Monday, 19 October 2009

Treble Trouble

Hi peeps. Another week of wonder in Uganda! It was a week of undiagnosed multiple pregnancy last week, which is a recurring problem here as significant majority of women do not have a scan in pregnancy. On Tuesday I diagnosed a set of twins at full dilatation who had not delivered after a significant period of time and the history didn't fit. I'm really beginning to trust my hands to tell me what I need to know. Abdominally it was not that obvious, but I could feel two distinctly separate amniotic sacs, one containing feet and the other empty. Alarm bells went off as this was a multiparous woman who really should have delivered by that point, with the leading twin a footling breech and the second twin probably cephalic... I had visions of locked twins. She was delivered by section and essentially neither twin was in the pelvis. It was liberating to not run to the cupboard and grab the scanner!

A bit later on after spending the morning in the admissions room having limited success with my appalling Luganda, I went back to the high risk side where I found the specialist delivering what was thought to be another set of undiagnosed twins. Between us, we delivered and sorted no fewer than 3 healthy babies, and I felt pretty comical walking with 3 children in my arms to the scales, trying to remember according to the pattern on each blanket, which triplet was which. It was a little bit like pulling rabbits out of a hat! And of course it hammered home why all the manuals for resource poor obstetrics bang on about checking for a second and third baby before giving oxytocin. The patient was expecting one baby, and the look on her face was one of sheer bemusement.

We had a big discussion on Thursday about triage on labour ward, which is not a concept that exists here, but is desperately needed. A lot of people in the meeting got quite excited, and myself and one of the specialists went to the labour ward, moved some equipment around and created a new admission room. This will hopefully pave the way for the triage system, which will in turn empower the midwives to see and treat straightforward cases, referring only women who really need to be seen by a doctor, and categorising those women so that the most urgent or complicated cases are prioritised. Hopefully this will lead to a more streamlined service ensuring that haemorrhoids and haemorrhage are not treated with the same level of urgency. It will be a simple system of traffic lights, as is pretty standard, utilising coloured boxes for the notes to be placed in. We are also going to look into acquiring a whiteboard to help prioritise theatre cases and stay up to date with each case that is awaiting intervention. These are simple systems that I hope will be effective. Implementing them will require a lot of energy and input but I think a lot of people feel very strongly about this project and I really think they could improve the patient's experience.

I've been kicking around Kampala this weekend, sampling some more of its fabulous restaurants. We went 'over the tracks' to the South of the city centre on Friday for Ethiopian food, but the restaurant we were hoping to eat at had finished serving food - at 745pm! We stumbled across a 'local' Ethiopian restaurant where we were told that we would be eating the mixed platter and that we could have beer but they'd have to go out and get it. Either way, the food was great, and we paid 19000 shillings for all 4 of use to eat and drink beer - which is basically £6 for the lot! Will we ever find it again? I doubt it very much... Saturday was spent chilling with housemates and Sunday was spent writing the triage proforma and cooking meat on coal!

This week I'm back on Oncology, and am looking forward to getting into theatre tomorrow.

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