Children's ward

I’m really noticing actually how poor this country is. I spent the week on the paediatric ward and there are so many little babies with big bellies and skinny arms from malnutrition. One little girl was the size of a 1 year old even though she was 13. Another baby was malnourished because her mother was only allowed to cook when she was on her period! It’s coming to the end of the dry season, in fact there was a drizzle of rain today!, and peoples stores of maize that they grew last rainy season are getting really low. And maize is about the only thing they do eat- fruit and vegetables are far too expensive. My guard came asking for a loan for some fertiliser- without it he can’t grow maize to feed his family of 5 for the next year and would starve. So I gave him a loan of equivalent of £80 which only bought 2 bags of fertiliser. He said he will pay me back from his salary over the next 4 months which means he will only get the equivalent of £16 a month of which £8 is his house rent (which has no roof). When I gave him the money he was so happy and grateful to me that I felt embarrassed and ashamed and went back into my house with my laptop, phone, ipod, electricity and running water and then felt guilty. I don’t think I’ll ask for the money back.

Children’s ward has kept me very busy- babies are small so you can fit 3 to the bed. There are so many sick ones and you feel so helpless. One little boy has severe malaria with an HB of 4. He went into heart failure after transfusion with oxygen saturations of 70% and then started fitting and we didn’t have any anti-convulsants. We also ran out of blood so several children with HB’s of less than 4 had to wait 3 days for a car to go and get blood. And now we have no gloves except surgical ones which we use instead but it’s a massive waste of resources and money! For some reason there is no forward thinking and planning and ordering things in advance before they run out. There are also a few safety issues on the ward- a Xray light box that doesn’t have a plug so the open wires are inserted into the plug socket right by a child’s bed, cots with no sides, beds with no springs which the babies fall through.

Of course there are loads of children with HIV and they seem to manage to get pus everywhere! Pus in lymph nodes, the chest, elbow, thigh muscles, scapula like I’ve never seen before. The pathology is incredible- I saw a little baby who had a retinoblastoma that was the size of a tennis ball sticking out of her right eye and covered in more pus. And there is a lot of diarrhoea and vomiting of course and ridiculously dehydrated children giving ‘loss of skin turgor’ a whole new meaning.

I was more impressed with the clinicians on the children’s ward. They seem to be relatively  conscientious and the nurses seem to do a few more of the jobs- still, not all of them ie medications not being given regularly including inhalers to asthmatics - it’s easier just to give aminophylline IV once a day.

I’m finding my practise of medicine is changing to one of- well I’m not sure what you have, I don’t have the tests to look for what a suspect and the ones I have are not very accurate so I’ll just give you some antibiotics and see what happens. And then if they get better you’re not sure whether the diagnosis was the right one and if they die you never know but you probably got it wrong. It’s very frustrating.

The children are really really cute though and it’s funny, because, for many they’ve never seen a ‘mzungu’ (white person) before, except in the books, so my face usually makes them start screaming – and I’m not even white- so maybe it’s just me and children.

Other than work I have managed to see some more of the country- there were some English medical students doing their electives here last week and we travelled to a place called the Mushroom farm up in the hills. It has an incredible view across the lake and to Tanzania and is really remote using water from the mountain and solar power for electricity. We trekked to a waterfall which we then abseiled down- a serious feat for me as I’m terrified of heights and  I was feeling rather pleased with myself that I’d come out unscathed. Then, while walking out of the shower naked, I proceeded to slip on my flip flop which then broke, naturally, landing on my bum, my arm and bending my finger backwards. Nice. The owners had some piglets that needed injecting with iron so sticking a needle into their bottoms helped me get over the pain.

I’ve also been exploring more of Rumphi – by day through trekking round the beautiful hills and by night in the local pool bar/nightclub. Not sure which were the high points- dancing with a sleazy male nurse from work African style or getting asked how much I was to buy for the night. Unfortunately women don’t go out- the only ones that do are prostitutes.

And I know that I’m trying to be a domestic goddess but yes I’ve caved already. I’ve employed a woman to do my washing- I like to think that I’m supporting the local economy. I am still doing my ironing, mopping my floors and experimenting with the cooking though- it’s surprisingly hard following a recipe.

Hope you are all freezing cold in England because I am equally uncomfortable sweating away and hoping not to get some fungal infection. But the rains are coming. Yey!

Lots of Love xxx