Sunday, 30 October 2011

Elective 16. Running the ward

I manage some smooth talking to avoid theatre, though my willingness to do anything but TURPS leaves me organising all of the pre-op investigations. Chaos. I do get my own ward to run, though, and also find the urologist has sneakily been using my PDA!

I work hard today to avoid being on the theatre team with the urologist, whose list today consists of two imperforate vaginas and 8 TURPS. I really don't want to be stuck with those TURPS, though yesterday when I asked the urologist if he enjoyed them, he said ''They are my bread and butter. Of course I do!". Perhaps it is a lot more fun to be the one carving a prostate away using a tube stuck up a penis than to merely be watching someone carry out the act. Somehow I doubt I would enjoy it. In seriousness, though, I hear it is one of the more life changing of surgical procedures. In just as much seriousness, the people who pick up the rubbish every week also have a vital job in society, it is just not a job that appeals to me personally.

Instead Of TURPing,  I help out at the chaos that is male ward in the morning. At least until Eggs (By now I know all about his love for his 200 chickens, and the fact he spends so much more time with them than on the ward) decides to go for his compulsory 10.15am tea break. This break has happened every time I have been with him on the ward, and usually takes well over an hour. This time it takes him over two and a half, time the Urologist needs patients prepared for surgery as he needs to operate on as many patients as possible. Perhaps the busyness of the ward was tiring him out, but it was quite exciting for me to be the person in charge of such a busy ward!

I still feel awful, but these pills should help me soon. Paracetamol, malarone and amoxicillin, they will make me feel like this!

Once Eggs returns, and the ward seems to be much quieter, with investigations that were needed (i.e. all the haemoglobin levels that were ordered and needed before surgery was started) sorted out, I wandered over to the women's and children's wards. The patients here are usually managed by Dr Bike, but Dr Bike juggles running this ward with all of the operations int he hospital, all of the HIV work and the good hour a day he spends polishing his bike in his boxers every morning. I wish I was joking. Today Dr Bike has been observing and assisting the urologist with the surgeries (i.e. TURPs) that are being carried out by the urologist. In itself, this makes me very happy, as it makes it look less likely that I will be asked to do it, but it also stops him from doing any ward rounds for this whole week if he decides he would rather be with the surgeon. Fortunately I caught him leaving the theatre on his bike while looking for him. He told me he has helped in two TURPs and has "learnt all he can". I take this to mean he found it very boring as well. He has handed over assistance to a nurse I call Bugsy because of his dress sense, with hat. I have never seen anything else like it over here. Bugsy is rarely here, and I have no idea what he usually does, but I am sure Dr Bike was glad he was around today to let him escape. While the flight of the surgery-obsessed Dr Bike in the face of the TURPs makes my hatred feel a little more justified, I still don't have anyone to help me on the ward round in women and children's ward.

Getting back to my original tale of the striken women and children, and my heroic rise to the challenge of saving them all (yeah right), Dr Bike told me to do the ward round by myself before riding off into the distance. In the ward, the suspicious nurse was still very suspicious of me doing the ward round on my own (as she very well should be) but accepted that if I didn't help out  now the children would likely not be seen until 5 days time when the urologist had left. A whole week without Investigations, assessment, treatment or chance for discharge (they are paying for every day). Ignoring My poor literary skills regarding such hopeless bracket use (written on a PDA using solar power and hand writing recognition, though I am not sure how that would affect my grammar) the head nurse let me do the want round. For something I felt I had to persuade her into allowing me to do, I suddenly felt I didn't really want to do it. Possibilities of missing something and someone dying float through my head, but I did ask for this. Fortunately, all the patients are relatively well (relatively for a hospital, remember) and none are too well that I need to worry abort discharge. I ask for a few cannula to be taken out of children who are now well hydrated and drinking fine without vomiting (doctors here are very quick to give IV fluids) but it is the last child patient who stops my jaunt short of a happy solo completion. A child who had been admitted with pneumonia on Monday had only been given one days worth of treatment, an injected penicillin. This was odd, as normally amoxicillin is needed to continue the treatment. I don't really know what to do, though I know I want to prescribe amoxicillin syrup. To cut a long story short, I went to find a doctor, and persuaded them to come back with me to the child. Chief came back, looked at the notes and said "good job, that's right, next time you can do it yourself" and left back to his busy job running the hospital. I write up the amoxicillin prescription carefully (using my BNF) above Chief's squiggled signature, and feel validated. Perhaps next time I will do it myself. I would prefer not to though...

A good thing I had a nice morning, really, as the afternoon is filled with paperwork. Eggs escapes the male ward quickly; leaving me to make sure all of the pre-op investigations that the urologist ordered for this afternoon and tomorrow are done, and the post-op patients are cared for properly. Not all of the investigations the urologist ordered are available or this hospital (most notably urea and electrolytes (U+E), so I try and substitute what I can. Not such hard work (given the available investigations in the arsenal) but all the orders involve tearing our dozens of Squares of paper to write requests on to send to the lab, then recording the results on their return. Finding notes to record the results is the most challenging part of this, as I do not understand the seemingly biblic (seek and ye shall find) ordering system being used. In fact, after spending some time looking for 4 Sets of notes (Set meaning A4 pages with test results stuck onto them with Plasters [I really wish i was joking]) I have to ask one of the equally busy nurses where they are. The nurses (nursing students) are rushing around to care for normal (non-surgical) patients, the ones waiting for surgery, and these recovering post -op. The useful nurse walks to the emergency first aid Cupboard, opens the door, Lifts a box of drugs, and gives me another dozen notes. I have no idea why they would be in there, but it seemed quite intentional. The only rational argument I can think of is they were special patients in one way or another, and by filing them here it kept them away from the general chaos (or the chaotic medical student).

There are Officially 147 people in the 150 bed hospital now, but dozens of male patients waiting for an operation are 'out patients' meaning they sleep outside. They are seen as too healthy to warrant a hospital bed; the pregnant women sleep outside after after all. Today's list is 10  people long. If it continues at this rate (and I cannot imagine it will get any faster, the Urologist was working until 11PM) all of the people will not be operated on.

Every night, I get to wash in this small red basin. Such a taunt to have a huge bath with broken taps and not enough water to use it.

To finish with, the first beggar approached me today. He was one of the 'outpatients' just generally milling around the front of the men's ward. I Should have been suspicious as his English was much better (as in he knew more than 2 or 3 words) than any of the patients I have met before. He asked me how I was, then asked if he could have 100 Tanzanian shillings   (around 4p). I Was busy and didn't have wallet on me (why would I), so apologised and carried on with my bustle. Being in such an absurdly poor area, I am very surprised I am not asked all of the time. After all, as the only white in the village, I do stand out strongly. When I was in India, which was much richer than here, you couldn't go 5 minutes without someone asking for money. Here I have given away a few biscuits and many empty plastic drink bottles to those who ask (people like carrying around water!) Perhaps this is because everyone is ubiquitously poor, meaning no begging culture develops as no-one has anything to give away.

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