SATURDAY, MARCH 24, 2007
So, I'm getting my hospital on in Fort Portal now. Its an experience, for sure. I don't know what to say. Many of the details are gross and I doubt you really care that much, lots of malaria and a new perspective on HIV.
The hospital. Its a nice place to be honest. Run like... well I'm stuck for a simile. There are a lot of infuriating things. For one, lab tests have to be in by noon, and you might get them back in two
days, they definitely don't know the meaning of STAT, even for something like a urine Beta-HCG, or a hemoglobin. But what did I expect really? They do seem to do a good job, for the most part, with
what they have, and they are asking for help.
The staff are very friendly. They are all happy to have me around and its impossible to get them to refer to me as anything but Doctor. So I guess I'll be used to it by the time I am actually one. I've been
hanging out in the pharmacy doing some research for Dr. D, the head guy here, the last few days (since I got kicked off service) and the staff there are just fun to hang out with.
I've insinuated myself into the anaesthetic world as well. I have been doing most of the anaesthesia with T, one of the nurse anaesthetists. Its interesting, they have three nurses who do anaesthesia, each with different levels of training. T did a 1.5year course in Mulago Hospital, the big hospital in the capital,
G did a few weeks course at the local government hospital and the other one just picked it up here. It shows quite clearly in their confidence (and that T walks into the OR every day with her Oxford manual of anaesthesia and is constantly bugging Dr. D for a full on modern anaesthetic machine, one with cardiac monitoring, they don't have an ECG here BTW).
I was working with Dr. F for the last week. She is an American Dr. She is keen to let you know she is doubly board certified in surg and emergency medicine, and that she was in charge of a level 1 trauma
centre, whatever that means.
It was a hellish week. She complained constantly. At first I thought it was good to hear, that I could learn about the differences, but she seems to have expected a bunch of stoic North American patients, who
just happen to be black and infected with tropical diseases, in an equivalent to a level 1 trauma centre in the US. I kinda realised how amazingly out of whack her perspective was when she was distraught
that they didn't do laparoscopic surgery here. Considering how she complains about their open surgery I can't imagine what she was thinking. The maintenance and service of laparoscopic equipment alone
would kill the hospital, (for those poor sots who don't know what laparscopic is, its when they do the surgery without cutting you wide open but just make a few small incisions, put in a camera and some
manipulators and work that way, the two stitch surgery concept). I was just surprised that they actually intubated and didn't do the surgeries with bag and mask.
There are a few other things too, like she gets mad at them when they say she, or J, the nurse volunteering here are fat. I understand the N American view, but they were very clear that here that means that you are obviously successful, well fed and happy. Its quite a compliment, and most of the people at the hospital are fat..ish.
So I worked with Dr. F for the week rounding on medicine and surgery. Turns out she's not the best teacher (I have to be somewhat careful depending on who ends up reading this). She was very happy
with me when she could send me to pass messages to the nurses, and send me to get samosas for her when she was stuck infusing a unit of blood via an art line (they don't have central lines and a pt who was bleeding profusely needed good access and they couldn't get peripheral access. BTW Dr. F kept talking about how they didn't waste time with peripheral IVs they went straight to central lines which
seems... bad to me. Anyways, they tried a saphenous vein cut down, but she hadn't seen one since her internship, I hadn't even read about them and only heard about them on MASH, and the other surgeon
obviously hadn't done one in a while, they ended up missing the saphenous vein, but dissected down the the posterior tibialis quite nicely and cannulated it well). When I was called in early one morning to do some anaesthetics and then rounded on surgery before she arrived she wasn't happy. I went in at 0700, after a shower and breakfast, and rather than sit around I thought I would just get things going. I rounded, wrote my impression and plan and kept detailed notes to discuss with her when she arrived. We had thrice discussed my level of responsibility and what was appropriate. So I did this and she came in as I was finished examining the last patient, and went off. She said I couldn't do this, that I couldn't write
orders, and I said I was ready, and happy, to review every patient with her, she in a hmph said review, if you're going to be like this you are going to have to be on someone else's service. At this point I was so fed up and she was being so amazingly unprofessional and inappropriate that all I did was said fine and walked off the unit. What a saga eh? So I am now banished from medicine, and surgery until the local surgeon gets back for doing no more than I would have done as a Canadian medical student (which is much, much less than a Ugandan medical student would have done). I don't think she was ever
interested in me being anything more than a trained show dog, like she breeds at home. Following, watching, listening to her complaints and never having my own opinion, never seeing a patient independently (except with explicit prior direction from her and as nothing more than relaying orders) and just running errands and watching. Not for me.
So I'm killing time now, next week I start on Peds with Dr. C and we'll see what happens there.
But the anaesthesia is fun, except Dr. F expects to be involved in all the surg so I'll have to deal with that from now on, anyways, the surgery is done in old style. Manual BP, of course, but under Ketamine or Thiopental induction (decision based on BP) with Halothane or Ether maintenance. There is no oxygen tank but they have a concentrator, which I had never seen before. Many of the surgeries
are done under local with sedation, to minimise the risk of GA, something I totally agree with, but Dr. F seems un-impressed with. Without an ICU backing her up T (the nurse anaesthetist) didn't want to use a GA on an 80year old, so she sedated him, Dr. F bitched the whole way. I thought T was pretty reasonable about it.
Anyways, what else. I've been hanging out with a guy named B the last few days. Its a bit scary, he's from Alabama, nice guy but right wing, the scary thing is on how much I agree with him. I didn't
think I could agree with a southern USer, but we have a lot of common ground. We just don't agree with the liberal PC dogma without some basis to it. Its just been fun shooting the shit for the last few days with him drinking ungodly amounts of tea. Since Dr. F kicked me off her service I haven't had a lot of work to do.
So that's my story these days. More to come I'm sure.