Just Another Day

0800h – morning report from the night shift nurse.

0915h – ward rounds. I am in the female ward for these two weeks. Most patients in the hospital only speak the local language Bemba. For the entire ward round, I have to rely on the nurse to translate for me. History takes twice as long to take, sometime a seemingly simple question takes ten minutes of back and forth between the patient and the nurse only to get a two-word answer back. What investigations to order? It’s really simple. The lab can only do full blood count, ESR, specimen microscopy, culture, and sensitivity, random blood sugar, urea and creatinine; forget about liver function test, blood chemistry, or those fancy tumor markers, they are either out of reagents or they don’t do them at all. The only imaging available are x-ray and an ancient ultrasound machine. There is no ECG machine, no spirometer, not even a torch for checking pupils. So I am learning to manage patients purely based on the clinical picture. Empirical treatment rules!

1140h – go to the lab to get results ordered earlier. Find out that reagents for full blood count are running low, so are test strips for the glucometer.

1150h – check with the pharmacy to see what kind of proton pump inhibitors they stock. They don’t stock any. I can get some cimetidine if I want. Also, normal saline stock is running low; although I can get all the Ringer’s lactate I care to drip down patients’ cannulas.

1235h – finally out of the ward. Lunch time is officially 1200h to 1400h.

1405h – go to anti-retroviral therapy (ART) clinic. I sit in with a clinical officer as he sees HIV patients who are either starting on or continuing with ART. Frustrations all around as patients have not been able to follow the instructions on how and when to take their medications. A young mother from one of the islands of the big lake comes with her eight-month-old baby, both of whom have just been tested positive for HIV, to start treatment, although people from the islands tend not to come back after only one visit. Someone has sent a neighbor to pick up the medication for his five-year-old son, even though he knows patients have to be reviewed each time before new meds are given. An HIV-positive woman on ART tells of her husband who flatly refuses to use condoms or to come in and get tested. Long discussion with social workers ensues; home visit is planned.

1655h – ART clinic over. Head back to ward. A newly arrived patient is waiting for review by the medical officer. Another round of playing telephone with the nurse and patient. Admit patient, get ready to go home.

1740h – a wardie tells me Dr. P. is looking for me; he is waiting for me in the operating theater for an emergency surgery. The surgery is for a 36-week pregnant woman with placenta previa. The surgery is straightforward. Both the baby and mother are fine. Dr. P. sutures up the uterus and leaves me to close the skin. As I put in the last stitch and slap on the dressing, power is cut. One of the nurses turns on her mobile phone and we clean the patient up under the faint blue glow of the phone screen. I help the nurses push the patient back into the maternity ward.

1950h – I am back at the guesthouse. Famished and parched, I wolf down my dinner in candlelight.