My driver usually picks me up at 0815 for the 10 minute drive across town to work. As soon as you drive into the hospital you get stopped to have your temperature checked and to wash your hands. This is for everyone who comes to the hospital and is one of the remaining effects of the Ebola epidemic. Patients will also get triaged for any signs of Ebola and isolated if they come under the criteria.
Every morning at 0830 the nurses from each of the wards, all the doctors and other members of hospital staff convene in the conference room. This is my first port of call. Here they discuss any difficult or complicated cases on the wards. It is also where data for admissions and deaths is collected. I enjoy the morning meeting because I get to find out what is going on in departments I don’t usually work and get to have a chat with the staff afterwards. I also get to hear about any problems in the hospital which aren’t patient related e.g. problems with the lighting or night drivers. I never had to deal with the managerial/logistical side of things when I worked in hospital as a junior doctor so it’s interesting to see how things work (or don’t work) especially in this setting.
After this I go to ICU to do the ward round. The ICU here is not like the ICU at home, it is just a normal ward with better trained nurses and obs monitors for all the beds. All the ill patients sent here are transferred from the clinic or from the ward. I don’t always work in the ICU ward but the doctor who usually does is away so I am covering. This is the power of General Practice that I can cover most of the wards. Last month I was in paediatrics, today it’s ICU.
Mostly in ICU I see a lot of malignant hypertension and stroke patients. Hypertension is a big problem here. It is not picked up till late and even if patients know they have hypertension they don’t take medication long term. Often they will take Amlodipine when they have a headache and then stop once the headache goes. It is easy to buy medication in the pharmacies without a prescription. I have also seen stalls in the market with random drugs being sold. It’s basically like pick and mix but with drugs instead of sweets.
After the ward round I go to the maternity dept where I am teaching adult basic life support. Sierra Leone has one of the highest rates of maternal mortality in the world. I am hoping to train all the staff in the maternity wards in BLS. Some of theses nurses and midwifes have not had training in 3 years! Practical training always goes down better with the staff here than lectures and the staff are eager to learn.
Next we go to the outpatient dept where my office is based. Here I usually see any difficult cases that the CHOs have and help with the workload. It’s not so busy during the dry season and it gives me a chance to prepare for my next teaching sessions. Again I see a lot of non-communicable diseases like hypertension and diabetes and quite a few victims of RTAs. The children I see usually present with fever and many have malaria.
Because weird and wonderful things seem to happen everyday here I shouldn’t be surprised that one of my old patients walked into my office with a chicken. Her grandmother wanted to thank me for my care so kindly gave me a big bag of oranges and grounds nuts and a very much alive chicken. As a vegetarian I am never going to eat the chicken and it is too noisy to keep as a pet. Also I feel guilty accepting the chicken as she could sell it for 20,000 leones in the market. The entire time she sat there I kept thinking about the GMC guidance on accepting gifts from patients. Where does a chicken lie on the scale of gifts, is it akin to a box of chocolates or more toward a wad of cash. I decided to play it safe and asked her to keep the chicken and then shared the oranges and ground nuts among the staff in OPD and ICU who loved the unexpected snack.
I end the day back in ICU following up on my patients and seeing any new patients who have come in. Then it is back in the car to get driven home and so ends another day at Makeni Regional Hospital.