Monday, December 12, 2011

Ive had better days

Alternative Uses for staff Toilet in Hospital with no running water
On Friday night I woke about with a sore back and I remembered how earlier in the day I had been helping shift a semiconscious woman off the operating table. There are no theater assistants so anaesthetic nurse, scrub nurse and doctor have to do the transfers.Usually this isn’t hard as most people here are really thin, but on Friday the patient was heavy. I rubbed my back for a while and gradually the pain eased and I went back to sleep. A couple of hours later I woke with the pain again and it seemed worse so I took a couple of paracetamol tablets, but this time couldn’t get back to sleep. In fact the pain seemed to intensify. I couldn’t lie flat in bed so I got up feeling restless and uncomfortable, pacing round the room but that didn’t seem to help much either. Eventually the pain was so intense I started to throw up, and then I realized it was coming in waves and was centred over my right kidney: it was renal colic!  They say the pain of renal colic is the nearest a man can come to experiencing labour pain – so I tried to tell myself this should be a useful learning experience, but really I just wanted it go away, and to hell with learning experiences. Just after 8am Myrte appeared as usual, because we usually go across to maternity together but I was on the floor with  my head in a bucket – I explained what was going on and asked  her to go over to maternity and bring back some diclofenac, an anti-inflammatory analgesic – I was tempted to ask for a narcotic but I recalled that they can make the spasms of pain worse – and she duly returned and injected it into my backside. An hour later my pain had subsided to a dull ache, and by the end of the day I felt washed out and tired but the pain had gone completely and has not returned.

Fortunately there were no dramas in Maternity on Saturday until about when a woman in early pregnancy arrived in severe pain. I had never diagnosed a ruptured ectopic pregnancy with ultrasound before but even with my limited ability the blood inside her pelvis and abdomen was obvious. My initial thought was to send her to Bahar Dar – bleeding from an ectopic can be massive and can kill, and we have no blood bank – and I felt pretty wrecked myself. We tested her only  available relative and his blood wasn’t compatible, so I felt I had a watertight case to send her away but then we discovered the hospital vehicle was out of town taking the medical director to a meeting!

(In fact with him out of town for the weekend it meant that I was the only doctor in Motta! I probably shouldn’t have been surpised that all 4 medical doctors had the weekend off together because all but one midwife was also rostered away for the weekend – in Bowral where I used to work in Australia, there would be at least six rostered over the weekend and there we only had medium and low risk women, and about 2/3 the number of babies. How on earth did they expect Mintamir to cover maternity on her own for 72 hours? In fact what we did was send her home on Saturday and Sunday during the day and Myrte and I covered the place, as we had done  the previous weekend when the same rostering farce was in place : more on this later)
Stacks of teff harvested by hand as far as the eye can see; Hospital bottom right

But now I was stuck with this patient  – I really had no choice but to operate then and there – I reasoned the sooner I did so, the less blood loss there would be and the less need there would be for blood. I explained all this to the woman and her husband using Mintamir as my interpreter – she  had just returned in time – but the woman would not agree to surgery. “Alright” I said, “we will keep you here on a drip overnight and if your condition remains stable we will try and get you to Bahar Dar tomorrow. But if your condition deteriorates  we may have no choice but to do the surgery, blood or no blood”

I kind of like it when patients refuse to let me do something I don’t really feel like doing, but this was not really sensible. Fortunately, a little while later they got me to speak on their mobile phone to a relative  in Addis Ababa, and though I had no idea what the guy on the other end was saying, such was the quality of his pronunciation and of the mobile phone signal, at the end of the conversation she agreed to have the surgey right away.

In the west this procedure is usually done as “Keyhole” surgery and is usually fun to do, and often the patient can go home in a few hours. In Motta however we don’t have the expensive equipment needed to do it that way, so we do it the old fashioned way, which means making a 4 inch incision in her abdomen. In fact removing the damaged and bleeding fallopian tube was quite straightforward, and though we mopped a couple of hundred mls of blood and clotted blood out of her pelvis she did not need a blood transfusion, but will need a couple of days in hospital recovering before going home.

When I went home I was pretty worn out so it was lovely that Shewaye the schoolgirl who does the cleaning, had made me some very nourishing soup. She had arrived in the morning  when I was writhing around on the floor and spewing into the bucket waiting for Myrte to bring the injection. The three of us were planning to go the market, but in the end Shewaye went on her own while I lay on my bed slowly recovering, and Myrte went to the hospital and saw all the patients without me. Shewaye returned from the market later and made the soup that was waiting for me when I got back. It had been a memorable day for sure – I had never been so unwell, ever - I need to increase my fluid intake to stop it happening again. It’s the sort of thing you dread ever happening when youre on your own at sea.

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