“Why is there no milk on your branflakes?” “I’ve never had milk on my
cereal, and besides there isn’t any milk anyway.” ”Hmmmmmmm still think it’s
a bit weird” a rather painful silence then.… “So we’re off tomorrow, it’s
going be ten days of really hard work” she said “who’s off?” I said, between
mouthfuls of cereal “You and me,“ she said. A pause (whilst I cogitated and
chewed) then, trying not to choke on branflakes, “so (trying not to sound
too desperate) I’ll be the only medic” (out here anyone who is a doctor,
nurse or knows how to put a plaster on correctly is referred to as a medic)
“Um…….. (looking a little baffled by my seemingly obvious question)
yes, but you’ll have a doctor on the end of the radio. That is going to
require me to know which bits of the body are which and complicated medical
words to describe the patients’ symptoms, not my forte at all, I thought. A
restless night with, my only medical textbook learning words that would at
least give the impression I knew what I was talking about.
Off to an area that hadn’t been visited by a team for months, and visiting
not one, but two clinics that hadn’t received any input since May, and it’s
the boss, and me could be fun.
Day 1 “Could you come and look at this woman, I think she has died”.
The roar of engines overhead indicated the imminent arrival of a plane, a
plane that most of us thought would arrive in forty-five minutes time. Panic
stations, furrowed brows and people running around in all directions. A
collective chasing of tails.
Cargo to unload and patients to load on, then patients to load off again as
there were too many people on the plane weren’t on the list. Then a loading
of further load of cargo, then the loading, in a chaotic scramble of a few
patients who were being flown home. No concept that a plane overloaded by a
third will find flight impossibility. More unloading of patients. Angry
words. Engines revved. Doors closed. Away.
The plane bumped down to a shuddering stop. The area was more open than any
I had seen before. Vast plains of green grass, and of course mud, in many
directions. It was as flat as a bowling green.
Small hamlets dotted the horizon with small fields of crop next to them.
This area is one of subsistence farming. The small compound and clinic that
we had landed at had had a large program operating. There had been a large
inpatient facility and one of the largest TB treatment centres in the
country. In May this all changed, fighting had lead to an evacuation and,
with the clinic unguarded it had been stripped bare.
What can best be described as two days of madness saw many years of work
destroyed. The numbers of lives lost as a result of this, in terms of
patients who could not be treated and the damage to the community as a whole
is incalculable. The scars of the looting are still evident. I even found
part of an oxygen resuscitation mask being used as a bracelet by one of the
teenagers in the town (no, I’m not joking). The community has suffered for
the sins of the war and the local staff in the clinic have worked very hard,
against almost impossible odds, to keep some semblance of a medical service
operating. Not for the first time I feel humbled by the people who I have
come to work with.
The plane was soon a spot in the distance as it, carried another group of
patients. They had been kept alive by the ingenuity and dedication of the
local staff for long enough until help arrived another ten people walking
around who otherwise would not have been. The role of the foreign aid worker
is much overrated. In many ways we are a nice optional extra. The local
staff are the people that the bulk of the credit should always go to. But
sadly you don’t see movies about them
With the plane, and thus all contact with the outside world gone, I set
about seeing what patients had remained behind, all were acutely unwell and
the level of treatment available was patchy, however all were showing
encouraging signs of improvement. Various pneumonias, gunshot wounds and a
few children with malnutrition, oddly this is becoming bread and butter
stuff now.
As a rather chaotic ward round was drawing to a close, I got a tap on the
shoulder. “Could you come and look at this woman, I think she has died”. It
was said in such a way as a cashier might say “could you just enter your pin
number”. Bit late for me then isn't it ? I thought as we wandered across the
compound.
An Announcement
I realise that my blog has a mixed audience. It is difficult to write about
cases with enough detail to keep the medics happy but with enough
explanation that the non-medics aren’t totally lost in a world of jargon. So
in order to combat this I’ve bracketed some helpful notes for the non-medics
with the heading NM
When I reached the woman she wasn’t, in fact, dead. But she was making very
great strides towards that end. Her blood pressure wasn’t above 60 systolic
(NM This is not good) she had a temperature of 40 degrees (NM neither is
this) a pulse so fast I lost count, (NM all signs this dear woman is in big
trouble) she had a grossly distended abdomen (NM again not a sign that
things are going well) and she had given birth to a baby boy five days ago
(NM this is nice but not crucial right now), who was, despite everything,
very healthy. As stated before when you try to save a breast-feeding
mothers life you are also trying to save the life of her baby.
Trying to resuscitate someone by yourself in a mud hut in fading light, and
only one cannular (NM IV line) with the whole family watching your every
move could best be described as the fringes of my competence.
Having found the only vein the patient had left I attempted to put an IV
line in. Of course life would be too easy if the cannular managed to get
itself into this woman’s vein correctly. All was going well until it came to
the fiddly bit of advancing to plastic tube into the vessel. At this point
the plastic tube refused to budge. “oh for pities, sake will you just get in
there!” I said to the cannular (although I’m not sure if I used the word
‘pities’). Thankfully the cannular obviously listened and did ‘just get in
there’ and soon the woman was having the proverbial kitchen sink (in terms
of fluids and antibiotics) thrown at her.
We, and again I can claim no credit for this as the national staff did the
vast bulk of the work, kept her going for ten days until a plane arrived. I
went to see her this afternoon. Mum and baby doing fine.
Day 2 Two Twos are seven
A crippling lack of education has meant that most of the population are
basically illiterate and the ones that aren’t have moved away. When it comes
to counting stock and medicines the struggle very badly indeed. Here however
I found that my maths was also a bit dodgy and a pharmacy stock check that
should have taken an hour took a whole day. Most of which was my fault. Went
to bed with brain dribbling out of my ears.
Day 3
Breast cancer is a disease that strikes fear in Europe. It is the subject of
endless soap opera storylines and health promotion campaigns. Not here. What
exactly would you do with the lump if you found one? Today a woman attended
the clinic in the final stages of her disease. The cancer had spread and she
was pretty much riddled.
Trying to convey the hopelessness of her situation to her and her son was
one of the hardest afternoons of my life. Many times they asked why we could
not cut it out. I kept trying to explain the stages of a cancerous growth
and what happens when it spreads. The son said he would take the woman to a
traditional healer. I tried to explain it would just hurt her and make no
difference. But I can see his point, we were offering nothing but
painkillers and sympathy. A traditional healer would promise a cure. This is
what happens when you don’t have an effective health system.
Day 3 Bees and Broken shoes
Early in the morning, VERY early in the morning (no time for Branflakes) we
roused our troops and headed on foot to the next outreach site. The convoy
consisted of drugs, a radio and various other bits and pieces. The water ran
to chest height in places but I’ve written before about the roads and once
you’ve waded through water for a few hours once, the experience is pretty
similar the next time! This trip was marked by two key events. Firstly my
rather snazzy shoes, which up until this point had performed impeccably
spontaneously combusted. The strap broke in such a way as to make them
unwearable. I performed a variety of suturing techniques to hold them
together but they were, essentially, screwed.
The hours rolled by and the flat countryside splayed out
before us. It was time to stop for a break, and put another few stitches in
my shoe. “There’s a very odd fly in my hair” said the boss as we rested
under the shade of a tree “Looks a bit like a bee” I mused looking for a
spot to sit down on. Then glanced at the tree to see one side completely
covered in bees. The bees were clearly not great fans of ours and began to
swarm…
….It had been a quite day for Mrs Elizabeth and her children, she had set a
large fire going in the corner of her hut and was just getting her five
children settled for lunch. At this point their day was rudely interrupted
by a screaming noise and the sound of lots of people running, this was
followed by the sight of two white faced Europeans busting into her hut
screaming like thirteen year olds at a boy band gig, closely followed by a
large group of very angry bees. Luckily bees fall asleep with smoke and the
group were soon much calmer and the male European, who had been shouting the
loudest, was soon blowing bubbles with the children. They thanked Mrs
Elizabeth very much for the use of her hut and hoped they hadn’t disturbed
her day. A family anecdote for years to come.
After the attack of the bees progress was much slower, the
running had snapped another strap off the shoe. The next event was the
crossing of a large river. At this point I suffered my second equipment
failure of the day. My dry bag suffered a nasty tear, singularly making it
neither dry, nor an actual bag and thus making it a … er…
Days 4 & 5 Across the line
We crossed a former frontline in the fighting, and it showed. Thousands of
people without the most basics of life, but a health clinic that,
miraculously, had stayed open. Again there were patients we couldn’t treat.
There was a child with an abscess that had collapsed one lung and was making
strong inroads into the second and a woman with mental health issues. But
also many who were receiving care and getting better. The evening saw the
worse storm I have seen since being here. The omens looked very bad for the
walk back.
Day 6
Walk back can be summed up in three words Long. Hard. Slog.
Days 7 & 8 Shifting priorities
The wasteful nature of foreign aid witnessed today. A plane landed and pushy
American doctor got out. She went straight to the child she had come to
assess to see if the little girl had the disease she thought she did. She
didn’t, so she got back on the plane and flew away again. Had the doctor
glanced to her left she would have seen a large group of totally
un-immunised children and behind them a group of expectant mothers without
the basics of maternity care. All could have been paid for by the cost of
her plane visit to see one child with a non fatal disease that she didn’t
have.
Day 9
Spent the day in the clinic surrounded by patients many of them displaying
symptoms that I’d only ever seen in books. The learning curve here is
vertical and I’m sure I’m missing things. But you can only do your best.
Flew back to the main base the next morning.
So that was my week. Highs and lows as ever, thanks again for the messages.
Glad to know there are a few of you still reading! Today I’ve spent the
morning doing paperwork (booo) and the afternoon playing football (Hurray!)
I’m going to be a bit more settled for the next few weeks as I’m covering
various holidays and stuff so hopefully I’ll be able to update the blog a
bit more often. And get round to replying to a few e-mails. But I think that
is enough to be getting on with for now, ten days of hard work it was.
Tired. Off to bed.
