Friday, 28 October 2011

Elective 14. Overflow

Today the hospital is filling up to overflowing, I carry out a number of HIV tests with no privacy at all, I try and make a humane rat catcher for all of the bothersome rats in the roof, have a fantastic example of 'Tanzanian time' and I am feeling awful, with a temperature of 39.5°C, so will keep this post short.
The female and children's wards are stuffed to overflowing today. Dr Bike, who normally (should do) both of these ward rounds is away, and the nurse in charge is not too happy with me seeing patients by myself. This is fair enough, as I have always been very clear I am only a student, not a doctor. But this reluctance makes me wonder what Sporty and Smartie said (or didn't Say) to the nurses to have it accepted they would do ward sounds on their own. After all, people keep Calling me 'Dr' and I am always careful to deny it. I wonder if they bothered denying it at all.

Getting the ward round started takes a very long time as I have to get Eggs to do it with me. He normally just seems to do men's ward (on the normal Mon/Wed /fri pattern). The Men's ward is stuffed because there is a urology surgeon coming from Kenya to carry out operations, and it seems Tanzania has just as much BPH as we do in England. Men's ward is full to overflowing with patients waiting for the Urologist to arrive, and children's ward has filled up with children with congenital defects who hope the urologist can operate on them. It takes quite a bit of persuasion to get Eggs to come from his normal male ward to the other wards, especially as his morning already has a lot more work in it than he expected. I think he misses his chickens if he is in the hospital for too much time. Because of all of this, it is well after the normal 2PM hospital closing time by the time we finish. And there is still much to do. I feel too ill for lunch, and just go home for a bit of a rest. The silver lining here seems that if I am ill, I may be too avoid assisting in any TURPS. I have not forgotten how boring they were when I did my urology rotation in third year!

In the afternoon there are quite a selection of patients who need to be tested for HIV. Here the test is called a PITC test, and is carried out by pricking the finger at the bedside. I come back to the ward in the afternoon, still feeling very sick, and tell the nurses that I need to carry out a number of HIV tests. The nurses then go and crowd all of the patients needing the test (about 7) into the small nursing station at the side of the ward. I try to protest, but my feeble complaints are easily ignored. At least now I am allowed to do something, after all the problems with the ward round in the morning, so I don't want to make any enemies. In this situation, each patient watches as the others are tested and they all watch the test strips, which take five minutes to give a positive or negative answer. The tests are very obvious, and all the patients watching each other being diagnosed makes me uneasy, but it seems pretty standard here. Tanzania just doesn't really seem to do confidentiality, with breasts and scrotums regularly bared for the public ward during examinations with no curtains, while neighbouring beds look on interested. 

A similar HIV antigen-based test to those I was using in the ward. If the patient is positive, two lines will appear in the centre, negative gives one line (a control)

My further experience of 'Tanzanian time' occurs when Eggs and I ask for a patient to be given IV ringers lactate, 1.5 litres over 3 hours, as this patient, since admission Some time ago, has had a blood Pressure of 80/50. This is very low and it has not increased, despite asking her to drink plenty of water. Perhaps she is just not drinking much. I think the intention of this was to give the fluid and see if it increased the blood pressure, to see if it was something else causing the low blood pressure (patient also has HIV) or dehydration. Despite the fluid being written up at 2PM, as a stat dose (to be done now), and several nurses on the ward being asked to do this, when I came back at 5.30, as I said I would, to check the blood pressure again, the patient had only just been hooked up and had received 100 millilitres so far. While not a dire emergency, as this patient had been like this for some time, it makes me wary what would be done in much more important circumstances. Perhaps this annoys me most because I am feeling so ill and would rather be lying down, not traipsing all over the hospital, for what turns out to be wasted time, as there is no point checking the blood pressure now, as little had changed. I will have to check tomorrow (if I am allowed to go around myself), otherwise she will be checked on Wednesday with the next ward round, days after the fluid was last given.

My humane rat catcher is below, so far in its construction. I don't really feel like reading so have decided to try some engineering. I am not too sure if it will work, but it is something fun to do. I have been staying awake until 6PM so my sleep is not too interrupted. Now I am going to bed. Good night.

The rat catcher, it closes whenever a rat goes inside because of the balance. All I need to do now is to make it stay closed... 

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