Birthday Week
on Shona in Sierra Leone (Sierra Leone), 04/Dec/2010 16:49, 34 days ago
Birthday WeekIts been a good week (especially in comparison to last). It was my birthday on Wednesday; thanks to everyone for your lovely messages. I was teaching the students in the morning and they sung Happy Birthday to me! In fact I was also sung to by lots of the nursing staff. Tash and Alex had come to town to visit the hospital so we had a treat of fried chicken in bread for lunch (makes a change from laughing cow cheese in bread). I managed to do remarkably little work the rest of the day (apart from walking in on an attempted– and failed – resuscitation of a child who had come in gasping). Dying children were not what I wanted on my birthday so I avoided ER and ICU for the rest of the day.We went to Mamba Point Restaurant for dinner– Carole and I shared a fantastic selection of prawn tempura, fish carpaccio and a Mexican salad, all washed down with a bottle of real red wine (I say “real” as we often drink somewhat dodgy but none-the-less drinkable red wine from a carton – and this was from a proper bottle). Becky had made a fantastic and very chocolaty cornflake cake with M&Ms (the most chocolate I have had in several months) which came out with huge sparklers on top. It was a brilliant evening and would just have taken my husband being there to make it perfect.ICUOn Thursday when I arrived on ICU I asked the nursing staff if they were particularly worried about any patients. They promptly pointed me in the direction of a dehydrated and lethargic boy (who thankfully became a lot less lethargic when we started poking needles into him) and a pale and lethargic girl (also not so lethargic when she had her blood sugar checked). This was good as usually the lethargic children here are really properly lethargic– as in they are unconscious – which the next girl turned out to be. Blood sugar 0.6. Weak, thready pulse. Not responding to painful stimulus. She had been admitted the evening before and diagnosed with severe malaria (without a paracheck or malaria slide – as is usual here) and had been transfused with blood but not given any antimalarials…. Several boluses of dextrose, saline and blood (and some antimalarials…) later and in the afternoon she was sat up eating an orange. It was brilliant, especially after last week when I watched four children deteriorate and die in front of my eyes. It was terrible – one baby who had presented with a TWO WEEK history of cough and difficulty breathing – she died within a few hours of admission from severe pneumonia. Who in the UK would watch their child have severe breathing difficulty for two weeks before going to see a doctor? Its so sosad. Another child died of sepsis secondary to an infected injection site. And another two from severe malaria (presumably). I really was starting to feel like the Angel of Death last week. I ask the nurses to prioritise the sickest patients to see first on the ward rounds and spend a lot of time with those patients. Its something I’ve found mentally and emotionally very difficult, especially making the call to stop resuscitating (which of course I never have to do by myself in the UK). We obviously have no proper ICU facilities (1-2l/min of nasal cannulae oxygen is the best we can offer) soyou can only get so far down the resuscitation algorithms before knowing there’s nothing else to do. Medically its not a difficult decision, but emotionally its tough.ETAT TeachingAlso on Thursday Fred and I did some resuscitation scenario-based teaching with the medical officers. It was a good laugh and everyone participated well. Fred played the candidate while I was the instructor as a demonstration for them (scenario-based teaching not something they do much of here). We kept to simple stuff– how to triage, why to triage and that sort of thing. I have a series of interactive lectures called “Emergency Triage and Treatment Plus” which are brilliant for teaching that basic things done well can save lives. Hopefully next time the medical officers will do the scenarios themselves. Iwill keep you posted.How to Really Save a Life!So the way that our blood bank works is that the technicians will give a unit (or however-much) of blood for a pikin (child) if the family provide a donor to replace the blood that they use. A fairly sensible system (the blood is then checked for HIV etc and thrown away if positive). Unfortunately they won’t accept blood from lactating women. Many families are also scared of donating so go and find someone from the street and pay them to donate on their behalf. If it is really an emergency I sometimes send Sandra (from Welbodi) off to the blood bank with the mother, as they are much more likely togive her blood as a priority without waiting for a donor first. We did this twice yesterday (for the same child – who was still alive when I left yesterday having had two episodes of massive haematemesis), so in return Sandra and I went off to donate some blood. A very surreal experience and absolutely nothing like donating in the UK (apart from the massive needle!) He did try to check our PCVs but the centrifuge spun our samples out. He didn’t bother to ask if we were pregnant or lactating either! Anyway, we were treated to some Christmas cheesy music whilst donating and given some free water to rehydrate afterwards (no biscuit though). Cat and Becky had donated last week and Cat even got to hang up her own unit of blood for a child – who was sitting up and eating popcorn the next morning! (So anyone in Freetown reading this, come and donate blood. Anyone at home reading this, goand donate blood).The IMATT Christmas PartySo minus my unit of blood we went Up the Hill to amazing IMATT for their wonderful Christmas Party. It was brilliant– Christmas tree, cheesy music, even some decorations floating in their swimming pool. The food was ace (barbequed lobster – oh wow!) and the company better. The IMATT people are incredibly hospitable. They live in the lap of luxury (comparatively) and think that VSOs are a bit mad for volunteering (especially as a lot of VSOs live without running water and electricity) so they like looking after us (I think they also like meeting nice young pretty girls….!) Becky and I entered in syndicate into the “Money tree” and amazingly won Le 200,000 between us! This is just over £30 and youshould have seen how excited we were! A very fine night indeed.Bliss Christmas FairThe morning we headed to Bliss for the Christmas Fair in aid of St Joseph’s school for the hearing impaired in Makeni. Zoe and Theo were volunteering at the “guess the weight of the cake” and “guess how many skittles in the jar” stand. I pondered long and hard over how heavy the cake was in comparison to preterm babies. I guessed 1325g – and guess what! - I just found out I won! All I need now is the Spanish Air Traffic Controllers to stay at work and get my husband here tomorrow and it’ll be the perfect weekend!