Another eventful day!

It was a difficult morning getting the girls out of the door, with school refusal from one and a general lack of engagement from another. I was surprised by quite how much it drained from me here! Such a normal part of parenthood, yet with everything else, almost enough to tip you over the edge! Then as I sat in the morning meeting, my day was completely turned around as I was humbled by the thanks given for ‘saving the life’ of the laparotomy patient. I had been so focussed on the clinical challenge that he had presented, I don’t think I had really thought through what would have happened to him if I had not been here. The stark reality is that in all probability he would have died, incorrectly treated for severe malaria or at best transferred to another hospital too late. Considerable food for thought.

It was then to theatre to ‘tee up’ the young boy for removal of the coin – a novel technique of a bladder catheter to try and hook it out was to be employed. I was umming and ahhing about repeating the X-ray, but I’m glad I did. It had indeed migrated below the diaphragm into the intestines. It also transpired that it had not been 3 days ago he had swallowed it, but yesterday. I just hope it passes all the way through now, otherwise he will need a laparotomy if it gets stuck.

On the ward round there were two patients that needed suprapubic catheters. We would do this in theatre before the Outpatients and an experience this was to be for me. None of the special kits we have in the UK. Simply some local anaesthetic, a knife, a clip and the catheter. A procedure I did not enjoy at all not least because in the first patient who’d had an open prostatectomy, my first pass of the pilot needle encountered air (meaning I’d found some bowel). But both went well in the end, with the patients much relieved. I accept that it was absolutely the right thing to do for these two men who had been in urinary retention for 3 days, just very uncomfortable for me!

And then it was to clinic, starting very late and with 24 patients to see. Unfortunately, an additional dynamic today was that I had to pop back to the house a number of times to check up on the progress of the water and window netting. The water situation has become very complicated (two sources, low pressures, bore hole renovation) but was getting the close attention of the hospital superintendent and two engineers. The window netting issue transpired last night as we were assaulted by a deluge of massive flying termites in the house (body 3cm long, 4 wings each 4cm long. Massive! And horrible! I spent quite a lot of time ‘splatting’ them). I thought I had checked all the windows thoroughly, but the chidlers had spotted some large gaps in the veranda behind the blinds when they were playing. Well done them!

I was caught by a clinical officer on my way back to clinic to look at the XR of a child – who was being carried on his father’s hip looking only slightly sorry for himself – pretty astonishing given that his left leg was snapped in two (he had a nasty displaced spiral fracture midshaft of his femur). The attitude, approach and stoicism of the African people is really astonishing. Something for us all to learn from perhaps?

It was another busy OPD clinic with lots of orthopaedics and congenital paediatrics. A 1week old with bilateral polydactyly (an extra stump of finger growing on the little finger) was sent to major theatre where the theatre manager (not a surgeon) just cuts them off! Another 4month old with syndactaly (two of the fingers fused together). And it seems I have already become a sports injury specialist with a 24yo keen footballer attending with pain in his knee post injury two years ago. I was quite proud of my efforts at a knee examination, but unless he can travel to somewhere like South Africa or the UK for an MRI and arthroscopy, there is little that can be done for his probable meniscal tear. One highlight of the day was conducting my own consultation in Swahili – the doctor I work with needed to leave for a few minutes. Whilst only a very, very basic level of communication was required today I will write more about this aspect of practice in the future. The end of a very long day at work concluded with review of my young laparotomy. He is doing brilliantly. It is quite remarkable that regardless of the fact we have limited vocabulary in common, how emphatically patients can universally impart upon you their desire to have an NG tube removed (a tube through the nose and into the stomach). And remove it we could.

I returned home to a delightful household with a buzz of activity as the visiting students (UK nursing and laboratory) entertained the children – or was it the other way round! We also have a small amount of water in the tank (probably not enough to last the week though) and there are a number of materials in the veranda to fix the windows tomorrow.