failure. Try to prevent outward signs of further infuriation with relatives who,
despite the obvious visual malady of his critical condition, also voice the only
problem to be ‘hernia’ for 10 years(!) and request that we schedule surgery.
Explain that his hernia is not currently the most pressing concern and we need
to initiate emergency medical treatment.
10.58am. Start seeing outpatients. Usual mix of patients;
one group of whom are very well and most of my time is spent convincing them
that they do not need injections or lab tests despite their insistent requests,
or trying to advise both patients and nursing students that malaria is not a
symptom but an illness. The second group of patients are those whom appear pleasantly unaware of
quite how unwell they are and most of my time is spent negotiating with them
and their relatives on the need to be admitted to hospital. Admit 3 patients
to the ward; a 12 year old boy with a massively swollen abdomen, tense with
accumulated fluid now making it difficult for him to lie flat or breathe, an infant with malnutrition and malaria, and one young lady, very unwell with suspected TB.
12.14pm Check in on the lab to find out that happily the HIV
tests have arrived enabling blood transfusion to be organised.
2.47pm. Breathe a momentary sigh of relief as the last
outpatient card on my desk is duly handed back to their owner and they are
instructed towards the pharmacy. Try to not look disheartened/anxious/confused when 30 seconds later, two members of the Sierra
Leone army walk into my office and request for me to see one additional
outpatient who, unfortunately for him, has a rather unequivocal diagnosis; very
unusually, they have brought me a corpse. Thankfully they do not have expectations
of resurrection but simply need a medical doctor to confirm that the person was, in
fact, deceased. For a moment I think they are going to bring him straight in
to the consulting room but they agree to take their vehicle and the body round
to the room we use as a temporary mortuary next to the men’s medical ward to be
examined.
3.12pm. Conduct a superficial scan of the wards and check on
the earlier admissions.
4.00pm. Walk down to the nursing school classroom to teach
the final year nursing students on (ironically) safe blood transfusion,
including the prerequisites tests required and a separate lecture on the safe
use of antibiotics. Correct various assumptions about the role of antibiotics.
The prize for most unusual applications goes to one female student who is
confident that antibiotics should be taken every month after a woman has her
menstrual period in order to ‘cleanse her’. I wonder why we have problems with antibiotic
resistance…
6.04pm. Called to the delivery room to assess a woman in
labour.
6.24pm. Telephone my Nan in the UK to wish her well for her
cataract operation.
6.33pm. Supervise the delivery of a new healthy baby boy.
Almost miss the key moment when his shoulder get stuck due to the above telephone
call (whoops). Nevertheless, new mother and child do very well.
10.57pm. Called to Men’s ward to assist the other doctor
with a young man admitted vomiting large amounts of blood due to a suspected bleed
inside his stomach. Manage to place a line in his arm to give him intravenous
fluids and, after establishing which family members had a compatible blood
group, several units of donated blood.
2 am. Called back to Men’s ward. Greeted by a policeman in
the middle of the ward and a semi-conscious patient at the other end of the
ward with a trail of blood connecting the two. Informed by policemen that man
was seen drinking excessively earlier, then possibly got into a fight with a ‘friend’
and was found semi-rousable beside the main road with blood seeping from the
back of his head. Begin to assess the patient who becomes more alert, starts
thrashing violently, swears at everyone on the ward and then vomits profusely. Thank
the policeman for his kind delivery and begin to think I have been transported
back to a certain south east London A&E where I treated not dissimilar
patients. Once he is slightly more amenable to assistance I give him some
intravenous fluids, clean his head wound and place a temporary dressing.
Realise that the plastic apron has not been especially effective at protecting
my clothes and shoes from the patient’s bodily fluids.
2.38am. Return to house. Wash blood and non-descript bodily
fluids off clothes and shoes and climb back in to bed.
Shameless advert: If this sounds like fun, the hospital is
about to begin searching for and recruiting medical doctors. Details to follow
soon. Please note, (naturally) the post will not be compliant with the European
Working Time Directive.
Update May 2014. Please see links below for details of medical post.
· http://healthmattersinsegbwema.blogspot.com/p/medical-opportunity-advertisement.htmlUpdate May 2014. Please see links below for details of medical post.
· http://www.workingabroad.com/database/medical-doctor-nixon-memorial-hospital-segbwema-sierra-leone
