What a difference a day makes

It is fascinating how mood can change. Having been feeling distinctly blue (in a low-grade fashion) these last few days, something changed mid-morning and I found that I had very much recovered my ‘mojo’! Exactly what happened and why is unclear to me, but I suspect a combination of many factors including the insatiable warmth and kindness of the theatre staff. Or perhaps they had sneaked something extra into the cassava they fed me (an ordinarily very bland starchy root vegetable, that had been cooked in some way to be delicious). Afterall, they had noticed that I was feeling a little bit drained yesterday…. they were all eating it too.

Anyhow, today has been interesting, productive and enjoyable.

Interesting because I was asked to review a young six-year-old boy with sickle cell disease this morning. Examining his abdomen, he had the best example of splenomegaly (a big spleen) I have ever come across. Whilst perhaps not ideal for him, the medical curiosity of such things for an enthusiastic teacher such as myself is very exciting. Furthermore, having four UK elective medical students here to later share such a discovery with brought much joy for me. Sad perhaps, but I have always known I am a medical geek and at least I can confidently say I chose the right career!

Productive for several reasons. Firstly, we performed another two mesh hernia repairs (adding to our series). The first of these was a recurrent hernia in a battle-scarred abdomen which I was asked to start, but was so straight forward that I insisted my Tanzanian colleague completed it. This was great experience and confidence building for him. The second repair promised to be very straightforward and seemed the perfect opportunity to try and acquire some photographs I have been wanting for a guide that I am slowly putting together. The patient was delighted to be asked and the case proved to be perfect for the task. Not only did we get some great pictures, but performing the procedure in such a stepwise fashion turned the case into a teaching ‘masterclass’. This was very useful for the local surgeons (such tactics in a teaching programme should not be overlooked) and it was a delightful experience for me too. It’s always nice when you feel you have performed something really well.

Secondly, the medical students delivered the whiteboard I had bought to the surgical ward. Another one of my many service improvement ideas, it has been waiting for a couple of weeks to be marked up as a bed board for the ward. I must say that they had done a brilliant job, much better than my original idea. When I saw it, I was really chuffed, and the ward staff were delighted. Hopefully this will make locating patients on the ward much easier, as well as getting a snap shot feel of what is going on.

Enjoyable for all the above reasons, but also because I got round to distributing the four other holepunches I had bought (one I had already located in the theatre office). I had become very fed up with never being able to file papers in patient notes properly (yes, I am a surgeon. And yes, I can, and do, file notes). When it became clear that the hospital procuring some punches was not going to happen anytime soon (trivial perhaps, but money is that tight), I bought five myself. Cost me about £8. These ‘zawadi’ (presents) for the wards were received very warmly and I hope will make things that little bit easier and better. I only hope that they are not locked away in a cupboard, they had a feel of gold dust about them when I handed each over.

A final small victory for the day was the repair of my sandals. I had bought a pair of leather Massai sandals (very nice, environmentally friendly – no plastic –, and good for local trade) but the toe loop had broken. They were taken to one of the many shoe repair ‘shops’ and for the princely sum of 75p were not only repaired but given a substantial upgrade – he ran numerous new stitches through them.

As I write this, it is much cooler this evening having rained heavily in the middle of the day. It is blissful and I think I might treat myself to a quiet cold beer whilst the chidlers watch a movie on the laptop.

All in all, a great day.