Saturday, 22 October 2011

Elective 08. Stigma

As I mentioned before, ward rounds don't officially happen on Tuesdays, but Sporty Smartie and I do one anyway, as we have been taught that doctors should be seeing patients every day if they are sick enough to be in hospital. Unfortunately last night I missed a phone call to an emergency caesarian section at around 4AM. The cousin of our cook was having a prolonged labour and the baby was showing signs of distress (everyone here seems to be related). I won't be turning my phone off overnight again! Sporty and Smartie attended the C-section though, and  all went well, the baby being called 'Barak', after the US president. Obama has collected a real following here, there are ubiquitous OBAMA! T-shirts, the nurses round books are written in an Obama themed exercise book, and you can even get Obama sweets! 

An Obama torch in male ward, brings light to the darkest places...

On our student ward round were a patient admitted with Chickenpox at 27 years old, and an unnaturally sleepy baby, who was being treated for the diarrhoea he originally came into hospital with, while being rehydrated by intravenous fluids. We decided to give both of these patients an HIV test, which here can be done at the bedside with a finger pick in 5 minutes. The man with chicken pox point blank refused, telling us he was Sure he didn't have the disease and wouldn't let let us check him for it. Obviously it is his choice, but using the (student) nurses as translation makes this sort of conversation very hard. We explained to the nurse why the test is important over a few minutes, in depth, then the nurse said about four or five words to the patient. We asked the nurse if she had explained everything we had told her to the patient, and she said yes. What can you do? She obviously had just said something like "These white people want to give you an HIV test" rather than giving all the reasons why, which could well be why he refused...

This man was easier to talk to than the parents of the poorly responsive baby, however. We needed two translators again, due to parents not speaking Swahili, and the family seemed very offended we were suggesting that they were infected. We tried to explain that this was not the case, and HIV tests were actually meant to be routine for all paediatric admissions (Something Dr Bike had told us yesterday). The student nurse refused to translate this for us, insisting that they were not routine at all. We could not convince him they were, as he had just transferred from the male ward, where they are not routine at all. The parents, especially the Mum, were becoming very suspicious of us, though what she thought our intentions were I have no idea. Fortunately we finally persuaded them that this was a good idea, and even more fortunately the baby tested negative. Despite being a relatively common disease in Africa, it seems there is still a lot of negative stigma attached with being diagnosed with, or even tested for, HIV. 

Its me! Checking on the sleepy sick baby, you can see the cannula in the back of his hand from the intravenous fluids that were needed due to dehydration. The beds have had bedsheets put on them for nursing exams, this is unfortunately not normal. His lungs were fine! 

The saddest patient on the ward at the moment is the lady who I mentioned as suffering from poor nursing care over the weekend. She still seems to be in her own world, though after testing, fortunately we have found her to be HlV negative. In England there are plenty of paths the investigation would take, likely starting with a CT head to look at her brain, but none of these luxuries are available here. She keeps taking her nasogastric (NG) tube out by reflec, but is not consious enough to eat on her own. The nurses do not usually supply food, feed or wash patients but here there is no other choice, so other patients are cooking porridge for this lady, which the nurses are trying to feed her by putting it into her mouth. If she doesn't improve soon, I am afraid she will end up with some food or water in her lungs, develop aspiration pneumonia and die. Its so hard not being able to do anything...

In the evening, I saw Chief walking down the road towards his house, and jogged over to talk with him. I managed to persuade him to arrange transport to the nearest X-ray, which Dr Bike had been denying was needed. This will mean that the lady with the two broken wrists, and Ludwig with his strange lung sounds can be taken to the nearest large hospital to get their X-rays rather than sitting on the ward for a week waiting. I am not sure how Dr Bike expected the lady with two broken arms, now being ignored by her relatives because of her police complaint, to make her way there with two casts and two slings with no help, but Chief seems very on the ball, and I am sure that now he is involved, he will get things done promptly. I feel like a wannabe junior doctor, with all of this running around, sorting out what should be done to patients. I love it!

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