Differences.....
on Shona in Sierra Leone (Sierra Leone), 06/Mar/2011 14:46, 34 days ago
Last week I was in a shared taxi carrying a total of seven people: the driver, two children in the front seat, a man with another child, another man and me in the back. None of us were wearing seatbelts.On my last day working at the JRH in Oxford last year, a family came in having been in a road traffic accident on the M40. There were three children and four adults in that car and none of them were wearing seatbelts. The youngest child was seriously injured (but survived), the others were luckier and not injured so badly. I remember being so angry at the parents for putting their children at risk like this. That family had just moved to the UK from a less developed country and did not know the law (or a bit of common sense when you’re travelling at 70mph) and it was clearly a cultural issue.It got me thinking about other differences between Freetown and Oxford, especially ODCH and the JRH.1) The public perception of the definition of ER (Emergency Room). In the JRH parents bring their children in with snotty noses. Here the children are triaged as proper emergencies before they arrive in the ER.2) The definition of ICU (intensive care unit). The children here are just as sick as children in PICU at home (or, more likely, sicker). Clearly our facilities and monitoring is much more basic but in many ways we are lucky to have oxygen concentrators and IV fluids.3) When a cardiac arrest page goes off at the JRH, the following people come running: acute paeds reg, PICU reg, PICU consultant, acute paeds SHO, resusc officer, anaesthetic reg, anaesthetic consultant, operating department assistant, ER SHO, ER reg, ER consultant and usually one poor nurse running around trying to get all the equipment that everyone asks for. At the last cardiac arrest I was at at the JRH there was also a cardiothoracic surgeon and a whole cardiac bypass team. In ODCH there is no paging system so the“arrest team” tends to be made up of anyone who is standing there or can be shouted at to come and help.4) EMLA. In the JRH we use a local anaesthetic cream before inserting IV lines into children and have to wait an hour for it to work. Here there are fabulous nurses who can cannulate a stone and have no qualms about shaving off children’s hair to use scalp veins and just hold them still (or they’re so ill they don’t need to be held still).5) Bed managers. Thankfully, they don’t exist here. We just pile the patients in, two, or sometimes three to a bed, if needed.6) Breast feeding. Everyone does it (nearly everyone anyway). They are absolute experts - and there’s no trying to hide – every mother gets those “bobbies” out in full view of everyone to feed their pikin.7) Infection control. We do have an“isolation room” here, for children with tetanus and measles. Probably most children we admit would qualify for an isolation room at the JRH. But we have no plastic aprons, not enough gloves and not enough running water. Oh and most children here with measles also have severe pneumonia – meaning they need oxygen – meaning they need to be in ICU instead of isolation. It’s a balance of risk.8) Expectant mothers smoking outside the maternity hospital. I’ve never seen it happen here (hooray!)9) Security measures. In the JRH all medical and nursing staff have little swipe badges to get in or out of wards, and a video buzzer to let parents in and out. Here we have volunteer security guards at the main doors. They are of variable effectiveness– the children are only supposed to have one carer with them during the day, so the poor fathers usually get left outside. Meanwhile, the ladies selling fried chicken and doughnuts manage to get in….10) Coffee shops. As you walk into the Children’s Hospital there is a coffee shop selling Starbucks. The staff there knew me so well they would hand me my coffee as I walked towards them in the morning….! Here we have a little shack that sells white bread and laughing cow cheese, a “chicken lady” (who sells fried chicken) and the ladiesin triage who sell a wide assortment of food including doughnuts with a boiled egg inside (yes they taste as disgusting as they sound). No coffee though. However…. A Starbucks has just arrived - floating about a mile away from the hospital – on the Africa Mercy, The Mercy Ship!