Thursday
on Shona in Sierra Leone (Sierra Leone), 02/Jul/2011 14:12, 34 days ago
Thursday was a bizarre day, full of contrasts. Here’s what I did:I went to the S-C-B-U in the morning ready to start the ward round. I saw a couple of babies with one of the nurses before the entourage of medical and nursing students arrived. The patients were both very sick. S-C-B-U is bursting at the seams at the moment. The babies are literally squeezed in next to each other. One of the sickest patients arrested and died. Not much fun trying to resuscitate one moribund baby while trying to stretch across another one. If anyone ever tells me in the future that the JR NICU has no space I might scream at them. I spoke briefly with the relatives of the baby who died, and then had to carry on with the ward round. (I’m still not quite sure how I do this, and believe me, it is very strange. I always wish I could just take a few minutes to be by myself after a baby dies).I saw a set of beautiful preterm twins (I think about 32 weeks but not certain) with their mother and both grandmothers. Twin 2 doing well, Twin 1 (the little one, about 1kg) not so well. I saw about six other patients in a space the size of a cupboard. Complete with entourage of medical and nursing students. More reviewing of patients and I finished the ward round (feeling a bit faint– it is soooo hot in S-C-B-U), and went to the lab to chase up some results (we did seven lumbar punctures on Tuesday!)They weren’t ready yet.I spoke with one of the TFC nurses as I crossed the car park– she is a relative of Baby Number Three from last week’s blog. He died the night after I wrote my blog. I said “Oshya”.I saw a few out-patients. I admitted one of them (try not to admit if at all possible– there’s so little space and I’m so worried they’ll get a hospital acquired infection).I went to meet Sandra, Fred, Becky and Matt (the Welbodi team) for lunch outside. Egg sandwich today (wrapped in newspaper; usually the sandwiches are wrapped in confidential letters from some Ministry or other or research questionnaires (which have been filled in) or invoices, or children’s maths books or some other interesting thing) followed by some fried chicken as I was still hungry.I was just finishing my chicken when my phone rang– “Dr Shona, emergency in S-C-B-U” was all I heard. Despite me telling the nurses they can call me or the medical officer if there is a problem, they have never called me before! I ran off to find that Twin 1 had arrested. We tried resuscitating but to no avail. She died. I was very sad. I’mstill wondering what else I could or should have done for that baby. But I was inspired by the courage of her family, who said they now needed to concentrate on Twin 1 and thanked me for everything we had tried to do.I saw the remaining sickest patient again. He had grade 3 hypoxic ischaemic encephalopathy and was aspirating his secretions. Not a lot I could do for him more than oxygen, IV fluids and antibiotics. Even the suction is broken. I spoke with his auntie and his father so they understood how sick he was.In the afternoon one of the other VSO doctors Ginny had organised a party for the patients and staff in the room where ICU and ER were (they’ve moved to a new location last month). A brass band from the Ballanta Music School held a concert (their opening song was Michael Jackson’s “Heal the World” – strange choice I thought, a bit incongruous! – but they were very good). It was Rafael’s birthday so we all sung “Happy Birthday” to him. Then there was a DJ, playing all the Salonean favourites. Everyone was up dancing, enjoying themselves, nurses, doctors, patients, the little kids who live on the hospital compound. I have so many memories of being in that room, where so many children died, with so much suffering. It was a very strange feeling, dancing with my colleagues and having fun, while reflecting on all those memories. And knowing that so many families are still suffering.I spent the afternoon going back and forth between the party and S-C-B-U, amazed at the contrast between the two. I often marvel at the contrasts in this country, between the incredible poverty and the incredible beauty of the beaches. Never have a felt it as acutely as Thursday. However, the doctors and nurses deserve to have some fun once in a while so I danced along with them.I went to the tailor to pick up some more dresses– unfortunately he hadn’t quite finished them but we checked how they fit and I dropped off some more material to get (yet) another outfit made. I walked home as it was starting to rain.Carole came around for a drink– we sat on the balcony looking at the beautiful view drinking Real Red Wine (courtesy of Carole) and biscuits and cheese (courtesy of Cat).We went to Independence Beach Bar for drinks and dinner for Rafael’s birthday. It was POURING with rain and we all got drenched running from Carole’s car into the bar. I never quite dried out again. I was so cold (strange being cold in SL!) after I got wet that I had to borrow a jumper! Unfortunately the barbeque went out in the rain so we had to wait two hours for dinner – although it was worth the wait. I was still cold and wet when we got home and even wore a jumper and wrapped myself in a big towel to go to bed!A day of contrasts indeed.