I love my job, that’s the thought that struck me today on my way home from work, and it’s something I have not thought or felt for a long time now. I am so delighted with this realization that I wanted to share it with you all. I’ve had a pretty random day but then that seems to be the pattern here, if you can have a random pattern, and that’s far too mathematical a question for me to ponder.
Let me elaborate; I awoke and was immediately joyful at having the wonder that is electricity as this means both a hot shower & a mug of tea to start the day, my cup runneth over.
First mission of the day, lecture for the senior house officers in the hospital on ‘Pain Assessment & Management’. Still had power so it was looking good for my lovingly prepared PowerPoint presentation. Alas, no projector. Some helpful soul suggested I bring my own along with me and I very nearly retorted with some sarcastic comment along the lines of hiring a truck to bring tables & chairs too, I am so glad I didn’t because I was later introduced to said gentleman – the dean of the university. A projector was acquired, I didn’t ask & they didn’t tell me whence it came. Eventually the tutorial went well.
Onwards, via boda-boda (moped-taxi), to Hospice. Tuesdays is ‘case conference’ day, when the clinical team get together to discuss any difficult cases or problems that have arisen in the last week. Today we heard about a young lady who’s been having an affair with a married man and has found herself almost twelve weeks pregnant but hasn’t informed the partner. She doesn’t want to have the baby because she is already bringing up three children single-handedly; she was widowed a few years ago. Abortion is illegal here. She fears that the man will stop seeing her if she tells him she is pregnant. The twist is that she’s HIV positive and as far as we know he is not or at least hasn’t been tested yet. We batted the various ethical issues back & forth for a while – I found it difficult to accept that the concepts of autonomy & confidentiality are exactly that, just concepts here. The rest of the team felt I was being idealistic & had to accept the realities of their culture…we agreed to discuss things further with the patient & see what course of action can be agreed upon.
Next came the all-important ‘morning tea’ which bears no resemblance to tea at all and should really be called ‘hot tan-coloured milk’. With chapatti or stale sponge. Not exactly my ideal mid-morning snack but everyone else devoured it as usual.
And then off out for visits, in two separate teams, in two separate vehicles…except we only had one driver as the other has gone to Kampala to collect the morphine supply for tomorrow’s outreach clinic. So I became a hospice driver for the morning. First stop, a garage in town to buy an inner tube & get it inflated, alas not for tubing down the Nile in my swimming costume but for a lady with a terribly painful rectal tumour who can no longer sit down. She looked somewhat perplexed but being a mzungu means that you can come up with crazy ideas & the local people will humour your eccentricities. Inflatable seats are one thing but I’m not sure how she’ll take the morphine & KY jelly topical preparation I’m delivering to her tomorrow.
Our next stop was to pick up a priest who was a little irate at our tardiness but soon stopped grumbling when we told him we were doing the Lord’s work with a patient. We drove out of town into the bush, through fields of matoke and pineapples, to another patient’s home where we were greeted warmly by all of her extended family and ushered inside before the heavens opened. Ten of us squeezed onto two sofas and a few mats on the floor and the priest led prayers for the patient and her family. With highly suspicious convenient timing, the prayers finished exactly as the heavy downpour of rain subsided, so we said our goodbyes and left. That was the consultation. No history taking or examination, no discussion about management options or treatment prescribed. I hinted to a colleague (well ok, it wasn’t really a hint, I don’t really do hinting or anything so subtle do I? It was probably more of an indignant squeak) that maybe I was capable of more than just chauffeuring a priest around the Mbarara countryside and was told that this is part of the holistic care we provide for patients. When I suggested that the priest could perhaps holistically get a boda-boda so that we could use our time more efficiently elsewhere they laughed & said I was ‘too funny’ – I accepted it was futile to pursue this one & took defeat gracefully (ok, ok, I don’t do graceful either, I took defeat slightly grudgingly then!).
And so, back to Hospice for lunch, where I made the most of the fact that I am recovering from a small gastric upset to excuse me from the mountain of matoke & G-nut paste that I am usually presented with. Much to the concern of our cook I settled for a safe banana.
Teaching for the doctors again this afternoon, this time on ‘Breaking Bad News’ which was a success; we had power, I took my own projector (a brilliant suggestion of yours this morning Mr dean, sir) and nobody arrived more than thirty minutes late.
Passed by my PO Box & found two issues of the Guardian Weekly newspaper waiting for me, I think the staff believe that in storing them up they’re helping by saving me from having to collect them so frequently. Either that or they hate me…I’m going for the former explanation though.
Then back to Hospice once again to catch up with the rest of the team & ensure all is organized for tomorrow’s outreach clinic, which they assured me it was but I am not convinced.
Now I’m at home & the power has just gone, but it doesn’t matter because I don’t need a shower too badly, it’s beer o’clock so don’t need the kettle for tea & I’ll have salad for supper. Once the laptop battery goes I’ll delve into one of my two unread newspapers. And once my rechargeable lantern dies I’ll light the candles. And if all else fails I’ll have an early night in preparation for whatever lies ahead tomorrow…
