The Big 2-5

Tuesday 10 July 2012
2210hrs local time

Dear friend,

Two days into the week and I am officially fully immersed in the clinical work here. There is now just myself and the other (new) Zambian doctor, Dr M, covering the hospital with the help of our lovely medical student (also my flatmate) and the nursing staff. We have decided to split up the hospital so that I oversee the ~40bed women’s ward, while Dr M covers mens and chlidrens. Mondays, Wednesdays and Fridays are ward round mornings, followed by Clinic in the afternoons (primary care), while Tuesdays and Thursdays are set aside for operating.

Not knowing any of the patients, it took me four and a half hours to do a ward round yesterday. For those of you who have journeyed with me through medical school, you would know I am not a “medical” person. My buzz is from getting things done – hands on – so a four-hour ward round is generally something to be avoided as much as possible. Yet when you are the lead clinician, doing the examinations, making the decisions, time seems to go by remarkably quick!

Tuberculosis, HIV, malaria, syphyllis, malnutrition – the Big Five and all their sequelae. I felt so out of my depth on the ward round. The last time I gave any thought to HIV was in a lecture theatre back in third year of medical school. Sexual health education is almost nonexistent here and it is so sad to see such rampant pathology from diseases that are otherwise preventable with sound knowledge and safe behavior. There are also the cultural issues: women unempowered, the fears of stigmatization and male polygamy still in existence in certain tribal communities. 

Day 2, Case 2

A women in her twenties was admitted with abdominal pain and maybe some discharge. A bit vague in history she came forward for a PV exam. On examination there seemed to be hard, matted stuff all around the cervix, green and brown in colour, with no discharge or bleeding. Closer examination of this material revealed grass and sticks and dirt… most likely a trial (?self, ?witch doctor, ?other) remedy which was now causing her harm.

Which brings it all back to education. Empowerment through knowledge, knowledge through education. It never fails to astound me, how much of health has so little to do with medicine!

On another note I turned the big 2-5 today. Yup, I am celebrating this -- what on paper seems like a momentous -- milestone in Mama Afrika and it has been a great day! It was my first full day in theatre with a mix of arranged acute and elective surgeries. With just myself, Dr M and a very experienced theatre nurse present, it is a completely safe learning environment where I don’t have to be anxious about being drilled or looking stupid and where I can ask all the “silly” questions I dare not ask back home! They were all Obstetrics & Gynaecology cases, but I didn’t mind because regardless of the procedure itself, it is always a feast of suturing practice. Plus, I love being in theatre. The world around you dissolves away, leaving just the task in front of you.

I won’t go on about it anymore except to say, I am looking forward to all the Tuesdays and Thursdays ahead.

I don’t even mind the ward rounds on the other days of the week.

Thanks for your birthday well wishes and thoughts, warmly received from the remote bushes of Zambia. I was going to finish with a photo chronicle to mark the day but, alas, the internt connection just doesn't seem good enough. Next time. :)