Friday, 31 August 2007

Lata Hospital

So we've been here the best part of a week and a half and we've settled in quite well now. The food situation is good although we've yet to come up with any good ideas for breakfast other than rice pudding. The best thing is the fish, you can get a freshly caught fish (tuna, red snapper, and barracuda) for about 60p (and I mean a BIG fish).

My time at the hospital is fairly easy going. I usually start at around 8am, (after a 20 minute walk from our house) depending on the day the first thing is usually a ward round where we go around each ward (which is basically just a small room, each with 8 beds.) There are 4 wards, male, female, children and maternity. At the moment the hospital is about half full. The doctor is really good and talks me through and asks me questions about most cases. The common things include scrub typhus, abscesses and new baby checks. The ward round usually takes about an hour to an hour and half (everything is pretty slow as it goes Solomon time.) After the ward round is the 10am coffee break, which the Doctor adheres to very strictly, I usually just drink some water and scoff some biscuits.

After coffee a few different things can happen. Mondays and Tuesdays we just float around and see any acute patients who need more than nurse care. Wednesday there is an ante-natal clinic which I went to yesterday, it is pretty busy and they are making full use of the fetal heart doppler I brought with me. Yesterday I spent the morning helping out there. Most of Thursday morning is taken up with surgery which is usually excision of abscesses or sterilisation procedures. For me this is the most interesting part, mainly because I like surgery, it is so different to the UK in that everything is very basic. I've been taking the role of the anesthetist and giving ketamine to put people to sleep. This morning I assisted in a TL (sterlisation) on a lady, it was really interesting as I got to get quite stuck in and was able to do more than I'd ever be able to do in the UK. The doctor is away next week but when he gets back hopefully i'll get to do a lot more of that. In one of this morning's procedures there was a power cut and the operation had to continue by torch light until the power was restored!

The most interesting thing so far has been an emergency cesarean section last Saturday evening. It was pretty intense as they are done very rarely here, most of the regular staff were not here so we all had to scrub in and help out. Things didn't go exactly to plan but everything worked out well and mother and baby are fine.

Fridays involve either checking the acute patients coming in or catching up on the surgical list. There is also supposed to be a seminar every morning where all the staff come together and someone gives a talk on something (I'm supposed to be doing one sometime) although the last 2 Fridays this has been cancelled due to "stakka other things" ( ß pigeon ).

The afternoons are very flexible, It is up to me basically, I can go to one of the clinics (ante/post-natal or whatever else is on), I can stay and see the new patients coming in or I can louge around and see what else is going on. If all else fails I can walk home via the wharf, get a fish and sit by the sea at our guesthouse. So the timetable here is very relaxed and easy going but because of the 1-1 teaching I've already learnt so much. (more than I've learnt in the last 2 years in hospitals probably) It is really interesting; especially the surgery and hopefully I'll get to do a few more things in the next few weeks. The doctor is away for a week now so again it is up to me to find what I want to do, there is plenty going on, hopefully I'll get to do/see some deliveries as there are 1 or 2 babies born each day. That is my main project for next week.


Elaine said...

It is absolutely fascinating to read of your experiences here. I think you made a really good choice of elective from two points of view - firstly the experience to be gained and secondly to go get to see a completely different style of life in a far-off place. (The sailing was perhaps one of these wonderful opportunities you could have passed on!)

Anonymous said...

woah, putting people to sleep yourself?! and the lights in the OR going out?! - that last one is pretty much made-for-tv.

your elective sounds absolutely amazing! i guess that's the great thing about taking an elective in a (3rd world?) country ratehr than somewhere modern - you get so much more hands-on experience.

PhD scientist said...

If you watched the "Follow the trauma doc in the ambulance" shows in the UK, they gave lots of ketamine in the field for analgesia, e.g. lifting the truck off the man's legs, taking the embedded bolt out of his back, re-siting the bones in the fractured tib fib if there were no distal pulses, and so on. I was quite surprised how often they were zapping it in, but I think they like it because it is dissociative rather than "traditional" sedating, so it doesn't depress respiration and CV function. I guess this is also why it would be used as a stand-alone anaesthetic in a "basic" setting like LM's hosp.

PS Also handy if the doctor moonlights as a vet, or vice versa.

Slightly to my surprise, they use ketamine quite a bit on kids in the UK (honest). When our baby dropped half a brick on her big toe a couple of yrs back the A&E consultant wanted to give her ketamine so he could surgically remove the remaining half of her crushed toe-nail. Mrs PhD ( battle-hardened hospital doctor) and I refused the procedure because we didn't really fancy our 13 month old experiencing "K-hole hallucinations". (Happy ending - the toenail grew back OK).

More on ketamine on Wikipedia.

Finally, when 'Er Indoors worked in anaesthesia she did used to say ketamine worked especially well on little old ladies...

Cal said...

Wow, sounds like you're learning lots, I'm so jealous! (tries not to sound too much like Hermione...)

But seriously, it sounds like you're having a great time out there... Maybe I should do my elective out there too! I love seafood!