ABCD & 3TPR+MOB…

Welcome to the Emergency Triage Assessment and Treatment workshop. We will start by learning our ABCs. A is for airway, B is for breathing, C is for circulation, oh, and coma and convusions and then comes D for dehydration.

If you get stuck on one of these letters with your patient, it’s an emergency and you must rush to the emergency room to get ABC and D stabilized first. However, if ABC and D are fine we will proceed to 3TPR and MOB. Proceed to what you ask? To the priority signs.

Three Ts, three Ps, Three Rs and M and O and B. Tiny infant, Temperature, Trauma. Pallor, Pain, Poison. Restless, Respiratory Distress, Referral. Malnutrition, Oedema, Burns.

If any of 3TPR and MOB is positive, your patient is a priority case and must go to the beginning of the line. If ABCD & 3TPR+MOB is fine, then you are dealing with a routine case and they must wait in line.

This is the gist of what was taught on Monday to 20 nurses taking the course. It may sound very simple, however, when actually going through cases and scenarios it can become a little more complicated. Or, maybe it just seems more complicated because in reality, it’s always a matter of going back to the basics. The ABCs.

Along with the theory came the practical sessions, which today were relatively simple, focusing on checking vital signs, calculating doses for antipyretic medication like paracetamol and weighing and measuring patients. Although these are actions the nurses perform on a daily basis it is still important to review and make sure all staff is working in the same way. Throughout the week we will continue to build on their theoretical knowledge, introduce more scenarios and focus on more practicalities such as inserting guedel airways, using a bag and mask to ventilate a child, doing chest compressions, giving iv diazepam, inserting intraosseous needles, giving fluids to a patient in shock, checking a blood sugar and more. These are all crucial aspects of nursing care and very important for nurses to learn, specifically those who work in triage, outpatients and the emergency room.

These nurses have the potential to help reduce the child mortality rate at the hospital and we really hope they are encouraged to work at the highest standard possible. Hopefully they will implement what they are being taught to ensure appropriate care for the children. And maybe even those children who come in critically ill will have a better chance at survival due to emergency measures being taking more quickly. I am very hopeful and ready for Day 2 of the workshop.

Rain, rain and more rain...

Rain, rain and more rain, that just about sums up the weekend here in Freetown. Rainy season started over a month ago, but surprisingly last week there was very little rain and August is supposed to be the wettest month. Well, this weekend made up for last week’s dry spell. It started raining on Saturday morning and rained on and off all day and I think it literally rained for most of Sunday. And when it rains it really pours. Roofs leak, people get soaked, gutters overflow, dirt roads become mudslides, etc. Even our road is a terrible mess now. Since they are re-digging the gutters they piled up the dirt on the side of the road. Well, the heaps of dirt are now slippery mounds and the road itself is one big mudslide with large collections of water here and there. It’s definitely not a pleasant walk down our road anymore; for now.

On Saturday we had to go to the hospital for the afternoon to meet a team from Wales coming to help with both the lab development program as well as the Emergency Triage and Treatment workshop. I guess since it was raining all afternoon anyway, it wasn’t a bad place to be. At least we were inside, dry and doing something useful. Sunday I did go to Regent but as soon as I was home it really started pouring and so we stayed in for the rest of the day. There was no way I was going to go out in the tropical rainstorm. Again, I ended up working all afternoon and evening. There is just too much work to do. So, I started answering work emails one after the other and putting them in my outbox, waiting to be sent the next morning from the hospital.

Unfortunately this morning on the radio we heard that a house on Mountain Cut road collapsed, killing 13 people of which 9 were children. It is a tragic event due to the heavy rainfall and poor construction of the house. Apparently there is at least one person who was critically injured that was taken to Connaught Hospital. It’s another sad story. And another story like many others. Every year it seems the rains lead to deaths; a house collapsing, children being dragged away in a flood or a mudslide due to erosion as an effect of deforestation. There’s always something. But, fortunately the rain is beneficial as well; for crops to grow, for the water level Guma in the dam to fill up, etc. And of course, for the expats, the rainy season is the cooler time of year. Yes, last night, I even put on a vest.

View from my balcony...

I thought it was high time for a new photo for my blog. So I have chosen the amazing view from my balcony. A view overlooking the city of Freetown with it's palm trees and many buildings and in the distance the shores of Lungi. To get to work everyday we drive through this city, far past the outer right border of the photo to get to the Children's Hospital on the eastern side of town. As you can imagine, traffic can be terrible! The journey to the hospital at 7:15 am takes about 40 minutes whereas the journey back home usually takes an hour and a half. The longest we've been stuck in traffic going home is 2 hours and 40 minutes. Let's hope that was a once only occurrence.

Please continue to follow this blog to read more about my experiences in Freetown, and more specifically the happenings at the Children's Hospital. Comments (if relevant) are welcome, especially from those I know! More soon...