Thursday, 24 November 2011

Elective 33. The Good Samaritan

Today starts, with an early rise to see Mama and Dada off, then, excitingly, an omelette for breakfast, the first time our chef has cooked one for me! I then spend some time breezing around the wards, catch Dr Bike in a good samaritan style act, then head over to the football field we were at yesterday for the late afternoon/evening. I am now reading Norwegian Wood, a sad, lonely book for all the time I am spending time by myself, but one Smartie had bought with her, and one of the few books left that isn't Chick-Lit... It is also very well written!

On my trawl of the wards in the morning, it turned out that two patients had died overnight. One was the man I mentioned yesterday, who had the huge skin cancer/sarcoma on his leg. This was to be expected sometime soon, and I hope all the drugs that he was given yesterday had made his last day better rather than worse. The most important medication would have been pain killers, but I think only paracetamol and ibuprofen are available at the moment, so it certainly wasn't a painless last day. Poor chap. The other patient who died was a woman who has been here for about two weeks, after being admitted and diagnosed with HIV. She had malaria a week ago, and yesterday her haemoglobin was measured as being low (6.4g/dl), though I have seen a lot lower with no problems in my time here. It should be above about 11.5g/dl in the UK to be seen as normal, but here people have much lower with little problem. I think it is the poor diet. Because the Hb was low, someone had decided that she needed a transfusion (the blood comes from relatives who are matched, there is no stored blood), and she was given a transfusion last night just before she died. I have no idea why she died. She was talking happily while sitting up in bed yesterday. There do not seem to be coroner's inquests in this part of Tanzania, so I suppose no-one will ever know. The death certificate Said malaria, though this had been treated a week ago and she no longer had the infection. I think it could have been something to do with poorly matched or given blood, as it happened so suddenly and the blood was the only change in her management, but there is little I can do about this. Sometimes I feel so helpless and pointless here. These things 'just happen' but the should't. And I can't do anything about it.

While bad things happen in the hospital, the baboons still come and play outside my house in their gangs, such a  free life!

Today I also went to visit the poorly boy who I had admitted yesterday with an unknown disease. The one who was HIV negative, but had kidney problems and a limp. He was now a whole lot sicker, could not walk at all, and just lay in bed crying pitifully. This illness was getting serious, and still no-one else had seen him apart from me and Dr BT in outpatients, who didn't know what it was, and hoped the doctor on the ward would sort it out. He had severe pain at the top of his left leg in the inguinal region, and after a careful history from the mother, I found that he had had a fall while running, scraping his knee, and the pain had come about a day or two after this. At least, this is what I thought she was saying. All the translating makes things more complicated. Could this be a fracture? The pain and disability was certainly severe enough for this, but the onset days after the fall was strange. I had no idea, so I went to find a real doctor to help me. Dr Bike refused, as he was not the doctor on call (fair enough, though he was just sitting by his bike in the entrance to the hospital relaxing), so after some searching I finally found the doctor on call to come and help out. After they had had an examination as well, while the child was screaming in pain every time the leg was touched, they decided the child had osteomyelitis in addition to the UTI that was already being treated. This meant that the child needed to be started on flucloxacillin to treat it. When I Came back a lot later in the evening, the boy was sitting up in bed, apparently feeling a lot better. I am very pleased I looked for help when I wasn't sure HERE, and am very sure I will be keeping an eye open for osteomyelitis in the future (I hardly knew anything about it until today). Hope he is as well tomorrow and keeps getting better.

While I was wandering the hospital, I came across Dr Bike a number of times. The first time he was taking a basin of water to the 80 year old man who I we admitted yesterday with the large cyst and infected skin. The idea was to give him a sponge bath, as this was not something the nurses liked doing. Dr Bike had operated and drained the cyst yesterday while I was at the school, and the man had turned out to be Dr Bike's god father. I congratulated him on taking good care of his extended family. The good acts did not end here, though. I later caught him sneaking into children's ward With a cardboard box. Curious, I asked him what he was up to. He sheepishly opened the box to reveal a bunch of bananas and a pot of rice and goat meat. He wanted to feed the malnourished child (who I called Ivy) who was suffering from marasmus, and her sister Holly. He was doing this as it was obvious that they had little food. He had been doing this for a couple of days. Wonderful! Making the effort to care when he really didn't need to, then hiding it away and not telling people he was doing it. My respect for Dr Bike has doubled. It reminds me that while people here often seem to lack training and be lazy compared to the UK, they do what they can the best they can because they do care about the patients, and the seeming laziness is likely just a cultural difference rather than actual not-being-bothered.

The football pitch is one of the best in the area, because someone has build goals out of wood!

In the late afternoon, I go back to the football patch I was at yesterday, as yesterday I was told that they would love for me to be involved in some of their football games. Today was a village league game, however, so I just watched, cheered, and tried to chat with other spectators despite not sharing much (any) language. Neither village was the one I lived in, but both were nearby and this was the best football pitch around. The embarrassment came when a teacher from the school invited me to join a couple of kids in a game of 'ball control'  meaning we just punted the ball to each other, showing off out 'skills'. One kid (about 18) did amazing chains of keepie uppies, tricks, the whole lot. The other, a lot younger (around 10), just passed it to one of us if he got it. I am a decidedly average football player (since I left school, I have only ever played it with primary school children when running sports activities as a holiday job), and this was all a bit embarassing. I can manage about five keepie uppies, and if I am lucky about 10. I repetitively let the ball fly away from us and had to go and fetch it, and after one particularly exuberant attempt, I managed to land the ball right in the lap of an elderly spectator of the match, shocking them and making them jump up, then fall over in fright. If I am invited over to play with a school match later, I am pretty sure it will be with the primary school pupils after that performance! Talking with the team captains on my way home, it turns out one of the villages doesn't even have a football, so they find it hard to train, creating balls out of tied together rags. Life here is so different to the UK that its almost alien. 

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