A bloody good Christmas!

JTH's first blood bank. Omar, a lovely Lab technician, is proudly standing by some emergency units of blood. We now have 24 units, enough to do four aortic dissections, or perhaps closer to the truth, keep 24 babies in this world

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.

This patient had malaria with a full house of complications: Cerebral malaria (malaria attacks brain), Acute respiratory distress syndrome (ARDS- malaria attacks lungs), backwater fever (massive breakdown of red blood cells which releases haemoglobin into the blood and then the urine), and kidney failure (malaria attacks kidneys). My Senior House officer, Angelo, is holding up the urine bag showing backwater fever. Left: Grace (HO), Right: Matthew (Harvard Consultant). The patient was critically sick and we were always operating on a knife edge with getting his fluid status correct. Sadly he died for reasons outside our control. If you look behind him, you will see our high care trolley. The cardiac monitor behind is off. We had no power that day and could not power the oxygen concentrator. He died because JTH had no electricity to deliver oxygen to his lungs.

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.

Stephen, our registrar, being given an introduction to ultrasonography by a Radiologist. From left to right: Sandra and Grace (two exceptional house officers), Fred (Consultant Physician, Harvard), Stephen, and Giles. The patient had a massive spleen

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.

The first postgraduate medical meeting. In the centre at the top is Dr Oromo Francis

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!

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6 Responses to A bloody good Christmas!

  1. Batool Rizvi says:

    You are doing a great job. I always enjoy reading your blogs. Have a lovely Christmas and a wonderful new year.

  2. Beverly Capon says:

    Ahhh, and we think we have it bad sometimes – the simplest things we take for granted when treating patients, going about our daily work. Hope you have a lovely 4days off, enjoy your quality time together…you deserve it. Happy Christmas Beverly xxx

  3. Thanks for the words of kindness guys. It really is very much appreciated when you are a long way from home.

    All the best,

    D+C

  4. Joseph Onyango says:

    I have been a keen follower of your blogs and I must say I am deeply touched by your dedication and determination to improve the way things were and are still are at JTH. South Sudan need more people like you inorder for it to rise up and soar in the right path of development. Please keep it up and may others be inspired by your selfless work and aspire to come to the same not just in the medical field but in all relevant socio-economic fields…Safe journey to and fro Uganda and Have a Merry Christmas and a Happy New Year. GBU

  5. Mary Offutt says:

    Theodore Roosevelt: ““Do what you can, with what you have, where you are.” That’s what you guys are doing. Are there any foreign nurses working with you?

  6. Debbie Morrell says:

    David and Claire – have been reading your blogs and feel really in awe at all that you are doing. It does make you appreciate all that we have in the UK
    Have a wonderful break in Uganda and get some much needed rest!
    Lots of love Chris and Debbie

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