Wednesday, 28 October 2009

Uncomfortably Numb

I really wanted to update the blog this weekend. I couldn't do it. Not because I didn't have anything to write, in fact quite the opposite. I couldn't find the words.

Last week I spent a bit more time on Oncology. Again, there was a lot of advanced cervical cancer. I'm beginning to really get to grips with examination under anaesthesia and am trusting my hands more and more. There was no theatre list this week, as we didn't have a specialist available to cover. This was a shame as I have not yet seen any oncology surgery done here.

So why the difficulty in writing? I want to describe to you what I am experiencing, to present the bare facts, but I don't want either myself, or more importantly the unit to be misrepresented. Mulago is probably the biggest maternity unit in the world. The unit delivers more than 30,000 babies every year. The hospital was built in the 1960's, and the labour ward was designed to take 20 women at a time. There is a miwife led unit on site, which delivers around 8,000 babies, but even so, if you do the maths you can see that the numbers don't add up. Women are referred from clinics on the outskirts of Kampala, and from farther afield. They can be in labour for several days before they are referred to, or reach Mulago. Women who have had caesareans in previous pregnancies often don't attend hospital soon enough, coming in when the pain is too much to bear with an inevitable uterine rupture. Mulago labour suite deals with whatever comes through the door, just like any other labour suite. The difference here is that often, by the time these women arrive, the outcome is inevitable and beyond prevention. This is frustrating for all involved. The midwives and doctors are phenomenally skilled, resourceful and innovative people, who work bloody hard in extremely difficult conditions with limited resources. I admire and respect each and every one of them.

I spent Friday night on the labour ward. It was, without doubt the hardest shift I have ever done. I witnessed a huge variety of pathology that I have not seen before. The volume of work was overwhelming, even with two theatres running simultaneously. We walked the length and breadth of the hospital looking for blood. The house was heaving. By Saturday morning we were beat. Totally beat. I couldn't have slept even if I had wanted to. My head was full of mixed emotions, disbelief, anger, frustration, sadness, and a very uncomfortable and unfamiliar feeling of numbness and I suppose relative immunity to what I had been involved in. For the first time in my professional life I was acutely aware that I had deliberately emotionally distanced myself from something that would most certainly devastate me at home. Why? If I'm very honest, if I hadn't, I could well have been on a plane back home on Saturday.

Already I have learned so much, not only about obstetrics and gynaecology, but about myself, about what kind of person I am. I know that by the end of this year, I will have changed, both as a doctor, but also as a human being. Being here is a privelige and a humbling experience, and I'm so, so pleased that I came. And by next July, I really think that there'll be very little that scares me. Although I'm not sure I'll ever get used to cockroaches.

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