Wednesday, 25 November 2009

The winds of change...

It's been a funny old week and a half. After the exhaustion of painting the labour ward, I was quite relieved that last week ended up being, for the most part an 'admin' week. That's not to say that I sat on my bum, in fact far from it. I spent time working on a funding proposal, attending a brainstorming session on how to improve the department so that it is more effective and efficient, with a direct impact on maternal and neonatal morbidity, doing a bit of teaching and helping to facilitate a course for midwifery staff aimed at empowerment, teambuilding and management of normal labour.

There's a huge amount of enthusiasm in the department at the moment, to change the way things are done. We're talking about everything from strategies for decongesting labour ward, setting up specific clinical areas and concepts to changing the way all staff work, initiatives to encourage teamwork and so on. A lot of it is a pipedream at the moment, but it's an achievable pipedream. I have no doubt about it. I can feel the process gathering momentum, and it feels like the winds of change are starting to blow the tumbleweed out of the department.

The other stuff I've been busy doing, is preparing for the invasion of Liverpool Women's Hospital - something I'm really looking forward to. There are 6 people coming out here next week. The group who have recently gone to Liverpool from Mulago had a great time, and have come back full of ideas and drive, to improve things on labour ward. The follow-up visit from Liverpool will add to these ideas. One of the things we're hoping to do while they're here is to set up a practical emergency skills training morning for the labour ward midwives. If this is successful, I hope that it can become a department wide, regular thing. It would be a fantastic opportunity to get doctors and midwives training alongside each other, and would help to foster the team approach to patient care that we badly need.

In between all of this I found myself on labour ward off and on, getting stuck into emergencies, while finalising timetables and the like.

Sunday was the Kampala Marathon. Since my good mates here are a bit weird, and like running for fun - I'm the kind of girl who would only run if I was being chased by something likely to kill me - I was duty bound to go and shout for them. On the face of it the Marathon seemed well organised. I decided to go to the finish line around the time I was expecting Elizabeth to finish the half marathon. Which was too bad, as it would seem that everyone running the half marathon went the wrong way and ran a route around 3 miles shorter than it was supposed to be. That coupled with the fact that competitors were hopping on the back of boda bodas to improve their times suggested that all was not as legitimate as you might expect. Justus - who lives in our compound - and I stood at the finishing strait. It was a brilliant people watching experience. The vast majority of people doing the half marathon and 10k, were evidently not serious runners, but people really doing something for themselves, for a sense of achievement. Some women ran in traditional dress and sandals, one guy ran it in socks, a number of people with significant disabilities, including one Batwa lady with severely bowed legs and another lady on crutches, competed. It was a truly inspiring morning, and for about 37 minutes I seriously contemplated taking it up as a hobby.

We were waiting for Adam to finish the marathon. They started to dismantle the barriers. And people started to walk across the finishing strait. And they opened the roads. And the cars came down the finishing strait. And there was still no sign of him. Or any other marathoners. Eventually in the distance, his lanky frame came lumbering towards us,, dodging pedestrians and traffic with a look of absolute exhaustion on his face, crossed the finish line - which by now we were standing ON, with the official photographers - and exclaimed that it was 'the most pain I've ever been in'. None of the proverbial there, Holmes. And then he got on a bus for 6 hours. Nutter.

On Monday I had a major victory at the passport office. Finally, I've been granted a work visa. That's not to say it was a stress free visit. Oh no. When you apply for your work visa, you have to go back after 7 days to see if your file number is in the book. What that essentially means is that it takes a week for your file to cross a corridor, and someone writes a (sequential) number on it and records it in a book. You then return and have to trawl through a list of numbers to find yours - which is not easy when they're all similar. You then cross the courtyard to 'room 2', where you are then advised to look for your number in another book. Unsurprisingly, your number will not be there. Nor will it be there the next 5 times you go back, even though each time you've been, you've asked the 'nice' lady behind the desk and she's told you 'next week'.

Needless to say that when I returned on Monday, my number still wasn't there, and decided to check with the 'nice' lady behind the desk, as I was concerned that the file may have been lost. The 'nice' lady behind the desk, must have gotten bored of being deliberately obstructive, told me there was no way it could be lost and sent me to speak to a man in 'room 10'. The man in 'room 10' then sent me back to the place where I'd originally picked up my file number, to find out what date the file had left this office, presumably in the direction of 'somewhere across the courtyard'. Once I had this, I went back to him. He looked through several lever arch files, several times, huffing and puffing. I was sitting there thinking about my next move and whether I was going to be looking for locum work back on sunny Merseyside in a few weeks. Eventually he located my file number, stated that the work visa had been granted and it was in the book. So I told him that it wasn't. At this point I was seriously getting worried. He wrote something illegible on a post-it note, to take back to the 'nice' lady behind the desk. She barked an order across to a man who fumbled through piles and piles of similar looking and chaotically organised files, and exclaimed that it wasn't there. The 'nice' lady looked at me, semi-sympathetically, and stated that my file 'must be lost'. She must have sensed my frustration and got someone else to double check, which was great, as the file had been there all along, and probably for the last 6 weeks. So I handed over my passport, and I have to go back next week. It feels like the kind of scenario Swann and Flanders would write a song about...

So far this week I've been on labour ward. Yesterday I kicked off my shift with a rapid forceps delivery in the admission room on a woman with a massive bleed, and a fetal bradycardia of 40 beats a minute. I realised I was doing something out of the ordinary when I asked the midwife to bring me a pair of forceps, to which the response was 'What, artery forceps?'. We shuffled the examination couch round, I ran and grabbed some stuff, and in the smallest space I've ever done an instrumental in (sitting on top of a dustbin), delivered the baby who came out screaming (thankfully). What I didn't realise until the patient stood up was that she was around 4 feet tall with a significant kyphosis. Forceps are not commonly used here, and when they are it tends to be by the old school consultants, but the vacuum extractors don't work. It's a skill I hope to pass on while I'm here. The range of pathology you see in one shift here is quite something, and no two shifts are ever the same. The rest of yesterday and today were surprisingly calm by Mulago's standards, and I spent quite a bit of time in the admission room teaching the interns. And I have finally mastered the trick of doing an ARM at 2cm with the plastic end of a needle!

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