The aftermath of rain is very pleasant in the air but a problem underfoot. The roads are muddy and full of holes and puddles and the route to the hospital is getting worse each day. There are lazy soldiers all along the route but the lazy navy is something else. Truth is we are grateful to Sa’ad our driver for travelling so slowly – we feel very safe with him and the ride is more comfortable that way. He avoids the bigger waterholes as we never know how deep they are.
With the rains we expect mosquitos but they are still strangely absent. Nevertheless I brought my pesticide impregnated bed net and determined to use it as a solitary mossie can ruin a night’s rest as I found in Addis some years ago. I unpacked the protective netting but could see no way to suspend it over the bed – no poles, no wall hooks or lights or pictures, no convenient furniture or curtain track – and then I spotted a screw in the ceiling clearly put there for the purpose, but how to reach it? The only way was to balance a dining chair on the mattress, stand on tip toe with my finger tips on the ceiling to steady myself while slipping a clove-hitch over the screw with my outstretched free hand. The string was from a luggage tag on my suitcase and served the purpose well. Thankfully I didn’t have to bail out and leap to the bed from a falling chair but I was well aware the method would not have passed the first step of any risk assessment.
Today we began with ward rounds and clinical teaching. The round was conducted by a doctor from Khazakstan who speaks and writes only Russian. It was not a good learning environment and the staff complained to us. I am reminded of a visiting doctor in Cambodia who spoke only a little French and wrote his notes in English which the midwives could not understand. Good communication is obviously important for staff and patient involvement and safety. The first patient was delivering at 25 weeks after ruptured membranes for several days and I’m reminded of our own first child born at this stage who lived only a few hours. Our second patient was an emaciated lady with a chronic cough who has weight loss for 4 months, who delivered a scrap of a baby yesterday, and whose condition cries out “TB!” There were around 12 people on the ward round but no-one had a stethoscope! One was produced eventually and her chest was examined. There are many abnormal sounds – she will have a chest X-ray and the baby will have a BCG. Then we had hydatidiform mole, severe pre-eclampsia, secondary abdominal pregnancy and hyperemesis in rapid succession – plenty to discuss and teach on – before our mid-morning break and return to the classroom. Our participants are highly motivated and a delight to teach. They are a bright bunch and there is hope of improvement if they continue working here.
The animal conspiracy took a new turn today with an attempt on the part of the speed bumps to multiply. Shy Mr Tortoise has come out of his shell and Mrs T seemed well pleased with his attentions. We may have to wait awhile for the baby bumps and much longer for their contribution to traffic calming but here we need to take the long view …