Wednesday 18th April
We set of eagerly for our second day at the hospital, each of us heading to our respective areas. Frankie was desperate to put together the oxygen concentrator, pulse oximeter and emergency trolley in key areas. However, in theatre the oximeter was nowhere to be found and the oxygen concentrator was back in the corner and not being used. In outpatients, there were O2 cylinders without reducing valves and no evidence of an emergency trolley. Having read the manual it appears we needed yet more equipment to make the O2 concentrator work. The next stop is to organise this special power equaliser. Kate went round with the doctors for their round on ward A and did some informal teaching with students and nurses on each paediatric ward on airway and breathing aimed specifically at the children who become apnoeic following treatment for seizures with diazepam. The teachings were received well and in total 22 people attended over the 3 sessions.
Becca had an interesting but difficult morning when a woman who was thought to be 34 weeks came in in the night bleeding but both her and her baby were stable. The doctors decided that the best option was to go for a caesarean section as it was likely placenta praevia. However, the responsible male for the woman refused to consent and even when her husband returned he too declined. They stayed on the ward and as I left both were stable but with uncertain futures. Prem went to the medical ward round only to find she was the only medical team member there. Unfortunately there was no-one to take it out on! So instead she went to meet with the senior nurses from IGAD to hear about their objectives for their time at Wau [which are reassuringly similar to ours].
We all finished the day teaching at the Catholic Health Training Institute and Sister Gracie’s Mary Hope Sisters Nursing and Midwifery School. Prem rather tentatively took her first nurse teaching session on ICU investigations getting a round of applause at the end. Frankie and Kate took basic resuscitation whilst Becca did a midwifery revision session for the final year students. All in all we taught 60 students today!
P.S. Claire has arrived in Juba and met with Ben and are now busy working! Soon to be reunited on Friday!
Love the super 7
19th April, Thursday
An even earlier start today as Becca was left on her own (again) at the midwifery school antenatal clinic with Purity, a nurse midwife from Wau hospital. It is one of the feeder clinics for the local population into Wau hospital. It was a really interesting morning watching the flow of women circle around the different clinic stations for various checks such as Hb, BP, palpation, immunisations and history taking. The traditional birth attendants were very interested to meet a British Midwife and keen to discuss things albeit through our very lovely head TBA, Mary who thankfully speaks both English and Arabic. After such a successful morning she then went back to the labour ward supporting a student to get a delivery. However, to top it off the staff toilets are slightly challenging resulting in wet trouser bottoms which you had to laugh at.
Frankie did a deal with James Okello (Director General at Wau) to secure the necessary additional parts for her oxygen concentrator. Frankie then gave a teaching session for the doctors on CPR, with her ground breaking algorithm (partially endorsed by the chairman of the rhesus council) which included a precordial thump and no defibrillator – which Frankie would like to published in the Southern Sudan Medical Journal. The importance of early recognition to prevent getting to this point was stressed!
Yesterday Dr Peter spoke to Kate and asked if she would address the high level of cannula associated thrombophlebitis. This morning Kate went round all three paeds wards observing practice and discussing with the nurses ways to improve cannula insertion procedure and post insertion care with the facilities available. The nurses were very receptive and expressed their frustration with a lack of alcogel (they ran out in hospital stores today) and gloves that were too large.
We are looking forward to the arrival of Claire our Sonographer and Ben our Ophthalmologist tomorrow. We have been very busy again with teaching both nursing schools this evening but managed to get a little time to eat and concoct two new cocktails: the Woo Wau and the gimango (recipes available on request).
Love the super 7.
South Sudan Medical Journal Blog 