Below is Dr Clare Attwood’s first blog post. I hope you can take the time to read this very moving account. Please send the link on to as many people as possible so we can spread news of the work the SSMJ is doing!
We have now been in Juba for exactly one week and it has definitely been one of the most memorable weeks of my life. Dave and I started work on the Emergency Medical Ward (EMW) at the end of last week and it came as quite a shock to me. Although Dave had worked on the EMW in 2008, I had no idea of quite how difficult work on this demanding ward would be. I thought that I had mentally prepared myself for work within a resource poor setting, but I was in for a shock. There were nurses, but not many and there were virtually no useful drugs or monitoring equipment that was not broken. We started the ward round at 9.30am and we were the only doctors on the ward. A few junior doctors joined us as the morning progressed, but as we reviewed the 20+ male patients, it became very clear that many of them were dying. However, the nurses were unable to take observations, as the equipment was all broken, and unless the families of the patients were present and had money to buy drugs from the private pharmacy, they were unable to give any medications. We bought some medications, but also watched patients die when more expensive medications were not available or they had just presented to hospital too late to be treated successfully. Never mind those horrible, stressful, bewildering first on-calls as a medical house officer in the UK. This was a lot worse. To watch young, previously strong men die, whilst their proud and stoical families watch on is heart-breaking. Knowing that they would be treated easily and effectively (and for free) in the UK makes it even worse. After 4 hours on the ward, and to my shame, I had to leave. I had never before felt so hopeless.
However, life on the EMW here is not all doom and gloom. With a knot in my stomach, I returned to the hospital the next day. Although Dave had reassured me that not all days on the EMW were as demoralising, I thought he was just being nice. He was actually just being honest! Although some patients had died overnight, many had not. Family members had found money and the nurses had given the medications and fluids that we had prescribed. I discovered that you do not need a blood test to check someone’s markers of infection or kidney function. When the relatives are able to tell you that the patient has had less fevers or is now passing urine, you are reassured that you are treating the right infection and that giving fluids was the right thing to do. I am rapidly learning how to work with the resources that you have available, be it people, investigations or medications. Through working within the system, we can gain trust, understand problems and eventually help to bring about change.
Here is a happy story…. A 25 year old patient was bought in yesterday by his friends. He was comatose (GCS most definitely 3 for any medically minded people out there!) and in the UK would have been taken directly to ITU via the CT scanner and a whole barrage of tests and treatments. His history was suggestive of malaria and fluids and Qunine were prescribed. A malaria blood film was requested. A very bleak picture was painted to his friends and I fully expected not to see him in the morning. The two friends nursed him on his side overnight, so he did not obstruct his airway and put their money together to buy drugs they could barely afford. The nurses gave him the medications and fluid as prescribed. When we came in today, he was opening his eyes and following basic commands. When we left this evening, he was sitting up and his friends were feeding him and helping him to drink water from a bottle. At this rate he will be discharged home tomorrow! The many manifestations of malaria are diverse, but the resilience of young people and the robustness of their physiology can be astounding. My predictions have already been proven wrong many times. I currently love being proven wrong!
Other things that are wonderful to be witness to include seeing the relatives camping out in the courtyard so that they can be there to wash and cook for and feed the patients. It makes the hospital more chaotic but more brilliant. Feeling welcome and part of a big team is also great. Prolonged hand-shaking with everyone that you know, or are introduced to is lovely, but not so good for hand-hygiene or timely ward rounds! Working hard in temperatures that must be over 35ᵒC, with rivulets of sweat running down your back (and I thought women were supposed only to “glow”) is less than lovely! Making countless very young children either collapse in fits of giggles or burst out crying and screaming because you are the first “Kawaja” (white person) they have ever seen does not ever seem to get tiring! Walking past the hospital public toilets that smell so acrid that it makes your eyes water and your throat burn is very unpleasant (and we are not the ones who have to use them). However, seeing mothers and wives washing patients’ bed clothes in buckets and then seeing them brighter than brighter and drying in the sun all round the hospital grounds is very pleasant. Working in JTH is an assault on all of your senses and sensibilities and is certainly never boring!
Anyway, this blog was supposed to be about a (very productive) meeting that we had today with the nurses on the EMW and how their working lives can be made easier. I also hoped to write about many other aspects of our day-to-day life (including the 4 hour church service followed by a biblical type downpour!). However, I think that I have written too much already. It’s just so fascinating to me – the good bits and the bad. If you are still reading, thank you! More about that meeting in the next blog………….