Sunday, September 1, 2013

Out of Africa

TukTuk and Tree

The last few days in Aweil were hectic. Quite apart from having to find the time and energy to write a comprehensive report on my six week mission and a “handover” document, there were patients to look after, emergencies to cope with, heat and rain and mud to put up with, and the endless round of exclamations, regrets, questions and farewells from anyone and everyone who realized my mission was about to end -  How was it?, where are you going? When are you coming back? Already? On Wednesday night everyone gathered at dinner time and thanked me for my contribution and wished me a safe trip home in the morning. All the goodbyes were said and I became a person in limbo, killing time before the flight in the morning.
Maura, Thomas and Kristin : wonderful colleagues
Looking back, I realize there were so many incidents and events and dramas I could have written about during those six weeks, so many near death experiences, so many extraordinary  examples of extreme obstetrics, of extreme poverty and awful neglect, that one merged into another during the hectic day that by the end of it, food and rest and escape from the flood of urgent crises was all that was on my mind.

I tried to maintain a diary, to keep track of everything swirling around me, and heres a couple of days from it – they are quite typical days:

Saturday 6th July
Started with emergency Caesarean before breakfast for cord prolapse : All good
The ward round
The hand seems to be improving   ( a patient had a horribly infected hand)
The SABO is not improving  ( = Sub acute bowel obstruction)
      took her to Green World Health Centre for AXR confirmed SABO, then gave enema with large result – tomorrow if not improving for transfer to Gogriel where there is a surgeon
       Green World was interesting, a collection of tiny shacks labeled Wards, the Xray building another concrete shack, and Margaret a big sexy woman from east Sudan somewhere
Evacuation of Molar Pregnancy after ward round
A spontaneous vaginal breech in primigravida
An iufd at 25 weeks delivered after arm and synto (IUFD - Intra Uterine Fetal death)
NVD twins   (Normal Vaginal Delivery)
Diabetic almost sorted!

Sunday 7th July
Busy day though its supposed to be the day of rest:
The hand is improving
The cachexia is not – she is dying and I don’t know why – probably TB
The SABO is not and needs to go to Gogriel where there is a real surgeon but its very hard to make this happen – pt has to be accompanied by a family member prepared to donate blood and to accept that if she dies MSF will not be able to return her to Aweil this seems inhumane to me especially as this weekend we have an MSF Official flown here from new york for god knows what reason, and another director from Juba also here. Got NG tube passed and large volume of bile stained fluid aspirated

Two casears  – a face and an obstruction with ROP in  multi

Destructive Delivery  – IUFD primigravid LOT after 2 days in labour, putrid hot mec stained pus and liquor. Demonstrated technique to Paulino

Bloody footprints
But even though  42 days on call is quite enough for anyone, its also too short a time, because I realized it took most of that time to learn everyones name and to learn which people I could rely on, and who I could call for help and and what systems and processes were in place that I could use to get things done, what was possible, what was not. I realized I had learned enough to start to become really useful just as it was time to go. But now at the end, mentally unwound I became ready to go.

 I was watching the weather and woke early Thursday morning to the sound of rain. I went in to do a quick ward round at 7 am so I could be back to go the airport at 9 – the rain had stopped, the clouds were lifting, word came through that the flight was “ON” and saying a last farewell to the few people still in the compound at 9, I hopped into the Lancruiser and went to the Airstrip.
Aweil Departure Lounge
There was an hour to kill so I just stood about avoiding the puddles and waiting. The “Terminal” was an open sided shed with a soaking dirt floor and a few puddles. A tiny drizzle of rain appeared – there was also a tiny new patch of blue sky on the horizon – and then a guy with a walkie-talkie had a quick look at the sky and cancelled the flight – “too wet” he announced. I had heard they tended to cancel flights at the drop of a hat and this was certainly an over-reaction – I was stunned.

Half an hour later the sun had broken through but it was too late; the flight was cancelled and I was taken back to the compound. It was a strange afternoon, because I reappeared in the compound and then went back to work in the hospital to everyones surprise, but no-one wanted to go through all the goodbye process again – I was sort of ignored, I felt like a ghost that nobody could see, as we coped with another round of dramas and traumas, anaemias and bleeding and pain and birth. I was mentally unwound and in a different space but had to  wind back up again.
In case I needed some?

The Nile at Juba
The next morning we went through the same process but this time the plane arrived and we left on time for Juba, a day late leaving but too late for my connecting flight.  I would have arrived in Sydney on Saturday evening, but with that delay the next available flight got me to Sydney on Tuesday,  the day after the end of the five day annual Sydney Boat Show. This was something I had been thinking of as a kind of reward for all the hardship of Aweil, something I had been looking forward to attending for months and it took me a while to get over my  disappointment.

But I was back in Sydney, back in the Hotel that had hot showers, really soft pillows, airconditioning, and Room Service! But better than that was seeing  family and friends,both in Australia and New Zealand a week later. From there I flew to Fiji, back to the boat and another beginning!

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