Monday, 28 November 2011

Elective 35. What a view

I start today by getting up at 5am (an impressive thing to do through choice for someone who really isn't a morning person) by heading away from my house and the village to watch the sun rise from a view over the rift valley. A beautiful site. On the way, I had a few encounters with snakes in the dark, a few small ones sliding off the path as I approached in the dark with my wind-up torch, and a large snake that was between the rocks at the view point with stripes on it. I didn't want to disturb it, so took pictures of it and waited for it to leave. Fortunately it did, and I was able to enjoy the beautiful sunrise alone. After this start, hospital life is quiet. Eggs has returned after a long time away, where his ward has not been seen by anyone, and two medical students from New Zealand arrive to keep me company.

A picture of the snake that I almost stepped on. Chief later looked at my pictures and told me it was a "Puff adder", a venomous viper which causes the most fatalities in Tanzania. Good thing I didn't step on it...

I watched the sunrise for a good two hours (though the full appearance of the Sun over the horizon actually took about 1 minute, astonishingly fast.) It was stunning, spreading across the flat savannah below me from my vantage point. It was like a scene out of the Lion King! I really enjoyed feeling the sun warm up my skin as it came up and rose, and hearing the villages dotted around below me start up with the sounds of life as the sun came up. A beautiful experience; just a shame I had to wake up so early to appreciate it! The sun seems to climb into the sky very quickly here. I am not sure if it is because we are on the equator, or the landscape here is so flat...

The pre-sunrise glow fills up the valley, while I stand by the metal cross the church has erected on the cliff to look across their diocese. 

The sun rises over the horizon of the savannah down below in the rift valley

Once the sun has risen a little, you can see miles and miles across the rift valley from my rocky vantage point shown

After all this was over, I went to the morning meeting to find Eggs had returned. Fantastic! I asked him if he was well, and he seemed pleased to see me, though gave no indication of where he had been, even when I asked him. The subsequent ward round I do with Eggs is very slow, as he has no idea what most patients are in with, or what has happened over the last week and a half, but I am relieved to have someone official, who knows what they are doing, back in charge of male ward. Despite all his short comings, he does know a lot and its much better having him run things than trying and failing to run things on my own.

Dr Bike is busy today, so persuades me to do his ward round of children's and female wards. I don't do much of note, other than checking on patients and changing around a few medications that had run out of stock. Pretty standard stuff by now. I then go to outpatients, where 3 hours passes with only one case interesting enough to remember enough of to write about it. Perhaps a good reason why being a GP doesn't appeal too much to me. Here, a man came in complaining of a testicular lump. We examined it, and found a non-translucent, non reducible lump that seemed to be a very enlarged left testicle. The man reported that it had come on suddenly a couple of weeks ago, and had been painful. An acute presentation makes a cancer unlikely, so it is hopefully not that, but I have no idea if the patient is being honest, just embarrassed he didn't come to hospital earlier, or there is a problem with the translation. Either way, whatever the problem (such as orchitis) it needs a second opinion because of the risk of serious disease such as orchitis. We decide to 'refer' to Dr Bike to take a look. Refer here means tell the patient to find Dr Bike in the compound, and show him. Dr Bike is usually happy for us to send people to him, if there is a possibility that they may be surgical. I hope this might qualifies!

I suppose that the real bonus of 'GP' like clinics comes from talking to the parents, and I cannot do that here, but as there is nothing else happening at the hospital, I still go to outpaitents regularly even though it can leave me feeling a little annoyed at times. I suppose it is good for learning from Tim's immense knowledge of drugs and their doses, and seeing lots of presentations I would never see in the UK.

After I return from outpatients, and have put the first spoon of rice in my bowl for lunch, two motorbikes pull up outside with the two New Zealand medical students on the backs, along with the skilfully balanced suitcases on the riders' handlebars. They are (in my world) called Kiwi (very patriotic, especially supportive of the rugby team) and Dolittle (later turns out to be able to talk with animals). I get on very well with them both from the start, showing them around the house (Don't use this, thats broken, and so on) then the surrounding area. While giving them the tour of the hospital, we are called into children's ward, where the gentamicin has run out, so the child will be no longer getting any antibiotics. There are very few antibiotics left in the hospital at the moment (we are out of most of the old favourites such as amoxicillin), so I put the patient on erythromycin (its that or metronidazole). We wander back to the house to talk, and so I can help them unpack. Nothing tends to happen in the afternoons. They seem amazed that I am prescribing here, and taking a step back, it is pretty stupid. Its not really safe, but often it is me or no-one to prescribe these drugs. In this case, the child wouldn't have been seen until Wednesday, and there was very little from me to even choose from, due to the poor selection from the pharmacy, but in out patients, Tim and I are expected to act as doctors. I warn them it will be expected of them, and take them to the point where I watched sunrise this morning to watch the shadow of the cliff we stand on grow across the rift valley with the sun set. They tell me they saw Mama and Dada in Dar es Salaam, when they crossed over on their way here, and as Mama and Dada left. Both Mama and Dada spoke of the terrible amenities available here, and neither planned on returning. A real shame. I hope they still plan to twin the two schools.

As the sun sets, the shadow of the cliff we stand on grows rapidly across the rift valley. Here you can see a small village on the far right, half way up, on the picture. People living from much further away than can be seen here have this hospital as their closest medical centre, and no transport. A rapidly shrinking lake can be seen on the left of the picture.

An unfortunate pasta dinner greets us on our return, over which we talked about terrible childrens names. Dolittle said she had seen children named "Abcde" (pronounced Absadee), "Raige Havok Uneek"' and "Jay-a" (pronounced Jaydasha) on her placement in an inner city hospital. I said I planned on calling my son Fellacio (a good Italian sounding name), and my girl Qwerty. Both pretty cute names! I get on well with Kiwi and Dolittke, they share my (puerile) sense of humour much more than Sporty and Smartie did. This is much more fun than being alone. 

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