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October 4th 2012
Published: October 4th 2012
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Hi all,

So I thought I'd update you on my week since my very eventful Sunday!

Monday we spent time on the ward doing the ward round and reviewing patients bloods as well as admitting new patients. I saw a patient with huge ulcers on his leg, quite impressive but that wasn't why he'd come in, he was short of breath. It was a lovely sunny day on Monday so after work I walked to traffic lights to get some money out and then went to the beach to go to Solomon's restaurant for dinner. I had a lovely walk along the beach, only getting hassled once by a very persistent guy who told me that he wasn't a bumster, in response I told him he was acting like a bumster and to leave me alone, that seemed to have the desired effect. Dinner was nice, I had chicken Yassa, this was spicier than the one I had had in Sanyang but still nice. We saw a great sunset too and I found some pretty shells on the beach.

Tuesday was Old Jeshwang day, we got there with no hitches which was good and I spent the morning with the midwives seeing ladies for antenatal care and family planning. They had no electricity all morning so no fans which meant it was boiling hot!! We got back and went to the ward to help with admissions and jobs then listened to the journal club which was 2 people reviewing different papers with us. I think the majority of it went over my head talking about different genes and chemicals but the 2nd paper was talking about when to remove cannulas which was a bit more relevant although not that much more interesting. Nisha was on call in the evening but we had been fairly efficient so she got home not too late. This turned out to be a bad omen and she was called into the hospital a lot overnight. A child died and an english man in his 70's had a heart attack and went into ventricular tachycardia, very scary for her but she managed to sort it out. Meanwhile I went out with some of the girls to butchers restaurant to have a drink and some cake, very nice way to spend my evening and we brought nisha back some cake so i didn't feel quite so bad.

Wednesday I went to Royal Victoria Teaching Hospital in Banjul. This was my first real experience of African medicine as it is a very resource poor hospital. I was lucky that there was an English doctor working for voluntary services overseas working here so I was able to go round with her. The majority of the consultants are cuban and don't speak that good English which make communication difficult. The house officers are generally local and work very long hours. The VSO doctor explained that she wanted to do lots of teaching with the junior doctors as she feels they are given too much freedom and not enough guidance which makes some of the things they do quite dangerous at times. We went on a ward round on the neonatal unit, I was surprised one existed but I saw that a lot of babies get sick when they are first born in Africa. There were 28 babies on the unit which comprised 3 very small and crowded rooms, the babies had their own cot if they were lucky but if they were small/premature the babies often shared a cot. The mums sat on chairs next to the cots but it was extremely crowded. There was 1 nurse in the whole ward, she was responsible for all the babies as well as translating for us if we needed it. It was definitely different. I didn't see anyone except the english doctor wash their hands and aseptic technique or even clean technique for inserting cannulas and doing lumbar punctures were definitely not seen.

One of the babies had hydrocephalus and had a huge head, it was nothing that I had ever seen before, the sad reality is that the baby will die and there is no one that will operate on him to save him. Another baby stopped breathing during the ward round and had to be resuscitated twice successfully, I discovered this baby to be dead when we came back from lunch, but I had been warned that the baby would probably die. There were quite a few premature babies, a few as early as 24 weeks, they were extremely tiny and went in an incubator with 2 other babies, the incubator was not on, they were not dressed, they did not have nappies on. They had drips and were recieving antibiotics but they were not being fed and therefore were not putting on weight but I was amazed that these babies were still alive having been born so early. We went to see the general paediatric wards as well were there were a lot of children with malaria. There were also many children sharing beds normally about 3 children to a bed. This just proved to me that what we see in the MRC is definitely Africa lite as they have much better resources at the MRC as well as more physical bodies to help. It is a massive task for the VSO doctor to try to help this hospital and to leave a sustainable change when she is gone as she is mainly being used as an extra body and pair of hands.

In the evening I went to senegambia to see the craft market and comissions some things to be made for me, however the man was not there. I got back just before the thunder and lightening started thankfully or I would have been soaked! We waited until the rain stopped before going to Mama's for dinner. I had had Domoda for lunch (ground nut and tomato based sauce with rice and chicken that was more bone than anything else) so I decided to chose chicken in garlic sauce which I knew was nice. We then made our way home before it rained again! The thunder and lightening seemed to be stopping everyones phones working and the internet as well which was annoying some people, it seems to be better today however.

Today (Thursday) I had been on the ward round and done a few of the jobs, mainly the discharges. Everyone is saying they will miss me when I am gone because they hate writing discharge summaries and I have taken that on as one of my jobs. I asked to finish early today as I had to meet Genevive who is one of Dr. Laing's researchers at Old Jeshwang. She gave me some of the completed forms for her research . I then got a taxi to Senegambia again and this time so the man I was looking for so I am now going to call him on tuesday to see if I can pick my things up, I am excited. Other than that I am now sitting at home writing this blog and thinking about what I might cook for dinner.

I will write probably on Tuesday about the weekend and my last few days before I come home. Hope everyone is well and the autumn weather isn't too horrible!

K x x x

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