It’s a quarter to 11 on Saturday night and we are almost halfway through our last weekend on call at our hospital. With only 10 days to go before the end of our contracts, all our feelings of guilt about leaving that had been successfully suppressed by training for, and then going on, our expedition to the Drakensburg, are coming to the fore. Word has got round the hospital, and everyone keeps asking us, ‘How can you leave?’. I don’t think they mean to be nasty, but each time they say it I feel a resurgence of guilt. We were hoping that the staff would be so excited by the prospect of some new equipment that they wouldn’t mind losing 2 doctors, but unfortunately a couple of extra pairs of hands are still worth more than a few BP machines and CTGs. Not to say that the equipment is not needed, or that it won’t be appreciated, of course.
It took us a few months to really get settled into work here, and our early days were spent frantically trying to get competent with anaesthesia and surgery and the other ‘bread and butter’ bits of rural medicine. It was only after about 6 months or so that we had the confidence to think that we had something to offer as well, which is when we started our teaching sessions for the nurses in our different departments. Even more recently, just a month ago, I decided to branch out and tackle the main problem I face in Paediatrics – malnutrition – at its root. Babies are seen on a monthly basis at their local clinics for weighing and vaccinations. Almost every child we see at the hospital with severe malnutrition has a growth chart that shows a slow and steady decline in weight that has been plotted by the clinic staff, with no action taken to prevent further decline. So with the help of the dietician, I held a half-day workshop on the identification and management of malnutrition in children for the nurses who work in the clinics that are in our hospital’s catchment area. The workshop went really well, and the group has decided to meet on a 3-monthly basis, but now I won’t be here to see it continue, and don’t know if all the enthusiasm will fizzle out in time. It takes time to build public health projects that make a real difference, and it’s time that I am not able to give this community.
On the plus side, I had a lovely surprise the other day, when an excited mother thrust a plump and giggling 2 year old child into my arms. Although initially confused, I eventually realised that this child was an ex-patient of mine, who was in the ward last year for over a month. She had terrible malnutrition and was also found to be HIV positive. We started her on treatment but the child wasn’t being reviewed at the hospital because she lives too far away (she collects her HIV treatment from a local clinic instead). The mother had come to the hospital to visit a relative and had been looking for me to show me how much her child has improved. The child certainly has improved – when she was in hospital she could barely sit, she was so weak, and now she looks so healthy you would never guess she had HIV.
I guess if you’ve positively influenced one person’s life, then you’ve made a difference to them, as in the famous starfish-on-the-beach analogy, and I should be happy with what I have achieved rather than thinking about what I am unable to, but it is hard. It’s like we’re trying to stop a sinking ship with two pairs of hands and a leaky bucket.
Hi! Very interesting read. Will follow this.