Monday the 23rd of July marks my 35th birthday!
I have had somewhat of a difficult week for many different reasons and at one point yesterday the words ‘give up’ crossed my mind. Thankfully, yesterday evening I met with a wonderful group of ladies and we talked about persevering and enduring. So, that’s what I’ll so. I will persevere. And when I’m unsure of things, I’ll spend time in prayer and try to figure out what God is saying and trust He will provide answers over time. Don’t worry. I’m okay. I have a wonderful group of friends here...which I suppose in part is a bit of the problem since a number of them are leaving. But even so, I know they are friends for life. And, I really do love it here and I know that no matter where I am in life, or what I am doing, there will always be frustrations and difficulties. Some of the same issues I face here I would likely face in the West. Right now, I suppose I couldn’t be in a better place. So, no giving up...
Anyway, I am working from home today. I had a meeting scheduled on the west of town and figured I might as well work on this side today. It gives me a little bit of space from the hospital too which is probably good for today. Power at the hospital has been awful all week and there hasn’t been any internet for 2 weeks and I need to get some computer work/emailing done. The plan was to go to the Spur Road office, but it has been pouring non-stop for the last 3 hours, so, I am still at home. Later today I will have to venture into town for a meeting and hopefully the rain has stopped by then! Fortunately, there is electricity at home for the time being and I have off-line email writing capabilities. I also have a speedy airtel dongle that I can use to send off my emails at some point. So, with a cup of tea and a chocolate muffin (thanks to my very thoughtful flat mate who I will miss a lot when she leaves!) I am working from home. Enduring and persevering...
Monday marked my first full day of clinical work at the Ola During Children’s Hospital. I spent the day in the outpatient department talking to parents, examining children, making an initial diagnosis, and starting treatments. It was a delight to be able to care for children again.
It has been difficult to combine my management/coordinating role with a clinical one. I love my job and definitely see the importance of what I am doing and the need to make sure that hospital systems/infrastructure/equipment are in place, but I often miss actually treating patients. Occasionally there are days during which I can spend a few hours doing clinical work, but it’s more of an exception than a rule.
A few months ago I was able to spend part of a week in our intensive care unit, which was difficult and intriguing. The patients were quite ill or had conditions that we could not diagnose and/or treat effectively due to limited resources, which was a challenge. At times we did not have enough oxygen to provide children with breathing difficulties with the oxygen support they needed. As you can imagine, this was a source of frustration however, it also reminded me of why Welbodi’s supportive role is so important. My experience in our “intensive care” unit was good, but I realized it is unfair to combine ICU work with non-clinical work. Those patients really need a doctor in there all the time. My plan was to see if the outpatient department was a better fit. It took me a while to get there, but after spending Monday there, I can say it is a much better fit.
I saw children with hydrocephalus, diarrheal disease with dehydration, severe anemia, pneumonia, malnutrition, probably tuberculosis, malaria, and cleft lip and palate. It was interesting to see such a variety of conditions, much like when I used to work in the Aberdeen clinic. I have to say though, compared to my previous job, the children at the Children’s Hospital are sicker with a high percentage needing admission. Admissions is something I missed in Aberdeen—it was tough at times having to refer the really sick children and losing sight of them once they were sent off. Now, I can admit them directly to the wards and even visit them at the end of clinic. This is definitely a bonus. It means I can chase up results, optimise their treatment plan, and arrange for ultrasounds. Of course some of this “chasing” can take time seeing as we have some glitches in our systems. Speaking of time, admissions are also more time consuming and so I end up seeing fewer patients a day compared to in Aberdeen. I didn’t realise it takes a fair amount of time to fill out the paperwork for admissions: history, examination, impression, treatment plan, treatment sheet, lab forms, prescription form, etc. However, it is worth it because I do like being able to admit patients.
Having spent some time away from clinical work it’s once again a bit of a learning process, but that’s okay, in the world of medicine we are continuously learning anyway. It’s a matter of reading up on specific diseases and treatment options as well as refining how to work as a doctor in a poor resource setting with limited diagnostic and treatment options. I have to continuously challenge myself to think outside the box a bit because it could be easy to give everyone a blanket treatment. You could potentially give every child an antimalarial and antibiotics and on average they would do fine. However, you would miss the more obscure illnesses and be over-treating a number of patients too. I want to stay sharp and give each of these children the best treatment possible with the resources available to me. I’m hoping to learn so much more in the near future and become better at something I am passionate about. For now, I’ll probably have to stick to one day a week in outpatients but it’s a start.
First posted @ http://blogs.bmj.com/bmj/2012/07/17/sandra-lako-clinical-work/
