Sunday, 15 November 2009

It's no Michaelangelo....

So it's been an industrious couple of weeks, where lots has been a achieved, decided and attempts have been made - although not necessarily successfully - to implement. Following fun times on Ssesse, my week was filled with ward cover on the antenatal ward, working very hard on the triage documents and getting them circulated onto the labour ward, trying to train the midwives in their philosophy and usage and then realising that without getting a critical mass of people on board, triage will not succeed. One of the problems is that where the midwives are using the instrument, the doctors sometimes aren't, the rooms are sometimes hijacked by patients who see an empty bed and want to lie on it, or there are simply not enough staff to run it. I've already had some decent feedback on the documents though, mostly positive, and we need to do a little bit of fine tuning and more intensive training and supervision.

Last Saturday, myself and some very generous volunteers trundled off to the labour ward armed with buckets, rollers and tins of paint to freshen up the high risk end, which was in desperate need of painting. It was an eye-opening experience for all of the people who volunteered. The labour ward was heaving, as ever. We decided to paint the smaller rooms first, as the large room was simply too full and the patients were too sick. Opting for an oppressive shade of forest green for one of the rooms, Adam, Jill, Julia, Maureen and I set to work masking the skirting boards and windows, mixing the paint in a futile attempt to make it lighter and the slapping the paint onto the wall. I say slapping as it had previously been painted with what looked suspiciously like gloss, making it difficult to get any purchase. Meanwhile, Elizabeth, Sungo, his girlfriend and their 8 month old daughter tackled the admission room and the neonatal resuscitation room painting it a slightly more pleasing shade of baby blue. In my journeys from the green room to the blue rooms, I got involved in more obstetrics than I'd planned to, resuscitating two babies and sending one woman to theatre. The experience, understandably, was a bit too much for some of our volunteers and by the end of the afternoon we were down to 4. We wrapped up around 6, went off and had a debrief involving some Mezze and wine, and went on 'debriefing' until shortly before 4am.

On Sunday I attended a wedding introduction, where I was required to wear traditional dress in the form of a hot pink Gomesi, complete with huge shoulders. Apparently I was 'very smart', although I'm not entirely sure about that, especially as my housemate's Ugandan girlfriend was nearly sick laughing when she saw me in it. It was a privilege to be invited and I was made to feel very welcome, given heaps of food and had the whole thing explained to me as it was happening.

Returning to work on Monday, our Forest Green was looking a bit patchy, and whilst we weren't aiming for a decorative masterpiece, we were still aiming for something to be proud of. The day on labour ward was consumed with seeing and assessing admissions and heading into theatre. We had a lot of sections pending when we arrived, and so managed to get the Oncology list halted so that we could utilise the gynae theatre. There is only one theatre on labour ward itself, so getting theatre space is often at the expense of the elective lists. Got home exhausted around 8, ate and crashed. Spent all day in theatre on Tuesday, this time entirely in gynae theatre as the anaesthetic machine in labour ward theatre was not functioning. We managed to get 5 sections done, including an impending rupture - an impressively oedematous bladder and a tight Bandl's ring were found, but fortunately no hole! Babies all did well, fortunately. On the ward round later one of the patients who didn't like the idea of being examined and wasn't getting a response from the Ugandan doctors looked me in the eye and wailed 'Muzunguuuuuuuuu'. The response from the team was that, 'You're clearly closer to God than we are'.

Wednesday I devoted to spending on the high risk side and just moved from patient to patient, pushing in fluids, dealing with PPH's and unrecordable blood pressures, doing assessments and running round organising. The highlight of the day was doing a breech extraction on an undiagnosed premature breech presentation, undergoing induction. I listened in and heard a bradycardia, found an unmistakeable set of testes coming out first and proceeded to deliver the baby according to what I'd learned on the ALSO course and from reading the MOET manual. Baby came out in poor condition, but picked with a few cycles of bag and mask ventilation and is happily screaming away on SCBU. My final patient of the day came up to me as I was leaving labour suite, grabbed hold of me with a vice-like grip around my hip, stated 'My baby is coming now, now', to which I responded 'What, now, now'? as she dropped to the floor next to the admission desk and pushed the baby out before I could get a pair of gloves. After yet another journey to special care I got home buzzing, for the first time in a while with a wonderful feeling of achievement knowing that I had directly saved three lives. Not often I ever got to say that back in the NHS.

Thursday was a day of admin and teaching, meeting Samir who was over from Liverpool on a cricket coaching trip, followed by the pub quiz, and Friday I was spent helping fill out a grant application for money to set up an obstetric HDU, which is badly needed. On Friday evening, walking through the go down with Adam to buy Avocadoes, he was on one side of the open drain inspecting the produce and I was on the other. He didn't think the avocadoes were quite ripe enough, but the stall holder was insistent 'THEY ARE READY!'. Minding my own business a well dressed woman came up to me and said 'Do you love Jesus?'. Taken aback somewhat at the lack of introduction before such a personal question I responded 'Everyone loves Jesus', in a 'What a ridiculous question' tone, whereupon she said good, and strutted off. I have no idea what her reaction would have been if I'd said something else!

Yesterday the surviving awesome foursome went back to labour suite to complete our stealth painting operation. We actually achieved a hell of a lot, completing the green room and then the larger room. We were painting around 8 women in various stages of labour and states of health and also happily plastered the walls with blue paint while the ward round, including women brought in from the corridor was conducted beneath us. We spent a large proportion of our day moving women from one corner of the room to another, but we managed to get two coats of decent looking paint on the walls. Our only casualty of the day was when Adam fell off the stool he was standing on the reach the ceiling, and painted a patient's forehead blue. I don't think she knew what had hit her. The midwives were great at shepherding women into 'safe zones' to prevent them being splattered. Some of the less uncomfortable patients also mucked in helping us to move bags, bedpans and all sorts. We had a really satisfying day! One more room to go... Any volunteers?!

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