I’m writing this in the hospital waiting for the power to come on. There is no point in me going to theatres and sweltering, as at this time it is not possible to do any work. The hospital is a very frustrating place when there is no electricity and no running water. However, at least we have daylight to work with – the staff members at night have difficulty even seeing the patients. There are a few torches and lamps around, but how are you supposed to work effectively whilst juggling a torch?
We are continuing to make some breakthroughs though. I have been working with the doctors from Harvard to set up a “virtual blood bank”. In every department in the hospital we have seen and heard of patients who have died because of a lack of availability of blood for transfusion; something that is a daily occurrence here, but virtually never happens in the UK. Something that is preventable. The Harvard team had the genius idea of getting the ex-pat community on board and asking them to donate blood. We do not have the facilities to store large quantities of blood, but have devised a system where there would be a small store of blood available for use in emergencies – patients who are bleeding to death. We then would call on our blood donors to come and replace those units later that day, at a time that is convenient to them, if the patient’s relatives are unable to donate. The hospital laboratory team have been very accommodating and on Tuesday I facilitated the donation of our first 6 pints of blood, by 6 generous people, each with their own fascinating story. We have more donors on Saturday. We are under no illusions that we will be able to provide enough blood for everyone, but this system is already saving lives. One unit of blood has already been given to a 10-year-old boy who underwent major liver surgery yesterday. The long-term aim is for Juba Teaching Hospital to have a fully functioning blood bank. However, this requires many things that we do not have; constant electricity and money being the two most vital.
We hope to not just include the ex-pats in our database of donors. In an ideal world the South Sudanese would donate too. However, there is a lot of superstition about blood donation and this will require a large amount of education to alleviate peoples’ fears. Even the doctors and nurses (who see patients die daily through lack of blood) are often unwilling to donate. This appears to be because we screen the blood. If a staff member in the UK tests positive for HIV or Hepatitis, this does not spell the end of their career in healthcare and the staff member will be given access to appropriate treatment, to keep the disease as dormant as possible. It is in their interest to be screened. No-one knows what happens if you test positive here. You would probably have to stop working and, as health professionals are paid poorly compared to other professionals, you probably would not be able to afford the medications that you would need….. even if they were available at all within the country. Sometimes it is easier to live in denial.
We are preparing for the big Christmas exodus. Within the next week, most of the senior doctors will go on leave, leaving only a smattering of on-call junior doctors to hold the fort. However, although there will be no elective work, patients will continue to become unwell. Our Harvard friends, Matthew and Fred, will be leaving tomorrow and we will miss both their company and their hard work. David and I need a break and will be taking 4 days. In preparation for this, we are starting up intensive training for the doctors of the Emergency Medical Ward on the ABCDE approach to managing the unwell patient. David has also written a guide on how to manage the most common conditions seen on the EMW. The nurses and junior doctors’ skills and knowledge have improved greatly, but we need to prepare for when David, Matthew and Fred will no longer be able to provide the 24 hour support that they currently offer.
So, onto our magical four days…. Since arriving 3 months ago, David and I have not taken off more than one day per week. Sometimes David has not even taken off one day per week. Most weeks I work one day from the hotel, as we have internet access and that provides a breather, even if I am still working. David hasn’t even had the opportunity to do this. We are tired. We are taking a four day break in Uganda. I’m not excited about spending 10 hours each way on a public bus, but I am very excited about resting at a rhino sanctuary! So, fingers crossed that we will be able to get our visas before the Ugandan Embassy shuts for Christmas! If so, we’re off on holiday!
Medical education took another leap forward this week. On Wednesday, the consultants of all departments had a meeting and many issues were discussed such as who would issue certificates, who would lead in each department, setting standards that each department had to adhere to and quality assurance. Each department would nominate a head for medical education and another meeting would take place in the new year. We now have a Director for Medical Education called Dr Oromo Francis and he is a human dynamo and has a clear vision of the form that postgraduate training should take. A UK consultant will also be coming to Juba next year to work with him.
Right, it’s been an hour since I started writing this and there is still no sign of power. I feel bad for David, who will be having a very uncomfortable ward round. I think that I have just seen the Finance Director for the hospital arrive. Earlier this week, after lots of hard work and lots of chasing lots of people, the Ministry of Health approved my application for an emergency budget for anaesthesia. Hopefully the money will have arrived in the bank by now and we can get about deciding who can fly to Kampala and buy our much needed drugs and equipment. It’s just a shame that I can’t combine seeing the rhinos with stocking our shelves, as the warehouse shuts for Christmas. Thankfully, I have a volunteer to go in the New Year!