Over the past two weeks, I have taken over the running of female ward. I was sad to leave Male Ward but also excited to take on a new challenge. Female ward is the biggest ward and divided in three sections – A, B and C. Sister Qwabe is the operational manager of the ward and I enjoy working with her very much. She proudly rejoices daily about her short height and rotund tummy, and isn’t afraid to call a mango, a mango.
Female patients are very different than my Male ward patients. Most obviously, I am dealing with lots of miscarriages. My challenge is to recognise which cases to medically treat and which to take to theatre for an evacuation. I had a woman on my ward in my first week that I discovered had a 25 week extra-uterine pregnancy (i.e. ectopic pregnancy)!
When I started two weeks ago, I had 8 cases of cryptococcal meningitis (all in section A) – a meningitis that only HIV patients get and that I had never seen in the UK before. It took me some time to remember who was who given they were in beds next to each other and many have the same surname. The treatment of choice is an IV antibiotic named Amphotericin B. But my use of this depends on stock levels. When out of this, I need to make a plan (as they say in SA). So far I have been relatively lucky despite not having the full course of this drug. One of my eight died (she also had TB meningitis and Bacterial meningitis) but the other 7 have gone home. Most of the women acquire this serious infection because they stop taking their anti-retrovirals.
Careful thought goes into deciding the location of each of the sections within our ward. Sister Qwabe explained that section B was behind the wall because they often have their breasts out and this would not be good to shock our visitors. It seems to me as if all the patients have their breasts out all of the time, but Sister Qwabe feels gogos are particular culprits.
I have 6 patients presently in my gogo section. One with a pelvic fracture (who will need to be an inpatient for 6 weeks for bed rest), an uncontrolled hypertensive (who did not know she needed to repeat her anti-hypertensives), a gogo (mother of 13) who surprisingly is HIV free, but has end stage cervical cancer, a paranoid schizophrenic who tries to escape every morning, a stroke patient and a t-cell lymphoma patient.
Section C is quite far away from the rest of the ward (where the nurses are) but has the new admissions, orthopaedic cases and the theatre cases. I feel these patients should be in Section A (given this is where we start the ward round each morning after we see the two ‘high care’ patients) but achieving change of this sort is a delicate process.
Another aspect of Female ward that I enjoy very much is the amount of singing and dancing. The sister and nurses love when I sing and especially when I dance with my bum out (Zulu way) – as you know I am completely tone deaf but they do not seem to mind. I reserve this for a daily special occasion – on Friday I had a young girl with a snake bite so we all started singing. The gogos love it and I think it makes patients feel more comfortable. Otherwise, I keep it as a treat at the end of the ward round.
Recent ward rounds have been more difficult because I have a swollen ankle. It is caused by a rare condition called Erysipelas. I knew I hadn’t injured it so the initial pain was very mysterious. I took a course of antibiotics and it has now almost completely disappeared. Hopefully my Zulu dancing will benefit from my added mobility.
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