Spiders
19th August
Anyone who knows me will know that when it
comes to irrational and life-limiting fears, spiders are my Achilles heel. So when it came to the question of Giant
African Spiders, essentially I just flipped into Ostrich Mode- I mean, I could
have done some pre-trip research but seriously, what would have been the point? “Sorry, Kambia Appeal, I was really keen to spend six amazing and
life changing months volunteering for you, but I’ve just google-imaged ‘The Spiders
of Salone’ and almost had a heart attack so…….. I’m gonna stay in Blighty if
that’s ok….?”*
So, what’s
to do? There’s only so many times I can come screeching out of the
latrine and wait, arms folded in the
pouring rain, to be rescued by Ibrahim (the master spider catcher) or Abbas
(less skilful, but armed with super-strength Raid and a cheery smile ‘Oh, Kate,
no worries, that spider, he can easily die!’) And, of course, what happens when there’s
no-one to help me? Trembling in the dead
of night (from impending bladder rupture,
likely as not!), fateful imaginings
taking flight….… Pincer fangs dripping with foul poisons! Abdomens bulging with
a million translucent spiderlings! Glittering eyes!! Thick hairy legs spanning
wider than dinner plates!!! All lurking,
waiting to pounce and devour me eyeball by eyeball!!! Honestly, what kind of self respecting toilet
allows itself to degenerate into some kind of hideous Shelob’s Lair?!!
These thoughts, they trouble me. Essentially the only solution available is not
to look for them. Back of the door, ok
sure-can’t have the escape route blocked off- but then-glasses off, squint a
little, focus on my shoe, just the shoe, nothing else, definitely not the walls
or the window ledge and definitely ,definitely not the ceiling. I know they’re
there but if I don’t look too hard I can cope, I can survive.
And do you know? I caught myself thinking
today that it’s really not all that different at the hospital. There are so
many issues, so many problems (chiefly stemming, I think, from the double
whammy of scant resources and a lack of effective leadership), that a forthright
appraisal simply serves to generate a
slice of instant apathy with a sprinkling of mild paralysis to go. But a squint, askance in the face of all the
chaos, and certain things, certain people start come into focus. Things that work, things that almost work,
things that can be changed and people
who are trying to make it happen. So you
pick your battles. Cleaning the wards
and getting observation and drug rounds going are our top priority this week,
and Victoria’s been working hard on getting the malnourished kids fed overnight
(and in the day!) Later I’ll think
about other stuff like antibiotic use and blood transfusion policies.
Having said that, we have been to the last
two weekly staff meetings. These, I
gather, are a sort of emergency measure
put in place by the District Medical Officer, trying to keep things functional until the new Medical Superintendent arrives
(date TBC). On one level this stuff is
almost out of our remit, but then again, it’s proving an invaluable way to not
only to show willing, but also of acquiring vital info-who’s supposed to clean the wards, how to order more antibiotics or blood
grouping reagents when the paeds ward runs out, how to get the generator on for
emergency oxygen…..just little things, you know J It’s
also quite handy for identifying who’s pushing for change behind the scenes, so
to speak… And lo! More ampicillin did descend from the heavens, and the
chlorinated waves did part upon the freshy scrubbed floors!
Maybe that’s enough about the admin for
now-time for some clinical snippets (at this point I’d just like to apologise
if any of the following is utter gibberish to non-medics…) Case of the week was definitely the women,
two weeks post partum, presenting with acute ascites (fluid in the belly). There aren’t
many tests here (understatement!) so after much chinwagging and
belly-prodding we tentatively agreed that the most likely cause was a clot in
one of the veins draining the liver (James was convinced that she’s taken some pro-coagulant ‘native
‘erbs’ featured in the Trop Med handbook!) Which was pretty bad news for her, given the
complete lack of any treatment options. Nonetheless,
we did drain some of the fluid, partly for her comfort but thinking also to then
send it for dipstick and
microspcopy. Well, oh my goodness-I’ve
never seen anything quite like it- two litres of frank pus, the colour of
rancid custard, almost too thick to even aspirate…..tuberculosis, surely, but
that’s not what the book said it should look like…nobody was really sure…. Mr
Francis was duly summoned -had he seen anything like it during his 20 years
manning the hospital laboratory? Yes, yes he had-TB. And- get ready for the really crazy part-having
a belly full of pus was actually a good
outcome for this poor woman, because TB is treatable and, more to the point,
the drugs are free. It’s the same with HIV-in a topsy turvy way making the
diagnoses can actually seem like a positive step (although how much of that is just
the comfort blanket of a definite diagnosis-so rare here-with a definite
treatment I don’t quite know).
Incidentally nobody here will actually call it HIV-VCCT, RVS, ‘slim’
–honestly it’s almost like something out of Harry Potter-The Disease Which Must
Not Be Named…
Over on the paediatric ward things are
ticking along-hearts were heavy when we couldn’t find a child who’d been
brought in sick as a dog the previous day, only to discover-joy of joys!! that he was simply so much better, transformed by a quinine drip, that he was recognisable
only by the puncture site where his cannula had
been!! It’s not always such a happy ending, but when it is it really does make it all seem
worthwhile. Erm, what else…a live
chicken joined the ward round on Wednesday after Sister purchased
it from a relative!! I’ve also had my
first taste of the operating theatre.
Anaesthesia was just ketamine and
diazepam - very disconcerting to be sat holding up the jaw with one hand,
feeling for the pulse with the other, the patient still wriggling about eyes wide open! There’s a sphygmomanometer, an oxygen
concentrator and a sats probe but that’s it.
No ventilator and nothing to intubate with anyway. It was scary, definitely, very scary, but Sister
Conteh, our nurse anaesthetist, knew what she was about. Knew the limitations of the technique, too, lamenting
the lack of even basic equipment, but I guess at the end of the day these were
life saving operations (caesarean and strangulated hernia)-and both those
patients survived.
In other news we’ve also started teaching
the CHOs this week (community health
officers-they take the role of doctors after
2 years training) and are on schedule to start the Volunteer Nursing Aide
program a week on Tuesday-the posters are up and ‘sensitisation’ (African
buzzword) has begun! Natasha joined our
merry band last Sunday and the three of us-Suzanne, Tasha and myself, are keen beans to crack on with training now,
as it just seems by far the best way to improve things. On a sadder note-James and Victoria are
entering their last week here in Kambia-next week we’re all going down to
Tacagamu chimpanzee sanctuary for the weekend but then they’ll be off back to
the UK and we’re gonna miss them lots L
Right then, Ramadan ends today and there’s
a party in the offing-I can smell it! So it’s a fond farewell from me ‘til next
time. Loving you all, God bless,
Kate
*Salticus , the ‘Tarantula of Rolleston’,
your reign is ended!
