A Hard Week at Work

This past week has definitely been my hardest here at Mosvold Hospital. It started on Monday afternoon when I (unadvisedly) swallowed some blood from an HIV positive patient. How? I was trying to get a cannula in the worst Stevens-Johnson Syndrome patient I have ever seen. From head to toe he was covered in lesions and there was only a bit of free space on the dorsum of his right hand. It is important that SJS patients get lots of IV fluids as they can (and often do) die from renal failure (not actually from their severe skin rash). I had got a drip in during the morning so thought I would be able to emulate it again. I was wrong. I have been taking ARVs (anti-retrovirals) since Monday evening when it happened on a precautionary basis.

I knew Tuesday would be hard as I was on-call. We were short of five doctors and so the workload increased dramatically. I was scheduled for theatre and was the anaesthetist. Unfortunately, the baby from our c-section came out without a heart beat (fresh still birth). I ran the neonatal arrest for over 30 minutes (managed to secure the intra-uterine line, intubate, and give the adrenaline) but we never managed to get the little heart going again. It is the first time that this has happened to me in theatre and was obviously very sad. My colleague continued with the c-section and no one told the woman until she got back to the ward. Theatre is usually full of life here at Mosvold with singing and laughing. It was a very sombre few hours.

The rest of Tuesday dragged. The RU was heaving and I was the only doctor in outpatients department (OPD) for the afternoon. I worked all afternoon and night but eventually managed to get into my bed in the early hours of Wednesday.

For the first time since being here, I spent some of Wednesday with a Psychiatrist (consultant equivalent). As Male Ward doctor, I feel some despair for my acute cases. I have found that there is a lack of options for medical therapy and there is not the support system than exists in the UK (Community Psychiatric Nurses). It was wonderful to spend hours with the psychiatrist learning new things.

Thursday was supposed to be spent at two of our clinics. I had to drive a ‘vintage’ 4x4 again. The bumber was falling off, the bonnet didn’t close, my ring mirror was smashed, the passenger’s one was falling off, the horn didn’t work (necessary with the cows in the road) and the brakes worked intermittently. It took 2 hrs to find a very small piece of plastic which I was promised would hold the bumper together. The rest didn’t seem to concern our transport office. Given the lost time meant I was only able to visit one clinic.

Ndumo clinic is right near a game reserve with the same name. It is very close to Mozambique – close enough to confuse my primitive mobile phone. (I like to be able to use my phone when at clinic to ring specialists accessible on hotline numbers.) I saw just over 20 cases and admitted one - a little child who was 7 but looked 3 and had not been in school for one year due to his severe rash on head and neck. His skin was falling off and Gogo didn’t think it was a problem. It will most likely be HIV related but I thought he needed a bit of a sort out and convinced Gogo and child to come back with me to Mosvold. He is doing better on Paeds ward but it will take a long time.

Friday was alright. Male Ward is full at the moment so ward rounds are taking a long time. I managed to get to OPD for the afternoon where I saw a variety of cases. Unfortunately, we are having some difficulties with the nurses there at the moment. Circumcision camps are happening almost daily and we are all short staffed. The nurses are not helping the doctors and often the patients. I feel patients are suffering and would really like to stop the circumcision camps. I continue to do my best in an increasingly difficult set-up.

I was on-call all day Saturday - from 8.00 am until 5.00 am this morning. Lots of OPD cases, maternity challenges and sick patients on the wards. The low point was spending two hours from 1.00 until 3.00 trying to get a 25 year old’s foreskin around a very swollen penis gland. I tried everything brute force, ice, sugary solution and a penile anaesthetic block but could not manage it and had to call in the acting medical manager. Luckily, he was understanding and found a solution in 15 minutes. Not sure how he did it but it involved lots of blood. Still, the episode provided lots of laughter for myself and Rosie. The nurse and patient found it less amusing.

Despite this difficult and trying week, I still love it here. Today has been really nice. I managed to get some sleep and enjoy a lovely swim at the dam with Henry and Rosie. Lots of my colleagues were about giving us a chance to socialise and forget work for the day.

* Rosie is a Warwick Medical School elective student who has been with me all week. I feel sorry she has had such a tough first week on her elective. She has been great company, really helpful and I have been lucky to have her around.