Monday, 21 November 2011

Elective 30. Running outpatients on my own

Today I get thrown into running outpatients on my own, learn about some sneaky Tanzanian methods of getting free medications, and spend an awkward evening doing nothing with the new visitors.

The wards rounds today are difficult, because all of the nursing students are still having exams. Fortunately a nurse I get on well with, Gabs, passed his exam with flying colours. His main examination question was on how to give a patient a sponge bath. I am pleased he passed, and feel he will go far as he has a very positive altitude, and genuinely seems to like caring for and helping people. It is a shame, however, that I have never seen a patient sponge bathed here, instead they often seeming to be left caked in their own blood or dirt if they cannot get out of their bed and wash themselves. Dr Bike was not available to run the word round (I can only assume that something arose concerning his bike's health), so Smartie and I did it by ourselves. During the ward round, we were inconvenienced by the fact that a patient had been admitted with a mild asthma attack, but there were no inhalers in stock, so we couldn't give her anything but salbutamol pills to try and manage her asthma when she was sent home.

Some more problems with the water supply means all the water to the village now needs to be delivered in barrels by truck. This barrel holds twice as much as the well can supply in one day. Having water (clean or not) is something we take so much for granted in the UK, but it is so important here!

After the ward round, I moved onto outpatients while Smartie had a little grumble and went home. Here I was again working with Tim, as there were no doctors in outpatients today. In fact, many days there are no doctors there, though I don't know what they do instead, as people like Dr BT certainly aren't seen in the hospital! After we had seen two patients, Tim said he had something urgent to do, I should keep going, and then just walked out. I know we are both inexperienced, but being left alone to diagnose and treat patients is petrifying. At least when he is in outpatients with me, we both had a 'safety net' as if were, where the other could spot something obvious that we had missed out. This time, I was left with a few nursing students, which was very fortunate, as otherwise I would not have even been able to speak to the patients. This was exactly the sort or position we had been warned against, and told to avoid, by the medical school while we were on elective. But what could I do? Fortunately, there were no terrifyingly complicated or confusingly tropical cases (or if they were I definitely missed them), and I was very careful with everything I did. I hope I didn't kill anyone. I can joke about it here, but really I think its a realistic fear that people should have, if you go and leave a medical student in charge, without even being able to speak the language, and no support from anyone with more than a years nursing experience. Having the nursing students there to translate in some ways made it worse, as their benign requests for me to teach them by explaining why I thought it was a certain disease over another, or why I had chosen a certain treatment, made me doubt my already shaky reasons for each choice. Needless to say, I was very glad when Tim returned. I had seen less than a dozen patients, and that was more than enough. At least with Tim here, I can hope that if I make a huge mistake (or he does) it will be spotted. Being a GP must be a lot more stressful than I first thought...

On Tim's return, I see him filling in a medical insurance form with a somewhat bizarre collection of drugs, even for Tanzania. I couldn't imagine what sort of patient he would be wanting to treat here, so ask about this and he, shame faced, tells me that the patient who he was filling it in for only needed one of them, and the other four are for him to treat his sick neighbours. I am not sure where I stand on this Tanzanian drugs-scam. On one hand, it is obviously illegal, and takes advantage of those paying for the insurance, using the money they pay in and reducing the pot available to treat those contributing. On the other hand, these people are poor, sick and need to be cared for, and should be treated, even if they cannot afford the drugs. After all, Robin Hood is usually seen as a hero...

The little goats that frolic around all the time are so cute! Sad to think that these little bouncy kids are going to be  served up for food soon...

In the evening, I have started reading Paperweight by Steven Fry. A very witty author. Smartie went to bed after dinner, at about 6.30, leaving me to try and make conversation with Mama and Dada. We had already talked about our respective days in the afternoon over tea ("I liked the sewing machines they had in School. I am Sure your mother would as well"...) leaving a rather awkward gap in conversation for the evening. It seems a very common phenomenon in those who have only recently met, if forced to spend a lot of-time together. Too much time for the usual pleasantries and superficial questions, but not having spent enough time together in the past to reflect back and laugh on previous experiences, or even let your guard down a little, and be a little less on your 'best behaviour'. You know what I mean, when you have just met people, especially those much older than you, and you cannot be your full jokey self for fear of insulting or upsetting them, as there is so much about them you do not know. Despite this gap in conversation, I couldn't exactly get up and get a book to read, showing how bored I was, so we sat in mostly silence for a good  length of time. It seems to be something the serene Tanzanians are very good at, so perhaps I should put this down as a cultural learning experience. All I know is I found if pretty boring. Perhaps I am not serene enough to accept Tanzanian lifestyles. 

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