Its been another great week in the world of capacity building and health. (please read with heavy sarcasm)
But I did promise that the next blog would be positive and up-beat - so here goes!
Well I think we have established that no-body at the hospital - including my VA - has the slightest clue what I am doing here. This came to a head last friday when ITU medicine ward decided enough was a enough & I should stop advising and see some bloody patients. Before I could explain that as an advisor, with the capacity building NGO VSO, service provision wasn't my main focus, I had MSF thrown at me. Hmmm I thought to myself, yes MSF - get your hands dirty, do proper clinical work, bear witness & get paid better - that might well be in the next 5 year job plan. Whilst the male nurses got really hostile & started shouting at me I retreated to the safety of my shabby VSO office .
Later that morning in conversation with the deputy director who barely knows who VSO are, less about capacity building, he told me I must not talk to nurses. So bizarre was this request that I asked for clarification before being quite sure that I was only allowed to talk to Doctors & must not talk with nurses. I had two responses to that one - 1) I am a health care professional, communication is essential with other health care professionals and nurses are health care professionals - WATER TIGHT LOGIC - can't argue with that. 2) If I can't talk to nurses how come they can shout and be hostile & aggressive towards me - honestly I think I had him more stumped on the latter point.
There is however a silver lining to all this. Free from the constraints of a ward that want a MSF doctor & lots of resources but not me, I found myself being requested by J to see a breathless baby that she was concerned about. I have mentioned before that the paediatric ward has & continues to have a whole load of capacity building support and it really does show. Positive point - change can happen but it is slow & bloody hard work.
The 6 week old baby looked to me as if he had bronchiolitis, respiratory rate was 80/min and he was recessing like a recessing thing on a very recessing day. Basically he was working very hard to breath and had been for the last 2 days, I was told. J quite rightly was concerned that the baby was going to get completely exhausted and have a respiratory arrest. Whilst I stood talking to the young mum & examined the baby he stopped breathing, so I gently stimulated him to remind him he needed to breath then explained to the mum to do the same if it happened again.
I then found the duty paediatrician & asked what he thought was going on with the baby. We talked around bronchiolitis & the viruses that cause it, what observations the child had, how I was concerned about his breathing and what their management plan was. Then very gently, after being shouted off a ward for asking where in the medical notes it said the 33 year old woman with 24 hours of untreated fast AF now had a dense hemiplegia, I asked the doctor if he thought CPAP may help the baby. I was expecting dismissive, condescending, patronizing, refusal of my opinion being worth anything (as is the norm here) but instead his brow creased & he said "do you think so?". Now my self doubt is at an all time low so I really gave it some thought before tentatively replying "Yes, I do think so."
What followed was a thing of beauty, out came the CPAP machine, 30 minutes of the staff trying to work out how to use it (so rarely it is used). This involved the oxygen connector flying off the cylinder at high pressure and nearly hitting the baby in the head hence negating any good that the CPAP could have achieved by delivering a fatal head injury to the child. But after some suction of copious snot and the mother now obsessively stimulating her poor exhausted baby even when it had remembered to breath - CPAP was commenced. Later that day I went back to see a much happier baby - still recessing but not an impending respiratory arrest. Every day I have been in to see the progress & I have been told by the head doctor all about how they are weaning him off CPAP & oxygen, almost like we are two doctors discussing a patients care. Today when I dropped by to see him he is now on nasal spec oxygen and breast feeding - see its not all bad. Not gold yet but a good solid silver lining....
But I did promise that the next blog would be positive and up-beat - so here goes!
Well I think we have established that no-body at the hospital - including my VA - has the slightest clue what I am doing here. This came to a head last friday when ITU medicine ward decided enough was a enough & I should stop advising and see some bloody patients. Before I could explain that as an advisor, with the capacity building NGO VSO, service provision wasn't my main focus, I had MSF thrown at me. Hmmm I thought to myself, yes MSF - get your hands dirty, do proper clinical work, bear witness & get paid better - that might well be in the next 5 year job plan. Whilst the male nurses got really hostile & started shouting at me I retreated to the safety of my shabby VSO office .
Later that morning in conversation with the deputy director who barely knows who VSO are, less about capacity building, he told me I must not talk to nurses. So bizarre was this request that I asked for clarification before being quite sure that I was only allowed to talk to Doctors & must not talk with nurses. I had two responses to that one - 1) I am a health care professional, communication is essential with other health care professionals and nurses are health care professionals - WATER TIGHT LOGIC - can't argue with that. 2) If I can't talk to nurses how come they can shout and be hostile & aggressive towards me - honestly I think I had him more stumped on the latter point.
There is however a silver lining to all this. Free from the constraints of a ward that want a MSF doctor & lots of resources but not me, I found myself being requested by J to see a breathless baby that she was concerned about. I have mentioned before that the paediatric ward has & continues to have a whole load of capacity building support and it really does show. Positive point - change can happen but it is slow & bloody hard work.
The 6 week old baby looked to me as if he had bronchiolitis, respiratory rate was 80/min and he was recessing like a recessing thing on a very recessing day. Basically he was working very hard to breath and had been for the last 2 days, I was told. J quite rightly was concerned that the baby was going to get completely exhausted and have a respiratory arrest. Whilst I stood talking to the young mum & examined the baby he stopped breathing, so I gently stimulated him to remind him he needed to breath then explained to the mum to do the same if it happened again.
I then found the duty paediatrician & asked what he thought was going on with the baby. We talked around bronchiolitis & the viruses that cause it, what observations the child had, how I was concerned about his breathing and what their management plan was. Then very gently, after being shouted off a ward for asking where in the medical notes it said the 33 year old woman with 24 hours of untreated fast AF now had a dense hemiplegia, I asked the doctor if he thought CPAP may help the baby. I was expecting dismissive, condescending, patronizing, refusal of my opinion being worth anything (as is the norm here) but instead his brow creased & he said "do you think so?". Now my self doubt is at an all time low so I really gave it some thought before tentatively replying "Yes, I do think so."
What followed was a thing of beauty, out came the CPAP machine, 30 minutes of the staff trying to work out how to use it (so rarely it is used). This involved the oxygen connector flying off the cylinder at high pressure and nearly hitting the baby in the head hence negating any good that the CPAP could have achieved by delivering a fatal head injury to the child. But after some suction of copious snot and the mother now obsessively stimulating her poor exhausted baby even when it had remembered to breath - CPAP was commenced. Later that day I went back to see a much happier baby - still recessing but not an impending respiratory arrest. Every day I have been in to see the progress & I have been told by the head doctor all about how they are weaning him off CPAP & oxygen, almost like we are two doctors discussing a patients care. Today when I dropped by to see him he is now on nasal spec oxygen and breast feeding - see its not all bad. Not gold yet but a good solid silver lining....
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