Medical Elective Part 2

I've finished my exams, and with them hopefully medical school! I've now got a week off before I start shadowing at Leeds General Infirmary on the Cardiology ward for three weeks and thought it the perfect time to post the next post about my elective.

...I awoke to both the sound of my alarm quietly bleeping on my cheap Casio watch AND of someone saying Hullo? Hullooo? BUGGER! I'd overslept and it was 8:05am. Faster than I ever thought possible I chucked on my light blue scrubs and newly bought Crocs (it was a good look) and quickly orienting myself found the front door to find a 5ft 7 doctor, roughly 60 years old with short curly grey hair wearing suit trousers, an African style top and sandals complete with white coat and the thickest glasses imaginable (Think Professor Trelawney in Harry Potter). This was Dr Kayumbo the doc I was to shadow for the next 8 weeks. He had a tendency to touch your forearm when he talked to you and stand just that bit closer than normal. Add to this image a high-pitched laugh. I distinctly remember thinking on my first day, he is the nicest man alive.

He had just been at the morning meeting where the on-call night team handover patients to the day team. These took place every morning at 8:00am and were entirely in Swahili, I went to three before I realised no one cared if I was there. When a patient died one of the two student nurses there read a passage of the Bible aloud which despite my atheism  was quite nice to be a part of.

My tour started in the main offices of the hospital; three in total for the hospital secretary, pharmacist and doctor in charge. Next was the pharmacy; a large room which was dark except for a few fluorescent bulbs casting shadows on the old chemical bottles and unused, aged medical equipment sitting on rows and rows of shelves. There was definitely an eerie feeling about this room. Maybe because of the state of disrepair everything was in it felt like the staff were ashamed of the pharmacy and you carried that in with you, it had this feeling of danger, of abandonment.

Anyway next was the operating theatre (to be best covered in another post as I had my second 'emergency' in there) followed by the medical ward, maternity ward and adjoining delivery suite, patient toilets and lab. The standards of the hospital were lower than I had ever imagined. This was to be an interesting 8 weeks.

Patients generally have to walk miles to get to the hospital unless they are critically ill then the hospital ambulance (a Jeep painted white) picks them up. The majority of the patients I saw were children with malaria or diarrhoea & vomiting and most of the family, including elderly grandparents, would walk the long distances daily in the Tanzanian heat to be there and then walk back every evening; except the mothers who could share the hospital bed with their children. On arrival, the families would then have to cook food on their small stoves in the hospital grounds to feed their ill relative. No hospital food here. Basically the cheapest, and therefore only food most people eat in Tanzania is 'ugali' which is cornmeal cooked until it turns into a thick dough-like ball. The poor ate no protein or fat, just this nutritionally deficient cornmeal. These people were tough! Food is eaten without any cutlery in TZ, the best way to eat ugali is to make it into a small disc and press in the middle so that you can collect sauce in the indent. Turns out there's a knack to it..!

In the UK ward rounds are done every day; the consultant visits each patient and the junior doctors give them an update of what happened the previous day, before talking with the patient and seeing how they are doing. This means that an experienced doctor can assess how the patient is doing and intervene as necessary. Things were a little different at Kilimatinde. Ward rounds were only done every other day at best, unless Dr Kayumbo was informed of specific patients that had become critically ill and warranted an extra visit. The problem with this of course is that if someone deteriorated between ward rounds, they would only get seen if the consultant was informed or else could face waiting a minimum of 24 hours for the next round. After about a week I got a serious itch to want to resolve this so started leading ward rounds on the alternate days to Dr Kayumbo, minimising the risk of critically ill patients being left unseen and losing the fight. Even that little change made a difference and filled me with pride. It's the little things..!


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