This is a therapeutic blog. 1^st day at work and 1^st day at school for the kids. A lot to manage for all of us psychologically. Nice to offload into cyberspace!

We all went to the Hospital Morning Meeting at 07.30am so that the whole family could be introduced to the staff. This was very well received and they are absolutely delighted for us to be here.

Following that Kate took the children to school (a lift in the hospital car kindly offered and accepted) and I made my way to find the surgical team (all distinctly lacking in the morning meeting). I went to theatres and found the theatre manager and the lead nurse anaesthetist – it was so lovely to see them again. They were so welcoming. And then came some fairly challenging news: 1) The lead nurse anaesthetist has hurt her hand (probably a scaphoid fracture clinically) which is a massive blow for me, she is by far the most experienced of the two nurse anaesthetists and if she is incapacitated, this will have a big impact on the service that we can provide (or I will have to turn my hand to dabbling in anaesthesia too…….gulp); 2) The surgical lead is on holiday for two weeks, leaving just a Clinical Officer (in simple terms the equivalent of an SHO) to run the entire surgical department. The other surgeon that I met last time has left for another post and the surgeon in training still has another year to go in the capitol. Yes, the entire surgical department is run by two people currently. 3) The lead for CSSD is away which makes it difficult to start doing mesh hernia repairs as the sterilisation protocol for the mosquito net needs to be established. And this also delays the incorporation of all the instruments I have brought. Then I found the Clinical Officer (turns out he was on call last night and doing an emergency caesarean section), a massive smile from him and a warm welcome definitely returned the proverbial sunshine to my day.

Firstly we did the surgical round – I will spend more time describing this in detail in the future – which was challenging to say the least. Mainly psychologically. It is difficult to describe all the different thoughts and feelings that course through your mind as you walk from patient to patient. Practice is of course very different here, but it is massively challenging to determine the line between what is ‘normal’ practice and what ‘should’ be acceptable. There are many factors that determine what is available / possible for patients here but one of my personal challenges is siting this hospital’s capabilities within the wider healthcare network of the country (although one major challenge in all this is ‘logistics’ as patients, if referred, have to make their own way to other centres and usually have to pay). And of course, the practice is very varied – a lot of orthopaedics, urology, burns, trauma, paediatrics in equal parts to what we would call ‘general surgery’ in the UK. I am very grateful for the broad training I had doing an ‘old fashioned’ BST as well as the broad base I had in my early years as a registrar. But what do you do when confronted with a patient who has fallen out of a coconut tree and has a dramatic leg misalignment? (no XRs yet, the injury was yesterday and they will be done today hopefully) – my guess is complex pelvic trauma which will result in bed rest & traction here for a few months (in the UK it would be CT, referral to a specialist centre for fixation of some sort). And what about the 21yo who fell off a motorbike 4 days ago and has complete paralysis of the lower limbs with a dermatomal / myotomal level of L3/4? To say a lifechanging injury is an understatement. The current plan is bed rest and hope for recovery…. I am very much hoping that we can refer on to a specialist centre. Not least because my questions about spinal nursing / bowel care were slightly challenged as there is only one nurse on the ward at a time…. Yet this is the challenging end of things and there is a lot of other work going on that is quite extraordinary (in a good way) given the resources that they have – again more to follow another time on this.

My ramble needs to draw to a close, but briefly, the rest of my day was in surgical outpatients, seeing 28 patients. Again, very varied practice and I was again grateful that I had been interested in paediatrics in my early years – a surprising number of PPVs, hydroceles and congenital abnormalities seen today. It was a long day!

School seems to have been a tentative success for the girls. Challenging as expected, but they seem to have weathered it well and even enjoyed it. Little Beth I think found it hardest, the attention was overwhelming for her. 

We will see what tomorrow brings for all of us.