I was already awake when my alarm went off at 6.30am this morning. My mind was racing all day yesterday worrying about work. Today would be the first day that I’ve seen and treated patients since becoming a “doctor”.
We arrived at 7.20 and decided to sit under the massive “Oral Rehydration Treatment” tree [picture to follow, or to be found on facebook – it is an epic tree], that provided some shade from the already intense sun. Petre, the clinical assistant, met us and showed us round. I was staying in the outpatients department for the day, whilst Danni went off to Maternity.
I was overwhelmed at first watching Petre work, at how he managed to make clinical diagnoses based on a few sentences of history and a scant examination. By the afternoon I realized that his diagnoses actually fell into two categories – “Malaria” and “Infection in the place where the presenting symptom has developed”. Such fun! The only investigations we could order were: Haemaglobin, Malaria test [RDT] and urinalysis – so when I got to diagnose patients by myself, I really was using my own clinical acumen. Well, either that or just copying Petre by saying every patient with a fever had Malaria. I have to say, it did feel weird prescribing drugs all by myself. Now, I know this may seem unethical to some of you [given that I may have passed finals, but I haven’t graduated yet], but really were it not for me then none of my patients would have got their drugs.
Mid-morning we performed a ward round through the male, female and paediatric wards. It was here that I could truly appreciate how under-resourced and poor this centre was. We met a woman who had been having an asthma attack for 2 days. The centre could only afford enough salbutamol for 4 puffs twice a day. There were no prednisolone tablets, no aminophylline, no nothing. I suggested that perhaps the patient may have a secondary pneumothorax and got a blank look back – the nearest place to get a chest x-ray was 50km away. In England, she’d be back to full health by now, having been fully investigated and treated for free. I love the NHS.
Nurses came in and out of our clinic all afternoon complaining of a lack of syringes [there were 2 left at 4.30pm on Monday], IV fluids [there were none] and staff shortages.
Again – I know this all probably sounds like I’m working and living in hell, but I can assure you that I’m not. For all the drawbacks, the health centre provides good quality healthcare where it can [lots of public health campaigns happen here, and it is fantastic to see!]. After work, myself and Danni walked through the village, and amassed about 50 kids following us! That was fun!
I’m quite tired now, so I’m going to stop typing and I’ll hopefully update later in the week, or maybe write something about the public health campaigns that I just mentioned?
Lots of Love, as always!
Dan
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