So another working week draws to a close -a definite bonus for us here in Gulu is that we are free of shift-work, and we work Monday to Friday - a rare luxury to nurses! Our shifts are 8am to 5pm...although the locals perceive time keeping as a problem and work to 'Gulu time' - trying to make time-dependent arrangements is problematic to say the least when its accepted that you can be up to 1.5hours late!!!
We are certainly learning to become very resourceful nurses! This week the hospital has run out of so many essential items. There's a permanent shortage of gloves with supplies running out daily. The hospital also ran out of a large proportion of oral antibiotics, supplies of intravenous antibiotics completely ran out, as well as all intravenous fluids, and to top it all off we ran out of cannulas (drip ports!) The radiology department remains closed due to no availability of Xray film, there has been almost a permanent power cut to the hospital all week, and a problem developed with the mains supply of water! So all week there has been no running water to the hospital. Handwashing has been done in vats of rain water -thank goodness for frequents down pours (oh it can rain here!) and alcohol hand gel!
Over the last couple of weeks we have seen an increasing number of cases of Methanol poisoning. A bad batch of 'local spirit' has been doing the rounds and the consequences have been fatal. Ironically the antedote for methanol poisoning is pure alcohol! The nearest thing that is available here is the local spirit called 'Waragi' - tastes a bit like a mixture of surgical spirit and gin! So Dr Nik has literally been prescribing shots of alcohol to his patients in casualty making the unit not too dissimilar to a UK A+E department on a Saturday night! The sad reality however, is that a huge number of people have now died from methanol poisoning, or are exceptionally sick, and many have gone blind. Apparently it only takes 10ml (two teaspoons!) of the drink to make you loose your sight. And these people all just thought they would have a good night out. A very sobering thought.
Friday 20 November 2009
Thursday 19 November 2009
A comedy day at the pharmacy...
We’ve spent the last 2 days going to and from pharmacy to get drugs for the patients. After each visit we return to the ward empty handed after being greeted at the pharmacy with a chorus of ‘he is not there’ from the student pharmacists. ‘He’ is the pharmacy dispenser for the inpatient medications who we find very hard to pin down! He works between the HIV centre and the main pharmacy and so is often busy elsewhere.
Today we decided was THE DAY!!! I was most definitely going to arrive back on Ward 2 with a range of medication to treat the patients. So we decided to start early:
9:30am Notes sort out and first trip down. ‘He is coming’ they said (don’t be fooled, in Uganda this may mean in 5 minutes or could be in the next 6 months). ‘Come back at 10.’
10:15am Down through the hospital I walked again only to be told again ‘he is coming’. A very friendly student pharmacist invited me into the pharmacy to sit and wait (I was having slight deja-vu at this point as I’ve sat there for a good few hours on other occasions.) So I made myself comfortable and patiently waited.
10:45 It turns out that he’s actually not coming but he does have the key which someone kindly goes to get. So I wait a little longer….
11:10 The person that had gone to get the key must have got lost on the way I think because he didn’t return! So the student pharmacist went himself to find it. Wait a little longer….
11:25 The sacred key arrives!!!! A team effort in dispensing the 8 patient medications that we needed for the ward. He handed me the boxes and I counted out the tablets and labelled the bags (Nurse/pharmacist extraordinaire!)
11:55 Returned to the ward (with a very big smile on my face!) to give Karen the drugs so that she could start to give them out to the patients on the midday drug round…..and it’s back to pharmacy for phase 2! IV medication!!
12:00 Back in the pharmacy that I’m starting to call home the dispenser told me that I’d brought the wrong order book and that many of the drugs were not there. I was not going to be defeated though! So I enlisted the help of our Ward Manager who is a fantastic source of knowledge and she came back down with me to sort it out. (I was really wishing by this point that the hospital had a phone system!)
12:20 We managed to get about a third of the IV medication and fluids that we needed. He asked me to come back tomorrow for the others (something I can’t say I’m feeling to keen to do having spent the whole morning there!)
12:30 I arrived back on the ward feeling really happy and satisfied with what I’d managed to obtain (see photo above!!). Needless to say poor Karen had been running around like a headless chicken while I’d been away! It’s just crazy how long a simple job like that can take!
Total trips down to pharmacy: 5
Total time allowed for pharmacy related work today: 3 hours
Total drugs obtained: 2 courses of amoxicillin, 1 of septrin, 2 of prednisolone, 1 of ciprofloxacin, 1 of chloramphenicol, 1 of omeprazole, water for injections, IV normals saline 500mls 15 bottles, IV cloxacillin 50 amps, IV benzylpenicillin 25 amps.
Today we decided was THE DAY!!! I was most definitely going to arrive back on Ward 2 with a range of medication to treat the patients. So we decided to start early:
9:30am Notes sort out and first trip down. ‘He is coming’ they said (don’t be fooled, in Uganda this may mean in 5 minutes or could be in the next 6 months). ‘Come back at 10.’
10:15am Down through the hospital I walked again only to be told again ‘he is coming’. A very friendly student pharmacist invited me into the pharmacy to sit and wait (I was having slight deja-vu at this point as I’ve sat there for a good few hours on other occasions.) So I made myself comfortable and patiently waited.
10:45 It turns out that he’s actually not coming but he does have the key which someone kindly goes to get. So I wait a little longer….
11:10 The person that had gone to get the key must have got lost on the way I think because he didn’t return! So the student pharmacist went himself to find it. Wait a little longer….
11:25 The sacred key arrives!!!! A team effort in dispensing the 8 patient medications that we needed for the ward. He handed me the boxes and I counted out the tablets and labelled the bags (Nurse/pharmacist extraordinaire!)
11:55 Returned to the ward (with a very big smile on my face!) to give Karen the drugs so that she could start to give them out to the patients on the midday drug round…..and it’s back to pharmacy for phase 2! IV medication!!
12:00 Back in the pharmacy that I’m starting to call home the dispenser told me that I’d brought the wrong order book and that many of the drugs were not there. I was not going to be defeated though! So I enlisted the help of our Ward Manager who is a fantastic source of knowledge and she came back down with me to sort it out. (I was really wishing by this point that the hospital had a phone system!)
12:20 We managed to get about a third of the IV medication and fluids that we needed. He asked me to come back tomorrow for the others (something I can’t say I’m feeling to keen to do having spent the whole morning there!)
12:30 I arrived back on the ward feeling really happy and satisfied with what I’d managed to obtain (see photo above!!). Needless to say poor Karen had been running around like a headless chicken while I’d been away! It’s just crazy how long a simple job like that can take!
Total trips down to pharmacy: 5
Total time allowed for pharmacy related work today: 3 hours
Total drugs obtained: 2 courses of amoxicillin, 1 of septrin, 2 of prednisolone, 1 of ciprofloxacin, 1 of chloramphenicol, 1 of omeprazole, water for injections, IV normals saline 500mls 15 bottles, IV cloxacillin 50 amps, IV benzylpenicillin 25 amps.
Thursday 12 November 2009
A few pictures of us at work...
The Medical Ward.
The main laboratory.
Debbie getting gauze from the 'sterile' pot.
Karen catching up on some documentation on the Male ward.
Karen outside A and E.
The main laboratory.
Debbie getting gauze from the 'sterile' pot.
Karen catching up on some documentation on the Male ward.
Karen outside A and E.
Tuesday 10 November 2009
HOSPITAL LIFE...AND DEATH!
So we have written about our daily routine. For any nurses reading, you may think that our working day is not too indifferent to nursing back home in the UK...this couldn't be further from the truth!!!
We certainly never expected things to be easy working in a developing country, but at times we become so frustrated its untrue!!! Tasks that in the United Kingdom would be extremely straight forward and simple, can be incredibly time consuming here in Uganda. Blood tests are a fine example of this. Acquiring the correct sample bottle can often involve visiting every department in the hospital...only to return to the first place you visited, where the staff suddenly 'discover' they had what you needed from the outset!!!! Needles and syringes are like gold dust so locating them can take time. Then you arrive at the laboratory to find it is locked! If you are lucky, the results may eventually arrive the next day!
The processing of blood tests is often money dependant. Tests we take for granted in a developed world, like renal function tests, must be paid for by the patient or their family. No funds = no test. Can you imagine this?
Medications are also often subject to patients self funding the drugs they require. The hospital has a basic supply of drugs. Above and beyond this, the patient must pay for medications from a pharmacy in town. Again, no money = no drugs...I'm sure you can imagine what this means for the patients ultimate outcome.
Supplies of basic necessities frequently run out, grinding work to a halt. A prime example is gloves. With the main presentation being HIV and AIDS you can appreciate that no one is prepared to take the risk with bodily fluids. The radiology department is only just operating again after running out of X-ray film for nearly two weeks. TB is a huge problem here and so being without specimen containers for a week proved problematic.
A RAY OF LIGHT....
Despite our many frustrations, there is a ray of hope!!! A new medical and surgical ward have been built, and yesterday the surgical patients began to move into their new premises!!! This has been such a long time coming and is such a boost to the hospital, the staff, and the patients!
The medical ward is at present, temporarily housed in the paediatric unit, so the sound of children constantly crying is deafening! The male and female areas are separated by the nutritional ward. Passing through this area each day is heartbreaking - seeing so many malnourished children. One child I saw last week, about 2years old, was so weak he couldn't hold the weight of his own body. His mother was trying to get him to stand but his legs kept buckling. Unbelievably sad.
The medical ward where we are working is yet unable to move as the bathroom facilities remain incomplete but at least there is light at the end of the tunnel! Unfortunately a new ward does not mean new furniture, so all the old decrepit beds will be going with us...if they don't fall apart when moved! Watch this space!!!!
We certainly never expected things to be easy working in a developing country, but at times we become so frustrated its untrue!!! Tasks that in the United Kingdom would be extremely straight forward and simple, can be incredibly time consuming here in Uganda. Blood tests are a fine example of this. Acquiring the correct sample bottle can often involve visiting every department in the hospital...only to return to the first place you visited, where the staff suddenly 'discover' they had what you needed from the outset!!!! Needles and syringes are like gold dust so locating them can take time. Then you arrive at the laboratory to find it is locked! If you are lucky, the results may eventually arrive the next day!
The processing of blood tests is often money dependant. Tests we take for granted in a developed world, like renal function tests, must be paid for by the patient or their family. No funds = no test. Can you imagine this?
Medications are also often subject to patients self funding the drugs they require. The hospital has a basic supply of drugs. Above and beyond this, the patient must pay for medications from a pharmacy in town. Again, no money = no drugs...I'm sure you can imagine what this means for the patients ultimate outcome.
Supplies of basic necessities frequently run out, grinding work to a halt. A prime example is gloves. With the main presentation being HIV and AIDS you can appreciate that no one is prepared to take the risk with bodily fluids. The radiology department is only just operating again after running out of X-ray film for nearly two weeks. TB is a huge problem here and so being without specimen containers for a week proved problematic.
A RAY OF LIGHT....
Despite our many frustrations, there is a ray of hope!!! A new medical and surgical ward have been built, and yesterday the surgical patients began to move into their new premises!!! This has been such a long time coming and is such a boost to the hospital, the staff, and the patients!
The medical ward is at present, temporarily housed in the paediatric unit, so the sound of children constantly crying is deafening! The male and female areas are separated by the nutritional ward. Passing through this area each day is heartbreaking - seeing so many malnourished children. One child I saw last week, about 2years old, was so weak he couldn't hold the weight of his own body. His mother was trying to get him to stand but his legs kept buckling. Unbelievably sad.
The medical ward where we are working is yet unable to move as the bathroom facilities remain incomplete but at least there is light at the end of the tunnel! Unfortunately a new ward does not mean new furniture, so all the old decrepit beds will be going with us...if they don't fall apart when moved! Watch this space!!!!
Monday 9 November 2009
A day in the life of Karen and Debs.....
Wakey wakey, cold shower!
Breakfast with the family (Sally, Nik and.....leaving Joe in bed).
A gentle wander through the dusty streets of Gulu past the green fields in the hot sun to work.
Morning mango juice from our local street seller.
Arrive at work: try and find patients and match them to their notes - patients are often outside, have swapped beds, be on the floor, or in some cases have 'runaway' (self discharged). The notes are often in disarray and so even finding them can be problematic!
Observations: We try and get around to each of the 35 patients and record Blood Pressure, Pulse, Temperature and Respiration Rate identifying the most sick patients on the way around. We're learning so much about clinical examination though as patients here seem to compensate for so long before their observations reflect it. Observations can take quite a long time as everything is done manually.
Ward Round: the Intern Doctor (house officer), Sally or Consultant Doctor will do a ward round. So many students come to watch that it is quite chaotic on the ward and it's quite difficult to get things done! We try and go on the ward round though so that we can pick up jobs on the way and listen to the plan for each patient.
Medication round: no easy task as there are no prescription charts and a large percentage of the drugs are not stocked on the ward. Sometimes the patients are missing which makes it a bit harder!
Jobs, jobs jobs! These include taking blood tests, trips to pharmacy or HIV centre, trying to contact the Social Worker or Physio, going to the lab to take specimens or get specimen pots, siting cannulas, admitting new patients.
There is a small distance between the male and female parts of the ward and we are often cheered up by 2 little friends who seem to live around the back of the hospital with their mother. The 2 little boys always have a high five, whistle or great big grin for us!
End of the day: exhaustion, exhilaration, frustration and a sense of achievement washes over both of us and we plod home debriefing on the day that has gone before. We go and watch the lovely sunset over our house and generally fall asleep soon after dinner!
Breakfast with the family (Sally, Nik and.....leaving Joe in bed).
A gentle wander through the dusty streets of Gulu past the green fields in the hot sun to work.
Morning mango juice from our local street seller.
Arrive at work: try and find patients and match them to their notes - patients are often outside, have swapped beds, be on the floor, or in some cases have 'runaway' (self discharged). The notes are often in disarray and so even finding them can be problematic!
Observations: We try and get around to each of the 35 patients and record Blood Pressure, Pulse, Temperature and Respiration Rate identifying the most sick patients on the way around. We're learning so much about clinical examination though as patients here seem to compensate for so long before their observations reflect it. Observations can take quite a long time as everything is done manually.
Ward Round: the Intern Doctor (house officer), Sally or Consultant Doctor will do a ward round. So many students come to watch that it is quite chaotic on the ward and it's quite difficult to get things done! We try and go on the ward round though so that we can pick up jobs on the way and listen to the plan for each patient.
Medication round: no easy task as there are no prescription charts and a large percentage of the drugs are not stocked on the ward. Sometimes the patients are missing which makes it a bit harder!
Jobs, jobs jobs! These include taking blood tests, trips to pharmacy or HIV centre, trying to contact the Social Worker or Physio, going to the lab to take specimens or get specimen pots, siting cannulas, admitting new patients.
There is a small distance between the male and female parts of the ward and we are often cheered up by 2 little friends who seem to live around the back of the hospital with their mother. The 2 little boys always have a high five, whistle or great big grin for us!
End of the day: exhaustion, exhilaration, frustration and a sense of achievement washes over both of us and we plod home debriefing on the day that has gone before. We go and watch the lovely sunset over our house and generally fall asleep soon after dinner!
Monday 2 November 2009
Yabadabadoooooooooooooooooooo time!!!!!!
So Gulu was taken by storm with a halloween party extravaganza on Saturday night! We tried to explain to the locals what halloween is all about with little sucess, and many stares as Flintstones, Ninja turtles, trolls, cowboys and indians amongst other characters walked around town!!!!! It may seem ironic that we are partying when we have written how some people are living in such poor conditions here -please forgive us for needing some degree of normality in our lives out here!
The Manchester gang transformed themselves into an award winning family of Flintstones, complete with car that we spent many hours building...which we later crashed on our lap of honour around the grounds of the party venue - its now officially declared a 'write-off!' But it help us secure the award for 'Best Innovative Group' and so we felt very proud of our efforts! Much fun was had by all, culminating in a street dancing to a group of local musicians playing the most fabulous music our ears have heard since arriving in Uganda!
The Manchester gang transformed themselves into an award winning family of Flintstones, complete with car that we spent many hours building...which we later crashed on our lap of honour around the grounds of the party venue - its now officially declared a 'write-off!' But it help us secure the award for 'Best Innovative Group' and so we felt very proud of our efforts! Much fun was had by all, culminating in a street dancing to a group of local musicians playing the most fabulous music our ears have heard since arriving in Uganda!
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