I have been very busy lately (hence no updates). The main reason being that I have been attached to the maternity ward. It has been really good. I've been able to do some normal deliveries and observe some abnormal ones. I have diagnosed twins, using the ultrasound was very fun. I have listened to the chests of countless coughing babies and resuscitated a prem.
I also observed a destructive extraction. A woman arrived from the Congo border having had seizures at home. By the time I saw her she was unconscious and unfortunately her baby was dead. She continued to have seizures despite a huge dose of diazepam. To complicate things further she had bad CPD (baby too big, pelvis too small). The midwife tried to do a vacuum extraction then called the Dr to do a craniotomy and forceps extraction. It was awful. I will never get used to the sight of a dead baby.
However, after another huge seizure, lots of phenobarb and a four day coma; the woman woke up, declared that she was hungry and demanded meat. The fact that she walked out of hospital under her own steam was an answer to many prayers.
I continued on maternity for the start of this week. Then Clement the paeds nurse went away for the day and asked me to run his ward for him. (he was supposed to be back that afternoon) two and a half days later i was still running his ward.
Meanwhile the head Dr got very sick with uro-sepsis and then nitrofurantoin lung (well we think it might have been that) and then c. dificile...
The end result being an emergency evacuation to Jo'burg. And as the medical lear jet couldn't land at Kalene Justin (the other Dr) had to go with him to care for him on the way. They went in a Cessna to Lusaka then the jet to Jo'burg. Luckily he had stablised in the 24 hours that it took to organise the evacuation and coped with the cessna trip well.
So... are you spotting a problem?
No Doctors left at Kalene.
Well not quite. They had managed to fly a Dr from another mission in on the morning that John and Justin left. He's a plastic surgeon from Hamilton.
But... guess who got to show him around, and organise him to do the theatre list, and assist with the first case, and find the ill patients that needed seeing... all the while still running children's ward!
Today was even more insane. Starting with a 6.45am phonecall 'we can't get hold of the midwife and there's a woman that's fully dilated and refusing to push'!
I found the midwife.
Then got a phonecall to say "there's an infectious disease specialist coming can you organise patients for him to see tomorrow morning"
Went to hospital.
Woman in labour, no one around, midwife not there yet. FHR 80 (without a contraction)!!!!Head nearly on perineum.Luckily the midwife turned up and a vacuum delivery + large episiotomy later I got handed a gasping meconium smeared baby. (who seems to be doing fine now)
And this is all before 8am.
You get the picture. The rest of the day continued on a similar vein and included an earful from on of the Zambian nurses (he didn't like the contents of the message I was passing on), a 3.5 hr paeds ward round and a dying patient among other things.
Oh and I also had meconium on my foot for 2 hours before I noticed (and it was another two hours before I had the chance to wash it off :)
This elective sure is exciting.