I have been in Gambia for 2 weeks today. I can't believe the time is going so quickly. I guess that's why I havent written anything on here since last Friday.
Over the weekend nothing too exciting happened. On friday night after having a quick hot sandwich from a local bar we came home and chilled out for a bit. I then watched the boys play poker using cotton buds as poker chips, I still have no idea how to play! We had a few drinks and then went out at about 12:30am to a bar/club called Ozio's, it was really good fun. We danced for a few hours then decided to head home about 3am. Everyone was really friendly and it all felt very safe which I was pleased about, drinking is not a big culture in the Gambia so everyone was just enjoying themselves dancing.
On Saturday and Sunday what can I say, it rained and rained and rained and rained! I've never seen anywhere be so wet, we had thunder and lightening almost continuously and multiple power cuts, only for a couple of minutes though so nothing too bad. On Sunday morning in a break between the rain we were for brunch which was all you can eat and drink plus desert for about £6, very good food and very good value. After that more rain, I was glad when monday came around so that we could leave the house again.
Monday I was back on the ward, I did the ward round with everyone as well as helping out with discharge summaries and generally trying to be useful in any way I could. The lady who was very unwell on Friday sadly did not survive until monday but we found out on monday that as well as having likely liver disease she also was HIV positive which was further complicating things. It was all go on Monday, people come and wait outside the gates from about lunchtime sunday to be seen on monday so it is always a really busy day with lots of new admissions. There was an 8 year old girl who had 2 fits in the last 12 hours, I witnessed one which was kind of scary as I wasn't sure what to do, she was in a safe position and being closely watched by her father but the case certainly didn't recieve the kind of care I would have expected had a child come in in the UK acutely unwell like this. She has since been discharged after having a lumbar puncture which was inconclusive, I wasn't able to follow her case but it seems that she was much better as I saw her walking around the next day. There were 2 other interesting patients brought in that day. One was a 2 year old child who weighed just 7.5kg, he was severely malnourished and very weak and floppy. He smelled of urine and his skin was full of dry patches and abrasions. He had been brought in by his grandmother which was unusual but when we heard the story, his mother had just given birth not very long ago and had to stay at home and feed the baby. This seems to be a typical story, the mother has another child and the child above that child seems to suffer as it is not able to get sufficient nutrients. I have been meeting many women who have 7 or 8 children and are one of at least 2 wives to the father, it's a very different world. The other interesting case was a 70+ yr old lady who came in with fatigue and shortness of breath, in the clinic she had a cardiac ultrasound which revealed a pericardial effusion, I was lucky enough in the end to watch this lady have some of the fluid drained, what an experience that was! She was scared, none of the doctors spoke her language so she had the procedure explained very breifly by a nurse who wasn't sure what was going on himself, he was just a student. She was given very little pain medication, certainly not enough to put up with having a needle stuck through your chest. We tried to do the procedure in the procedure room and were lucky enough to have ultrasound guidance but it was decided that it was too small in that room after our first try with no success. This poor, frightened woman had about 10 people watching her and 2 different people sticking needles in her, they had 4 attempts in the end and only managed to remove a very small amount of fluid. She felt a bit better after this and I am pleased to say that today (thursday) she looked much more comfortable although not completely better.
In the evening 2 people were leaving after 3 months here so we once again when to our cheap version of Nando's and had a lovely dinner. There were plans for a late breakfast the next day to say goodbye but I knew I would be busy at work so I said goodbye that evening.
On Tuesday I sat in clinic and got to practice taking blood pressures which was a useful skill for me. We saw a very jaundiced man with a raised JVP and oedema and a swollen abdomen and a child with quite severe stridor who we admitted to the ward however he did not stay as the ward was full, he is coming back tomorrow (friday) to check on how he is doing. Other than that we saw a lot of people with hypertension and a few people with diabetes, I felt more in my comfort zone here however some of the blood pressure readings were quite scary, there was a man with a blood pressure of 190/160, very high. Tuesday evening we all decided to stay in as it was once again raining. We cooked pasta and watched tv as a group which was nice and chilled.
Wednesday was the day that Dr. Laing came to pick us up, we went on quite an adventure. She took us to the old jeshwang clinic where we will be spending some of our time, hopefully on a tuesday, this is where I am hoping to get some maternal health experience as the clinics are mainly midwife led. It was a nice clinic, totally funded by the Uk even some of the salaries, the government here has not held up their side of the bargin, they agreed to fund salaries after it was built but are currently denying this. Dr. Laing has a meeting with some people sometime this week to discuss this. she also took us to Serrekunda hospital which has recently started doing obstetric and gynaecological surgery, it was interesting to see the patients on the ward and to see where the theatres were, there was surgery going on so we couldn't see inside. They have also just fitted out a paediatric malnutrition ward with 6 beds that has teaching posters up on how to feed children so they are adequately nourished. The nurse was telling us that in the culture it is the father who gets fed the best meal and the children are fed the left overs, if a child is not able to push forward for food often it will not get fed. We also saw inside the A&E, this is nothing like I've ever seen before, heaving with people, hardly any space at all and very little staff, it is definitely very different to home. The last place we went was serrekunda clinic which is like the old jeshwang clinic in that it is nurse/midwife led, a lot of health education and public health type things happen here. We saw babies being immunised and breast feeding technique being taught. There was also a couple of wards and a TB clinic all of which are nurse led. There was a labour ward and we were lucky enough to hear a baby being born, 10 minutes later we saw the baby be taken to be immunised which was mind-blowing but efficient. The serrekunda clinic was the biggest contrast to the MRC, it was how I had originally envisaged Africa before seeing photos of the MRC, dirt floors, barred windows with no glass, very damp, no fans or air conditioning but it seemed to be in better working order than the old jeshwang clinic with much better record keeping and a much busier catchment. Wednesday had already felt like a long day as it was very muggy weather, we headed back to see if we could help on the ward at about 3:30 but luckily for us it was quite quiet so they told us to have the rest of the afternoon to ourselves.
I took the time off to go on a mission to the cash point, about 20 mins walk away from the MRC but in the muggy heat a little bit of a task! I only realised when I could see the cash machine that I had in fact forgotten my cash card very stupidly, luckily I had some money leftover so I didn't need to worry too much. In the evening we went to a nigerian restaurant, what an adventure. We walked with our torches in the rain to this restaurant, we weren't quite sure where we were going but eventually we found it, it didn't look very open. A kind guy on the road showed us where to go so we went round to the back of the house to this restaurant and the owner comes out in what looks like pyjamas, very sweetly she offers to cook us whatever we want but we decided it would be kinder to come back another day so we took her card and said we could call next time. This led to our next adventure, our kind guy led us to the next restaurant, it was thunder and lightening and rain, pretty scary in the dark and very slippy with the mud. After about 10 minutes we said thank you to the man and decided to cut our losses and get a taxi to a different place as there was no sign of this restaurant and we were hungry and wet. We ended up getting a taxi for just over £1 per 4 people to an italian restaurant. It ended up being amazing, such a good night, the Italian guy was so funny and we were the only people in the restaurant so he came out and told stories and jokes in between cooking our food, lots of fun! Eventually we got home, late but it was worth it, we got back just before it decided to pour with thunder and lightening again!
I feel like I have written a small essay, my word count at the bottom says 1900 which is about what I write at medical school for an essay so I should probably stop. I haven't spoken about today but I shall catch up with that probably on Sunday or Monday. I am now going to go in search of food!
Hope everyone is well.
K x x x
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