Welcome to Hospital

Day three

Today I went to church for the first time in a while. It certainly won’t be the last: staff and students are expected to attend a morning service daily at 7.45. Unfortunately the message fell on deaf ears since this is conducted entirely in Swahili, but we managed to bow our heads and stand up at the right times. We were introduced to the masses and treated to some truly lovely singing from the choir - we are lucky enough to be able to hear them practise from the guest house too.

We spent the morning in the local clinical officer classroom, consisting of a long and detailed student presentation on a case of peptic ulcer disease and its subsequent discussion. Luckily for us the doctors and students work in English. We toured the hospital making introductions for a little while and then went back to the guestroom for some lunch.

Afterwards we met our supervisor, and made some progress to getting a “working” permit. This involved scribbling my CV on an A5 sheet torn from my notebook (dishearteningly it was not at all difficult to compress to this size), and obtaining passport photos from a man with a digital camera whose friend willing to hold a whitish sheet behind me. The latter task required another daladala trip to Moshi and this time I had to stand, my spine securely kept in this shape (&) by the compressing actions of other bodies from all sides.

After dinner the Imperial girls and I were alerted by Mary’s screams from outside as she became acquainted with a large beetle (between kitkat and penguin bar) whilst talking to her parents. Alarmingly for Mary and her parents on the phone but cruelly amusing for me, this friendly animal flew into her hood and hair before becoming firmly attached to her hoody, eventually requiring kitchen utensils to remove. The situation was resolved peacefully (albeit loudly) with injury to neither man nor beast.

Day 4

A morning in the operating theatre.

This morning I sat in on an internal medicine clinic, mainly seeing patients with hypertension. Apparently an extremely common problem at Machame, and – as in the UK - often overlooked or neglected due it being asymptomatic until complications develop. The doctor used a mercury sphygmomanometer the same as we learnt to use in first year, before they were almost completely replaced by the electric ones due to some theoretical mercury risk. Part way through the clinic the doctor tagged in a different doc and abruptly announced he had to go and perform an emergency caesarean section.

As mentioned before I’ve not covered obstetrics yet and so I was initially quite excited at the prospect. I realised whilst changing into scrubs that I might be about to witness a family’s personal tragedy and my stomach turned over. The lady was given an epidural in theatre, and once the doctor had used the introducing needle to check the absence of sensation in the lower limbs and abdomen the patient was cleaned and draped and the first incision was confidently made. The doctor and nurse worked fluidly without any spoken communication between them and, to my inexperienced eyes at least, operated expertly.

The patient had been in labour since the previous afternoon but the baby was too large to fit through the pelvic outlet. Not knowing much about the procedure I concentrated on noticing some differences from the theatres in the UK, such as the re-using of surgical scrubs, masks, drapes and surgical implements – all of which are single-use in the UK. The anaesthetist had no anaesthetics room, and was content with only a handheld pulse oximeter, GP-style electric blood pressure monitor and a single canister of oxygen. The overall cost to the hospital is quoted at 150,000 shillings, a little less than £60.

Soon after starting the doctor had his hand deep inside the lady;s abdomen and pulled out a unreasonably massive and slimy human baby boy. I declined the offer to help close, remembering to “first do no harm” -especially not catastrophic and absolutely avoidable harm. The baby was over 4kg, which is about the same size as a 5yr old child, and although it was rudely bawling, covered in ectoplasm and had an unnaturally deformed-looking head, it was actually sort of beautiful to behold, really.