I’m on-call tonight for the hospital, and its not been outrageously busy so far – a young child with cerebral malaria causing fits and needing a blood transfusion, a fifteen year old with EMF (EndoMyocardial Fibrosis – an extremely rare condition in which children develop severe heart failure, and are admitted every few weeks to drain fluid which accumulates in their abdomens!), a young woman with pneumonia who is likely to also have HIV, an older child with diarrhoea, vomiting, cough and fever who is likely to also have cerebral malaria… Not too bad so far, but unfortunately I’m likely to be up through the night doing caesarean sections. There are two women in our labour ward who have been in labour for some time, but are not progressing. We’ll reassess both at 1am, but I suspect it may be a busy night in theatre! Well, I did warn you at the end of the last blog that I’d probably be a bit more medical this time!
The title refers to one aspect of my work here that is part of my normal repertoire! Yep, colorectal surgery! Our clinical officers (A&E doc or GP equivalent) don’t seem to be particularly good at diagnosing anal conditions, and I keep getting referred patients “Admit for Haemorrhoidectomy”, who actually have no such thing. In fact in the UK, we rarely operate on piles, as there are other less invasive treatments that usually work. However, I actually have yet to see a patient with decent piles here! The ones who are referred are suffering from a simple bit of excess skin (no treatment required), a small bruise or perianal haematoma (settles by itself), or an anal fissure (incredibly painful and usually treated with a special cream in the UK, but here requires a bit of a stretch!!!).
The difficulty I have is that I want to properly examine the patients, but it is difficult to see the lining of the tail end without the correct equipment. So, I have ordered a special tube and light called a sigmoidoscope, over the Internet that will hopefully be brought out to Uganda from the UK by one of our next visitors. I’m looking forward (perhaps that’s not quite what I mean) to being able to better diagnose and treat patients, and then also to educate the other docs and clinical officers on common colorectal conditions. I have some tutorials that I can use, and it’s good to have identified a simple difficulty/problem that I can easily sort out and train others in. After all, that’s a large part of why I’m here.
Can you tell I’m feeling well rested and cheerful after a good weekend off? Actually Saturday afternoon was quite exciting. I’d been in Kampala in the morning shopping for food, which was a surprisingly successful trip and I had a pretty full rucksack! On the way back in the matatu (share taxi-minibus) the heavens opened and we were completely deluged. Unfortunately I was sitting in the wrong seat and at one point had to get out into the rain to let someone else out, and boy was it wet rain! On this occasion I had to change at Luwero, the town on the main road after which its dirt road for 16km to Kiwoko. The next transport along was actually a car-taxi rather than a minibus matatu, so seven adults and four kids plus my rucksac piled into this rather small saloon car for the journey! I wouldn’t really have believed it possible to get so many people so far in so small a space! The exciting part of the journey was that every so often we would pull into the side of the road – to let a speeding rally car fly past! The “Pearl of Africa” Rally is on at the moment, and the stage for Saturday afternoon included the main road to Kiwoko. Of course, this being Africa, they didn’t close the road to traffic at all – that would spoil the fun of dodging other road users and pedestrians! However, for all those who have commented on my driving in the UK, I have now actually been on a rally drive course during a race…..and lived to tell the tale.
Anyway, I hope life is bright wherever you are reading this, and that you are enjoying what I’m told is unseasonably good weather in the UK. Apologies for any errors here – my mother had the kindness to write this week and tell me off for several spelling and grammatical mistakes in my writings…. And I can’t even use the excuse of typing in the dark any more!
Please keep Kiwoko hospital, its staff and patients in your prayers.
Steve
No comments:
Post a Comment