It's Always Darkest Before The Dawn

You’ll be happy to hear, especially after my slightly depressing last post, that things have getting a lot better for me over here. My relentless campaign to make friends with endless baked goods, enthusiastic small talk and buying countless 2L bottles of coke for staff (they would drop not so subtle hints to me like ‘oh god I’m thirsty, if only I had 2L of coke’) is finally paying off. Not only have I managed to make connections with people at work but a few weekends ago I attended a cultural weekender for Ex-pats in Lesotho and met an entire network of arrogant heathen westerners who will drink, dance, and discuss liberal left wing topics with me like how much he hate trump and love the gays. I can feel my sanity slowly returning to me, one slut drop at a time. All the western people I have met live in the capital, which is about a 2 hour drive from me, so I can only see them on the weekends. When I visit it’s a world away from life in my small village. The Ex-pats have beautiful houses, with modern furniture, unlimited wifi (which doesn’t randomly switch off for days) and fridges full of western delights like fresh coriander, coconut water and dairy products. There are not many people able to live this western lifestyle in Maseru, it’s a pretty small community, so once you make friends with one person in the group, sudden you get known by everyone. Now when ever I go to the the only high end supermarket in town, checkers, I run into everyone I know all with trollies full of fresh herbs and coconut water. 

Work has also gotten a lot more interesting. It recently became apparent that I have more medical experience than any of the other medical doctors at Maluti. An absolutely terrifying thought, that I am the ‘medical expert’ here. Once people started to realise this I began getting roped into all kinds of projects. I’m currently helping the lab to create a formal handover process between the night and day shift, I’m providing guidance to the CMO and heads of nursing on how they can implement an EWS in the hospital and assisting them in buying all the necessary equipment to allow such a system to work, I’m developing a formal induction for the locum doctors and in doing so I am collating policies from every department of the hospital and formally writing them down, something that many departments have never done before. I’m still working on the mega data QI project to create unique patient identification numbers and improve the filing of patient notes as well as my own project on improving the rate of review of investigations by doctors for patients on the ward. It’s a lot, and I keep getting asked to do more. 

Huge crowds attended the funeral

I collected some wild flowers to give to the family

The other week we had a very sad incident where a very senior nurses brought her husband into the hospital with chest pain. They very quickly went into cardiac arrest and an extremely chaotic and emotional resuscitation ensued with an unfavourable outcome. The patient was a very well-known member of this very tight community and afterwards everyone was in floods of tears. It was felt that the hospitals complete lack of any clinical protocols was a contributing factor as to why the resuscitation felt so chaotic, so I was asked if I could write some for the hospital. I could hardly say no given what was going on around me. Following this incident I lead Maluti’s first ever cardiac arrest debrief. There was some hesitance form the staff to do it, as one person told me ‘black people don’t talk about their feelings’ but after I explained that a clinical debrief is less of a counselling session and more of a quality improvement exercise most people got on bord with it, and afterwards everyone who attended said they found it extremely useful. The debrief highlight how incredibly unequipped the hospital is to deal with cardiac arrests, something you would have thought would be fundamental to any hospital. Amongst the issues highlighted was the fact that the hospital has no formal way of initiating a cardiac arrest code, no way to alert staff that it is happening, other than running around screaming for help. The emergency trollies (despite being checked daily) were all missing essential equipment and medications. The hospital lacks vital medications to treat or even assess for life threatening conditions partly due to stock outs, and partly due to lack of funds. However most worryingly of all was the fact that the hospital only had 2 defibrillators, both of which are the automatic kind, the ones you would expect to find in any leisure centre in the UK, not the quality required for advance life support by highly skilled medics, but even worse, only 1 of them isn’t functioning at all, and staff were mostly unaware of how to operate it. It’s actually a miracle that they were able to run anything even vaguely resembling a resuscitation given the circumstances. It turns out, not having access to a manual defibrillator is a limitation that most of the hospitals in Lesotho have, this is just one of many reasons why private ambulances normally take their patients across the border to SA rather than any hospital in Lesotho. 

So following this, as the most senior medical doctor in the hospital, I was asked to write protocols for the management of ALL medical emergencies. No big deal. Speaking with my supervisor back home I was told that in the UK it takes on average 4-6 months to get a single protocol written, approved, and in circulation, So far I’ve written 14 and I have just over 3 months left here. Should be easy….