Holding Down Fort

Both medical officers at the hospital are away these couple of days. So I am the only “doctor” around – a pretty scary thought to me, even though the patients don’t know any better. Fortunately, all the nurses in all the wards – male, female, pediatric, maternity, and labor wards – know what they are doing and are always there to save my skin.

I spend these couple of days on ward rounds. The nurses on each ward go with me from bed to bed, translating and generally helping me communicate with those patients who don’t speak English, which is the vast majority. They recommend which patients can be safely discharged, but give me the power to sign the discharge card. They write down in the drug chart the medications I order and gently remind me of the correct doses when I get them wrong. Just like that, I slowly go through the wards, reviewing those who are staying, discharging those who can leave, and clerking new admissions.

By now, I am fairly familiar with how everything works in the hospital. I have learned to live with the limitations of various departments. Want an x-ray? Better order it while there is power and get the patients to the x-ray department right away; you never know when power is going to go out. Want to order a particular medication? Better check with pharmacy to see if they normally stock it; even if you know they do, still check, because they may have just run out of stock. Want a lab test for anything? Better check with the lab, because they can run out of reagents for even the few tests they can do. Want to refer a patient to the provincial hospital? Just write the referral letter; you never know when the hospital will have a vehicle going to Mansa, it could be tomorrow or it could be next week. It can be frustrating sometimes when you know a certain medication can give a patient so much relieve or keep his condition under so much better control, only that the medication is still under patent in the West and there is no way any of them would be able to find it or to afford it. One way to keep your sanity is to tell yourself that you have done your best for the patient under the circumstances with the tools available. It may sound defeatist or fatalistic, but here, to have the expectations from life we take for granted in the West is not only wildly unrealistic, but also a sure recipe for one’s mental implosion.