Have been off work for the past week, which has been largely a blur of sleep and getting up to take large anti-viral pills every four hours. From Oct 5 on, I did not feel good and had an odd headache – unusual I realized because it was only on the left side of my head. On Saturday, I began to break out with the rash of shingles on my forehead, and from Sunday until really yesterday, Thursday, I have felt quite miserable. Tonight though seems a bit closer to normal, so I hope the progress continues. Thank goodness for the antiviral being readily available here (because of all the AIDS patients, I’m sure) and that I realized early what I had and got on the drug – the rash subsided without ever blistering, and my eye was never troubled. But with sleeping 18 hours a day, I did not accomplish a whole lot.
There are signs that dry season is coming – more wind, and we have gone a couple of days in a row without rain during this past week. The week before, it poured buckets every single day, and we only saw the sun parts of two days. My garden looks good – great cabbages coming along – and I am eating my own beans now. It’s great.
One of the previously trained nurse anaesthetists from here is now in medical school in Ghana – Ernest. Ernest had been reading this blog, unknown to me, and saw the photo of three of my current students, and realized they were his good friends. So he phoned Faith, from Ghana, to greet them all (he and Faith had been ward auxiliaries here together a number of years back). I thought it was such a neat story. Greetings, Ernest, when you read this! And know that you are held in very high esteem back home here in Mbingo.
The OR has been extremely busy – complex cases, long hours. My anaesthesia students / interns are really struggling with the amount of labour being demanded of them, and I can understand. The OR would not run without them though. The number of surgical residents continues to increase every year, without a parallel increase in OR staff, or ward staff – and it does not work very well.
The recovery area though is helping a lot. Patients are moved out of OR a lot faster, and then are properly recovered, and given pain medication adequately, so they go to the ward usually quite comfortable. I am very happy with my RR students, but also with the general team attitude between them and the anaesthetists. I cannot say enough good things about these people – they are team players, cooperative, collegial, with real commitment to good patient care. It is such a pleasure to work with them. I forget how the saying goes, but it essentially that in any business, what matters is “who gets on the bus” – and we definitely are blessed with the right people on the anaesthesia / recovery room bus at MBH.
A week ago, last Friday, we had a very heavy day. Sometime well after 2pm (the official end of shift), I sent my RR students home, and stayed to recover a little boy who had had a big abdominal surgery. He took forever to waken, so while I was sitting there, David who was on call for the night wheeled a small howling boy in for me to “babysit”. It turned out I knew this little fellow, Bryan, from recovering him a few days before, after surgery for severe Hirshsprung’s disease (absence of nerves in the colon which therefore does not function properly). Now he was having obstruction again, and was hot and very sick – and very unhappy to be taken from his mother. I remembered him from the first time for his beautiful smile – and indeed, once I got him comforted, and more comfortable with a little morphine, the smile returned. Then he began to take quite an interest in the other little boy. Bryan is 6, the other child, Bolshi was 8. Unfortunately Bryan is francophone only – and I Anglophone only – so our communication was charades, but it was a pity because he obviously a very bright observant little boy who was making many comments about things. He was fascinated by the NG tube that was draining Bolshi’s stomach – and not frightened as you might expect. And then he reached out to touch Bolshi. I pushed their stretchers together, and Bryan reached over and took Bolshi’s hand to greet him, as any good Cameroonian should do. It was incredibly sweet to watch. In a bit, Bolshi did finally surface, and was able to realize that another child was there, greeting him, and to respond, before I sent him to the ward. The next day when I went to see how Bryan had fared with his surgery, he gave me his beautiful smile, and pointed a few beds down the ward to where Bolshi was. I now have not seen them all this past week, but think I will feel good enough to go over tomorrow. I just hope they have both done well.
Goddie’s little brother did arrive – his name is Rooney and he is just a beautiful baby. I am so thankful he arrived while I was still here, so I have been able to see the newest small Middle Quarter neighbour.
Time is flying, and I am way behind with news from here. We are already at the end of week 3 of the PACU nurse course – ¼ of the way through. My 5 students are experienced nurses, even though a couple of them have had only 3 months of formal nursing training. They are hard-workers (one of the main criteria for choosing them), and committed to their job, and they are a pleasure to teach. I find I’m having to translate all the physiology into very practical terms, rather than present it academically – but that is not a bad exercise for me either, and really rather fun, especially when I see comprehension come across their faces as they realize the “why” of something they have been doing for years. Interestingly though, they are being given a very bad time by other nurses on the ward, who are jealous because this group are being given more training. I am inclined to go and tell the persecutors that their behaviour is precisely the reason they were not chosen for the training! But so far I am just teaching the class for an hour each morning, and then taking either 2 or 3 of them at a time into OR to work in the recovery area, while the others go to work on surgery ward.
The nursing supervisor has been very helpful in already ordering work to start on a few renovations to an area of 4 beds on surgery ward which will become our “high dependency unit” for the sickest pre- and post-op patients. I hope I get to see it functioning before I leave, but if not, at least it will be underway, and the anaesthetists can take over its supervision.
The beginning of week 2, we had a graphic example of why a recovery area is needed. A woman who had had a hysterectomy, done as usual under spinal anaesthesia, dropped her blood pressure about 15 minutes after coming to us in recovery area. Her spinal was still very high, so at first I assumed that was the cause, but when she did not respond to the usual treatments, I called the surgical resident. Fortunately he is our best, and listens, and with a little prodding from me and from the head anaesthetist, he took the patient back into OR and found 2000ml blood in her abdomen, from an artery that had come unsutured. In the four weeks between the end of the anaesthesia course, and the beginning of the PACU course, there was no functioning recovery room because of inadequate anaesthesia staff; this woman would have been sent directly from OR to the ward, and almost surely would have died, because nobody on the ward would have recognized her distress until she was almost dead. It certainly impressed my students that their role was critical (I was impressed too). We have also had 2 young children die in the past month during the night after their surgery – why, nobody knows, only that they were “found dead”. Clearly the HDU is also badly needed, with better staffing and more knowledge and more monitoring, to prevent these needless deaths.
There has been an influenza epidemic here at Mbingo the last few weeks. I was flattened last week for a few days, which I guess is one reason there has been no blog. Several of my friends had been sick, and all said they had malaria, and had taken the appropriate treatment. When I began to have chills and the aches, I wondered if I was going to have my first dose of malaria after 4 years in Africa – but soon realized that the respiratory symptoms were a true influenza. Some of the surgeons were talking about this, and said that in fact flu feels for all the world like malaria, with which of course every African is only too familiar – the headache, joint pains, fever and chills, GI upset, general malaise – they call malaria the great imitator. The drugs to treat it are apparently diabolical too – usually people say the treatment is even worse than the disease. How bizarre it is, that billions have been spent on HIV in Africa, and hardly anything on malaria, which is the biggest killer of any disease worldwide.
There was a wedding in church 2 Sundays ago. The bridal party came in at the beginning of the service, then the church service carried on as usual, but with an interlude in the middle for the saying of the vows. At the end there were the usual wedding things – speeches, presentation of the cake with all its symbolic colours (green for growth, purple for nobility, gold for eternity, white for purity, etc) and the shared “first chop” as the couple fed cake to each other, and finally the celebratory gift-giving as everyone sang and danced in a long line to the front of the church. And then of course there was FOOD. Weddings here are really fun, a truly joyous time in what is otherwise a pretty humdrum life.
School is finally starting to settle in, I think. My vegetable lady has still been in Mbingo market, but said she was starting work at her school this week. A few kids are coming to me with school work. Felix is a boy in class 6, the son of a single mom who I suspect cannot read herself – he needs lots of help with reading, way more than I have time, or skill, for. Salamatu, my little Fulani friend, is also in desperate need of reading help – she really has hardly a sniff even about sounds of the letters and she is already in class 4. Much of this is because she speaks no English at home and receives no help. And Norrin and Becky who live behind me in Middle Quarter started coming this week for help with English; they are in form 1 (like grade 7 at home), and actually seem to be doing well. They are attending the government secondary school that is 2 km from here, and it is interesting hearing how things are done there. I helped them last May with spelling and English and they seem to have made progress since then and seem much more grown up, even though they are only 11. They were laughing at my accent – they have been taught with a good British accent, and even when I try to use a Cameroonian accent, they think I sound really funny – which I do. They are fun to be with – the other kids are hard work!
Stephen’s wife who attended teacher training school last year did not get a job at Mbingo 1 as she had hoped. So yesterday she went down the road to the small government school in Muguh, and was given the 14 students in class 3 and the 14 in class 4 – for which she will be paid 15,000cfa (about $35) a month!! She is happy though, as this helps her keep up her newly learned skills, and will give her an in at getting a government job next year.
Goddie has developed a fixed idea that he wants to be a whiteman. He and Fervant and I skyped Auntie Jan on Saturday, and his greeting to her was “Auntie Jan, I want to be a whiteman so I can come to Canada and help you!” We are trying hard to convince him that we like him very much just as he is and that he most definitely does not need to become a white man to come to Canada – but so far, we don’t seem to be convincing him. His new baby brother or sister is due to arrive any day now, so maybe that will distract him from the whiteman idea!
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