Travels with my Stethoscope .

Tuesday June 18^th 2013

I just thought I would post my impressions after a week here in Juba, if only to have something to compare it to in 6 months time, when I’m sure my impressions will be very different.

 Work here in the clinic is quite punishing, more so than I thought. It’s not the crazy busy of my last job, where I hardly knew my name from night to bonkers night, where I was frustrated at the lack of autonomy (except where it suited), where I ran from one crisis to the next. It is a steady trickle of really very unwell people, coming to us as we are honestly, and I’m not biased, I’ve seen the competition, the best in town.

There are those who have been out in “the field” ( I intend to go into that in a later post), for months, and return to “civilisation” (Juba) , dry, exhausted, mentally and physically burnt out, and as a consequence of all the above, usually with Malaria, Typhoid, Giardia, or a combination of all three. They come to us as their company pays for them to, for a bit of sanity, a bit of a chat, and of course, for us to make them better. We have the drugs – mainly – we’ve been waiting for vaccinations to arrive from Nairobi for 2 weeks now, all to do with the paperwork of getting liquids that require a cold chain through customs, we have the knowledge (well at least the others do, I’m still learning) , and we have friendly faces. Sometimes I think it’s the friendly face they come to see...

There are those who are local staff, whose company pays for them to have treatment, and who shyly come in, looking a bit embarrassed, with the most raging Malaria, and are so grateful that it almost hurts.

Those who expect to be treated like royalty because they are paying – the most hilarious Indian man today who was “100 per cent!!!” insured ! (he had more exclamation marks than that, honest)

Those that are so tired of being ill they become angry – my best advice to a young Dutch girl this morning who had been ill for 3 months was to go home for a bit – she came in this evening for a check-up and told me she had booked 2 weeks at home leaving Friday – she just needs her Mum.

I love it.

The schedule is tiring itself – everyone works a 6 day week, plus we at the clinic do 2 on calls a week. Last night was my first one on my own. The clinic closes at 5, and after that it is only emergencies that come in. The last few nights there had been a few phone calls and nothing else. I had the poor Dutch girl in at 11pm, till 0100. I probably would have kept her later, but after 0100 she would not have been able to get home – she works for Oxfam and their curfew is 0100 – after that you’d be pressed to find a driver that will negotiate the road blocks (and the bribes that have to be paid to get through..). I got to bed about 2. At 0430 I was woken by a young girl from an NGO who thought she had appendicitis. I asked a few questions, advised painkillers, told her to call me in an hour if she didn’t feel better. At 0630 the Dutch girl came back, weeping, fed up, and no better. I then worked a full shift, and just as I was closing the clinic at 5, got a chap in with a temp of 41 – proper Malaria. Although I was not on call, my colleague who was on call, was busy with the Dutch girl (who had gone home and come back again), so I stayed with him until 2000, when he finally felt well enough to go home.Nothing compared to a 12 hour crazy shift in a busy acute hospital, but steady, 2 hours sleep at a time, and tiring nonetheless. That is pretty much the reality of it, for everyone in this town. It’s no wonder the rotas are usually 8-10 weeks on, 3 weeks off. You’d go mad otherwise.

I love it.

To end today, I got a fit of the giggles. We have the lovliest lab technician, who is South Sudanese. His grasp of English, when asked a technical question, is superb – he gave me a lesson on which bloods I could safely store without being haemolysed today, with all the appropriate jargon. When challenged with social English however, he struggles a bit. As I was asking him if he minded working Sundays, as our other lab guy is a Pastor and needs Sundays off,  we got a bit confused over the issue of him needing to take a day off during the week to compensate.

“Which day off during the week would you like off ? it doesn’t need to be the same day every week, you just need to tell me a bit in advance”

He nodded and smiled. Good.

“So, this week, it being Tuesday, which day would you like off?”

Long pause.

“Monday please “.

Long pause.

“But it’s Tuesday, you need to take a day off you haven’t already worked....”

Long pause.

“OK. I’ll have Tuesday off”

I think I have convinced him to have tomorrow  off, but I will not be at all surprised to see him in the morning.