Standards have been slipping in our department. After one month of fair practice the junior doctors have once again slipped into old habits. Attendance to teaching has been steadily falling over the last two weeks. Doctors are once again not coming to work and not giving reasons for their absence. A shadow is falling upon the Medical Department.
With this in mind I thought that I would bring some order to the Medical Department by having some “compulsory teaching” on Medical Ethics. In it we would visit the qualities of a good doctor and look at the attitudes and ethics involved in good medical practice. We would also unveil a new medical staff rota and introduce some care pathways for the Medical Department.
Full of hope, I went to the conference room for our standard departmental teaching, which for the past four weeks had been taking place every Tuesday afternoon. Out of a department where I might expect fifteen doctors. However, after three quarters of an hour of waiting only three doctors came- my consultant, Dr Elijah, and two medical officers.
That day, for me, was the darkest day of Juba Teaching Hospital. My disappointment was not because attendance was poor. It was not because of the teaching I had taken time to prepare. It was because I realised that no one cared. A doctor is nothing without medical ethics. They are simply a person who has bought a stethoscope.
However, hope floats. Dr Elijah and the CEO, Dr Wani, had a chat with me and they decided to organise an emergency meeting of consultants. I received a few phone calls that evening from medical officers who knew how upset I would be. That demonstrated to me that empathy and compassion were not lost. The next day, more medical officers expressed their sadness and asked if teaching would still be possible. “This is what we will do,” I replied. “I would like you to gather the doctors, organise a teaching slot on Friday, and if you are all there and on time, I will teach. Otherwise, I will focus on the few doctors who are interested.” We shall see what the future holds for our juniors but in the meantime, I shall pass you over to Clare to continue the story.
Clare here: So the story continues…. the meeting with the consultants went ahead. 8 consultants turned up (a very good outcome) and after a few introductory slides the floor was opened to debate. Issues relating to junior doctors were honestly and openly discussed, as well as the reasons for the problems. It became very obvious that these people cared deeply about their hospital and were not blind to its faults. The consultants declared their desire to regain control of their hospital and to grasp this opportunity with both hands. Dr Wani, especially, spoke with passion and displayed his abilities as a leader. He received several rounds of applause as plans for change developed. We left the meeting with a strong sense of hope…. and a plan for a 2 day workshop for all consultants within the next 2 weeks. What an outcome!
Aside from this positive meeting, I have had yet another week of rollercoaster emotions…. Samaritan’s Purse, an NGO, has been at JTH this week, performing cleft lip surgery on around 45 of South Sudan’s residents. A lot of work went into finding patients from all around South Sudan and great expense went into flying them here and back safely (no roads!). It has been a slick operation from start to finish. The lead, Karen, has managed to organise staff (nurses, paediatricians, surgeons, anaesthetists, technicians, translators…..), equipment, drugs, food, drink and patients to all be in the same place at once. Luckily, JTH was that place. Even more fortunate was that they were so keen to teach us. It has demonstrated to the staff here what we are capable of, with the right drugs, equipment and expertise. The anaesthetic medical assistants were performing safe general anaesthesia on babies by today. So was I! I have never seen them so enthusiastic about their work. I have never seen them better at their work. I have never enjoyed working in JTH so much.
Chatting to the lead anaesthetist, Dr Mark, a US trained anaesthetist who moved to Kenya in the late 1990s was also pretty inspiring. His hospital was once like ours, but he had set up a training course and had trained up and fully staffed a whole anaesthetics department, with 8 functional and productive theatres. Mary, one of the nurses that he had trained was also there. Anaesthetically, she kicked my butt! What an inspirational pair.
The big dippers of the rollercoaster came when I was required to work in the next door theatre. Mostly in order to manage emergency cases. This just served to remind myself and the other anaesthetists that the high standard of care that we had been part of was not “normal” for us. Back to broken machines and absent drugs and missing equipment. Back to no supply chain. Back to no electricity and no oxygen when you have an anaesthetised patient. We don’t have a back-up generator. We don’t have a back up anything. In anaesthesia, it is important to always have a “Plan B” for in case “Plan A” doesn’t work. Its hard enough getting together a Plan A in the first place a lot of the time.
Samaritan’s Purse have been generously sharing their time, their expertise, their drugs and their equipment, when we have needed it; in order to treat our other patients. However, they are only here for this one week. With the permission of the JTH anaesthetists, I have written to the Ministry of Health, explaining our situation and asking for help. The Samaritan’s Purse team are leaving us a lot of their left-over drugs, which is great, but this will only last so long.
I’ll finish on a high note….. We have been part of a wonderful team this week. We have changed the lives of many people and their families, in a relatively short amout of time. Newborn babies with cleft lips are often left outside of villages, to die, but by demonstrating that there is another option, we can save lives. We have also improved the quality of many lives.
Today, I anaesthetised Margaret, a 7 year old girl. Obviously bright and very cheeky. The translators explained that she had been kicked out of school. My first (naiive) thought was that she had been badly behaved. Oh no, she was a good student. It was because her teacher thought that her cleft lip was a sign of witch-craft. Margaret and her 5 siblings had also been abandoned by their mother, because she could not cope with the stigma associated with having a child with a cleft lip. Margaret was brought to hospital by her dad. He looked at her with such love and pride. We returned her to him with no cleft lip and with the chance of an education and a brighter future.
One day, mothers will not be encouraged to abandon their babies and adults (especially, I hope, teachers) will be educated enough to understand that a cleft lip is not a child’s fault. Programmes like Samaritan’s Purse are offering education and, to those affected, they are also offering hope.