Mon 23rd April
The highlight had to be a morning visit to Sister Gracey and her clinic, Sisters of Mary Help Clinic(Salesian sisters). Her clinic is an inspiration to all, clean tidy and seemingly able to function without funding from any government organisations. Her nurses work at WTH as well as the clinic and we could see where they learned their better habits. She won’t tolerate poor standards and one student was sent home as he wasn’t properly dressed! She is the Mother Theresa of Wau!
The rest of the day was spent with Ben and Claire settling in and finding their respective areas, while Prem continued with wall to wall teaching. Frankie taught the anaesthetic staff about oxygen and pulse oximetry and introduced the WHO check list!! Kate taught the paediatric nurses how to use a spacer with a wheezy baby who is now so much better. Supper was the beginning of a 24 hour period of coming outside our comfort zone. The cats enjoyed the goat spine leftovers.
Tuesday 24th April – outside the comfort zone
Ben had agreed to operate on a 7 yr old with a traumatic eye injury from a few weeks ago and Frankie had been volunteered to be the anaesthetist. Ketamine is not the best choice for eye surgery, there was nothing for airway management except a good chin lift and an oximeter for monitoring. Ben needed a totally still patient and would have preferred scissors and blades that could cut. We all stayed cool and after 45 minutes we had removed most of the destroyed lens and the eye looked intact. Relief!!
There was one interruption as Frankie was needed to anaesthetise another patient for a C Section (where had all the anaesthetic staff gone?). By the time she arrived the baby was out and Becca had found the language barrier particularly frustrating as the midwives gave deep suction to remove meconium on a floppy baby. She finally got close and was able to give some inflation breaths and the baby is now safely on the postnatal ward desperate for a first feed while his mother is sleeping off the anaesthetic.
Becca has made history on the labour ward with small blackboards over each bed recording progress of labour. At last there is something being recorded, not quite a partogram but progress none the less.
Claire has settled into her own office, with a fan, a nurse to wipe the Ultra Sound probe and tea and fresh doughnuts at 11.00. There is some progress after all! One of her patients was Becca who caused great hilarity for the student nurses as the pelvis was demonstrated to them. They seemed disappointed that there was no baby (We’re sure Ashe!!)
Prem continues to teach with extraordinary energy, not just her own subjects, but because Ben seems unable to split into two or even three, she has been teaching prevention of childhood blindness. Prem has also had to teach the finer points of Intensive Care nursing to 2nd year students, another first?? Becca and Kate have also had to turn their hand to eyes, thank goodness for powerpoint and pictures.
Oxygen remains one of our main objectives but we keep coming up against major hurdles. We bought the power regulators but now one is already broken, hopefully just a fuse. The original oxygen concentrator cannot be fixed in Wau so will come back toJubawith us. The 2 flow regulators for the cylinders have been found, but one is totally broken. We also have no suitable spanner or key to turn on the cylinders. Hopefully the local blacksmith can produce a key before we leave. The pulse oximeters are, however being used well in theatres and Frankie was blown away to see a caesarean section patient with an oxygen mask on her face and 2 litres of oxygen from the concentrator. In addition she had the pulse oximeter on her finger. Long may it last.
Tonight we are going out to a local restaurant with Alex and Peter the paediatrician, plus a local dignitary friend of Alex’s. Ben is grateful that there will be some other chaps around, the girlie talk at dinner last night was not really fair to him.
Kate had a devastating start to her day when she discovered a 3 yr old dying on the ward due to malaria, receiving a total lack of treatment. The nursing staff were waiting for the doctors to come on duty for the day and didn’t think to call for help earlier. We must have taught recognition to every nurse and doctor in the hospital over the past 3 visits, the penny hasn’t dropped. She then got everything together to provide oxygen on the paediatric ward with the second oxygen concentrator, only to find the fuse broken. This was the final straw so we all went for therapy with the children on the surgical ward and played with balloons.