Monday, 31 October 2011

Elective 17. The lackey

I spend Much of today working as lackey for Eggs. Good preparation for being an F1. The urologist was operating until gone 11PM last night, and looks Set to do this again. I am very impressed with that man's stamina, but even happier that I manage to avoid the TURPs list again. Imagine that, TURPing away until bedtime. Hellish. Instead, I go for a jaunt in the evening to hang our with a biker gang, in the attempt to find some more edible food.

The insects here are HUGE, and probably would make a sizeable snack...

Messing around with paper work today shows how poor the recording is of results and procedures, and more scarily, how irregularly some patients are given the medication (by the nursing students) prescribed (by the medical student). For example, a man with retention, severe constipation and hard Nodular prostate is not seen as candidate for surgery by the  urologist as he is not a simple TURP. The urologist is doing the simple cases in an attempt to do as many as possible. This man, with the nodular prostate and strange bone pain in his right sholder, may well haev prostate cancer rather than the easier-to-deal-with benign prostate hypertrophy (BPH) that TURPs are usually used to treat. This patient is still on the ward after being told that he couldn't have an operation, as he cannot urinate on his own, and has a catheter in. Yesterday Eggs and I prescribed ducolax (a laxative) as he hadn't defecated for days, and was very uncomfortable. When I was talking to the patient today (with the help of an interpretor of course) it turned out that he still hadn't been to the toilet. Looking at his chart, he hadn't received any of the drugs he had been prescribed here for two days, despite being part way through an anti-malaria course and on antibiotics for a urinary tract infection. With all the fuss over the patients getting surgery, or recovering from surgery, there doesn't seem enough time for the nurses to care for the non-surgical patients. 

While I was on the ward, one of the nurses was complaining that she had to wake up during her night shift to do some observations on the post-op patients, something she had never had to do before, and how it wasn't fair. I think perhaps if she came to the NHS, or healthcare in the UK she would have a real wake up call. The nurses here work amazingly hard. Tanzania seems a country of extremes. Some people seem to do so much work its hard to believe (for example, the urologist starting theatre at 8AM, and finishing at 11PM two days in a row so far, or Chief, who seems to be everywhere, doing a bit of everything, and who always has a smile), while other people never seem to do any work at all, such as Eggs, who managed to disappear for three hours in the middle of the day today, leaving me to write referral letters to hospitals I had never heard of and other such things. Because I surely know which patients need referral, which hospitals are best for them, and which patients we can treat here. On his return, he just flicked through the letters, said "asante" (thank you) and left again. I suppose this really is like the thankless task of being an F1, though in the NHS the consultant you work under doesn't usually spend the time he should with patients caring for his chickens.

In other news, Dr Bike is an attractive, unmarried (rare here) man in his thirties, who loves to flirt with the nurses. He has told me he plans on getting married next dry season (in a year), as food is cheaper then and more people tend to be free as they are not working on growing crops. He doesn't know who he will marry yet, but the plans are set. He does love teaching the nurses, which I really admire, even if it is just a ruse to find a wife. I walked past the window to the operating room while they were cleaning up on my way to children's ward, and stopped for a quick chat as I saw him lounging inside. In front of him were shreds of paper where he had been teaching medical facts, seemingly at random, and as I left he was lifting another nurse (clearly uncomfortable with the physical contact) up onto the table in front of him for a quick lesson in heart failure. His behaviour is somewhat risqué for this quiet Christian Village, but all well intentioned. I hope I get registrars that eager to teach when I am a junior doctor.

A wedding procession goes past in the village, celebrating a woman's engagement. The buckets may be symbolic, or perhaps it is just in case they get thirsty

In the evening I was Minding My own business, feeling sorry for myself, and just starting a new book - Messiah by Boris Starling, when I smelt the unmistakable Smell of sweetened spagetti drifting into my protesting nostrils. I cannot take this any more, especially as I don't even feel hungry, but know I should eat something. I cannot stand trying to force that 'food' down through my protesting tonsils. I have heard that there is a group of boys who usually BBQ up food, so walk off in the twilight looking for a BBQ surrounded by motercyclists eating around it. It is surprisingly easy to find, and once I am there, I find it they are very hospitable and sell Me a chipsi omelette for about 30p. This is omelette with chips in. Delicious, but , cooked in conditions that would send health and safety running. I 'hang out' with them mainly just laughing and hand slapping, as both of our language skills are lacking. An hour of non-communication later, and feeling a lot more satisfied, I wander the 20 minutes home. Now it is properly night time, I am fortunate that there is a sliver of moon left, or I wouldn't be able to see a thing. No lights here at all. The Tanzanian Sky is beautiful. Really really beautiful, and seems to have many times more stars than at home. It feels so wonderful living here under the glowing milky way.

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