Washing Gloves

I stood over the basin in the corner of the operating theatre and washed the blood off my surgical gloves. It was late on a Friday afternoon and we had just finished a caesarean section operation for a lady who had been in labour for 3 days. Normally after surgery you would remove your gloves and gown, dispose of them in the nearest waste bin and wash your hands. Therefore I was a bit puzzled when I was asked to clean my gloves before taking them off. I was soon informed that they would be rinsed further, powdered and then re-used for other clinical activities in the hospital. After a testing few days, one in particular in which 2 adults in comas and 3 convulsing children arrived almost simultaneously, the symbolic washing of a pair of supposedly disposable gloves that had been used only thirty minutes previously to assist the delivery of a new baby somehow summed up the extent of some of the difficulties and resource limitations.

Following the somewhat evident diagnosis of a prolonged obstructed labour the sequence of events necessary to deliver the baby were frustratingly protracted.  Firstly, the small team of theatre staff had to be located, who then had to establish whether surgical equipment used the previous day had been sterilised.  Next, it was necessary for the small generator to be moved to beside the theatre and diesel found to run it to provide power for the operating  theatre lights. The laboratory technician had to be called back to the hospital and finally the patients’ relatives encouraged to donate blood in case of bleeding.  Thankfully after the several hours it took to organise such matters, a foetal heart beat was still heard before going to theatre.

Despite the challenges encountered at the hospital, which at their worst had had me sending my wife Janna out in the middle of the night to buy drugs and drips for patients, there have been some small successes. Both the comatosed patients improved dramatically; one of whom, in retrospect we discovered had taken an overdose of his diabetic medication and simply needed a glucose drip to revive him. The other patient, a young woman,  most likely had cerebral malaria but responded well to intravenous quinine. In addition the three convulsing children were all discharged the following week and both the mother and baby from the caesarean are doing well.

Last weekend we attended a service in memory of the wife of my close friend Victor who sadly died suddenly 2 months ago. Victor is a friendly giant of a Liberian who first moved to Sierra Leone 20 years ago during the troubles in his neighbouring homeland. He is among the most kind-hearted and virtuous people I know, and, given his occupation as the owner of a small ‘bar’ in Segbwema, currently one of the most valuable as he is on hand anytime of the day or night to provide a cold Star beer and a haven outside the hospital compound.  We became good friends 3 years ago and although I did not know his wife well, they were obviously kindred spirits and proud parents to their 4 children, the youngest of whom is now 5. Tragically although they had been together for over a decade they only finally ‘tied the knot’ in a service 2 months before she unexpectedly passed away. With a life expectancy of only 48 years in Sierra Leone, death, even when it is that of a young mother and wife, is an accepted part of life. For a doctor, dealing with patients who do not get better is not uncommon and we become, to a certain extent, desensitised to the trauma of a person dying. Although it may seem insensitive, when I had to confirm the death of a young patient in the night, although I was upset, when I returned to the house I sat down and continued watching ‘How to Lose a Guy in 10 days’ on the laptop (Janna’s choice not mine). For me, the act of listening for a non-existent heart beat was something I have done as a matter of routine both in the UK and in Sierra Leone, but for the patient's family it was devastating and life changing. When I sat in the memorial service for Victor’s wife, even though I was not directly very close to her, this conceivably preventable death of a young mother felt very personal to me and I see the consequences of this to my friend and his family on an almost daily basis.

Victor with his wife and youngest daughter taken in 2010

Although it is necessary to have a certain detachment from the people we look after, sometimes seeing them not solely as patients but as a mother or sister or daughter, both ensures we remain empathetic in our vocation and arguably may allow us to rationalise activities such as sending your “better half” out to the village ‘pharmacy’ in the night for a vial of magic quinine when there is none to be found in the hospital.