My first week in the hospital

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I have now completed my first week in the hospital here at the MRC. It's really nice and everyone is really friendly. There is a main consultant whose specialty is paediatrics but he looks after the whole hospital. When I say hospital it's a bit of an overstatement, there are 3 wards, a paediatric ward with 17 beds, a female ward and a male ward with about 10-12 beds depending on the number of admissions. The wards are simple, each bed is a single bed and a bedside locker. There is no wall oxygen or anything like that and no electric monitoring. There is one electric BP machine for the whole of the hospital, a definite contrast. The only thing that I think the hospital does better than the UK is the space that it leaves between beds, there is definitely more space between beds than in the UK.

Monday I turned up having first encountered a monkey eating breakfast while I walked to the admin office as well as the biggest snails I have ever seen, the size of guinea pigs if you can imagine it. I sat through the ward review which starts at 8am every morning, I didn't really understand what was going on as I didn't know any of the patients but I got used to the style of presenting and was introduced to the whole team. There are about 8 doctors of various levels from all over the place. In my accommodation there is a doctor who has just finished her F2 training and is taking a year out to do infectious disease medicine abroad, she is here until December. From the ward review I went to the clinic and sat with one of the nurses while he triaged patients, this was difficult for me as the majority of the consultations were spoken in the tribal languages mandinka and wolof so I didn't understand, the nurse translated for me when he remembered but it was very busy. From there at about 12:30 I went to join the consultant who was seeing some of the patients we had triaged so that they could be admitted to the ward.

At 2pm I had to go and get my ID badge made but when I came back I joined the doctor from my accommodation clerking in patients. We saw a baby who was very malnourished and dehydrated so we tried to sort out rehydrating him so we could start to make him better. We also saw a man who looked very wasted with a palpable liver that was painful who had been admitted a few times in the last few months, his diagnosis was probably hepatocarcinoma due to chronic hepatits. He was the thinnest man I had ever seen, he looked like he would break if you weren't gentle with him and he could no longer walk he was so weak. We admitted him so that he could have his diagnosis explained and to get on top of his pain. This man ended up having a liver biopsy to aid some of the researchers in their research on hepatitis as well as confirming his diagnosis, he was discharged today (Friday).

The Tuesday in the ward review I was more aware of the new admissions so I understood what was going on a little bit better. Very sadly overnight the baby we admitted the day before had died so that set a sombre tone for the review, Nisha (post-F2 doctor) spoke to the consultant about what she did and they decided that it was inevitable that this baby would not do well, he was too sick, they mother had presented so late. We got the culture results back on Thursday he had salmonella sepsis and meningitis so he really was a very sick baby. From the ward review I joined the ward round which was difficult as I didn't know what to do to be helpful but I got the general idea of how things work. I had to go and do security and IT training so I disappeared for a bit. When I came back I was able to help with ward discharges.

On wednesday I joined the ward round once again after the ward review where I was able to be more useful, filling out forms for tests and writing out results. Nisha tried to let me listen to a few patients chests and asked me some questions to help me learn but she is learning herself as well as trying to take histories through an interpreter so it was difficult. We then went to clinic to see a few more patients that hadn't been seen yet. A pattern that I noticed was that the patients that were being seen for follow-up all spoke english and seemed well dressed and had secure jobs, they were coming back for follow up of hypertension whereas the children being brought in by mothers tended to be very sick and malnourished, this showed a definite division in wealth/social circumstances. I was surprised to see people with hypertension and asthma on the wards, I súppose I wasn't thinking about it but I didn't really expect what I consider to be western problems to be here in the Gambia. That evening we went to a restaurant called Mama's, it's really nice and very good value, I will have to remember to start taking my camera places as I'm not very good at that.

On Thursday ward review then ward round again, I got so involved in the ward round this time that I forgot to go for my health and safety training and someone had to come and fetch me. It was a bit of a waste of time as most of it was self explanatory but I did learn how to use a fire extinguisher!!! In the afternoon I filled out more ward discharge papers, rang the labs asking about tests and then we had a lecture about the protocol for malnutrition in children, this was more aimed at the nurses but it has prompted me to do some reading this weekend. One of the people staying at my accommodation was leaving so we went out for dinner as a place called ngala lodge, lovely food, very posh place, once again I forgot to take my camera, also forgot to take my bug spray as it turns out that wasn't a clever move, i am very itchy today! A lovely evening at a lovely place.

Today (friday) I was in the ward review once more and the ward round. It was all go however there was a woman with an unrecordable blood pressure and billious coffee ground vomit that was causing everone a lot of worry so it was educational to see how that was managed. There was a very wide gap between here and the NHS, back in the UK there would have been every type of monitoring on, she would be everyones priority and all the nurses would be crowding around as it was all the nurses had the attitude of I'll get to it in a minute while the doctors could not agree on the diagnosis whether she was in septic shock or hypovolaemic shock or hypoglycaemic, the lab work was taking a long time as well. It turned out later on that there was a degree of all 3 types of shock going on and this lady was very unwell but they were sort of getting on top of it. I am going to be very interested to find out what the outcome is on Monday. The ward round took until 12:30 and on a friday the working hours are supposed to be shorter finishing around 12:30 though that was not to be for us. There was a 2 month old baby with an obstructed ureter so I got to assist with putting in a catheter, we had to use an NG tube as they didn't had a catheter small enough. I saw a lady have over a litre of fluid trained from her tummy. The patient who has continued to shock me all week has been a 34 year old lady who has type 1 diabetes, she is 31kg which is tiny, you can see every bone in her body and she can barely support her own weight. There is a lot of debate surrounding this lady as no one is quite sure the best way to treat her as there is a lack of choice when it comes to insulin. I am interested to find out the outcome of this lady too. The consultant suggested to me that next week I clerk a few of my own patients and take charge of them on the ward obviously under supervision so I can do some research and presenting of my own. I finally finished after doing some discharges at 3:30 only 3 hours later than planned and got home for some lunch and a drink, I was starving!!!! We decided to go into town to get some supplies for the weekend which was fun but the weather had other ideas, it poured with rain for a good few hours so our trek was quite wet and muddy but good fun all the same. We stopped at alaeddin's on our way back for some dinner which was nice and now I am sitting here writing this. It's been a really good week and I'm really enjoying it but I'm very interested to see what next week will bring including going to the Old Jeshwang clinic where I should hopefully get to see some pregnant ladies as well as children.

So this is what i've been up to for the last week, sorry it's all very medical, i'm also using this as a personal log so I have an idea about what to write when I get back to the UK for my poster.

Hope everyone at home is ok and yes mum I am taking care with the Gambian men!

Would be lovely to hear what people are up to, comment on my posts if you wish.

Bye for now, will write in a few days.

K x x x

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Comments

[Alice]

HEY KATY!!
Hi Katy!!! Just started to read your blogs but it sounds like you are having a great time and learning so much! I will read all the other blogs when I get a chance and will most likely comment! I'm back in Plymouth now and lectures start this week... Failed at freshers week because I have been so busy with meetings every day for this that and the other!! Look forward to hearing more about your travels xx