Saturday 18th January 2014

What do you see, Dr, patient, ward nurse, when you see my uniform? If you are a  Dr, you see yet another agency nurse, who very probably doesn't know what she's doing, who's not familiar with the protocols, who is probably not very bright (after all, why on earth would you not want a full time job and the opportunity of promotion up away from the shop floor? Why would you not want a career ? ) You have less patience with me for not having done the things you asked me to 10 minutes ago, as you have  a relationship with the ward nurses you work with every day, and you understand them, you've talked to them, you know that they have 20 other things to do first. You sigh with annoyance and tell me it's not " rocket science" to know that I should have brought the dressings down to theatre with me that my patient was due to have done under anaesthetic. Well, it IS rocket science, Dr, if no-one told me that was how it was done in this hospital. I'm an agency nurse, remember, I work somewhere different every day.

And what do you see, patient? You see a white uniform, or a blue uniform, a uniform you don't understand as it doesn't match those of the ward staff. You don't know my rank, my experience, or even if I'm actually a nurse. You think I may be a Physio, an OT, or a Radiographer. Actually, you, the patient, are my saving grace - once I tell you who I am, you don't really pass judgement as long as I look after you well.

And you, the ward nurses - what do you see ? You see yet another member of the workforce that morning who will need supervision. Another one who will need to be shown where everything is, lent your pass to open every single door that is locked with security keys , another member of staff who won't be able to fill in the paperwork properly . It's hardly surprising you are not always delighted to see me, when I'm one of 4 agency nurses that day on your team of 6 . You see that I am being paid more per hour than you, to do probably do half the job.

You don't see our stories, our experience . You don't see the reason we work for an agency, the family responsibilities that make it impossible to work in a team where your rota is random , the personal lives behind us, that mean we have to be able to take days off at a moments notice to sort out our elderly relatives/children, even pets.You don't see that even though we get paid more than you per hour, that if we get sick, or can't work, we don't get paid. You don't see that we have to work double shifts if we want to have a few days off. You don't see that our experience is valuable, as we know a little about a lot of things - we have to .

There is a certain camaraderie amongst agency staff. We compare wards, hospitals, the friendliness (or not ) of the staff, the amount of patients we were expected to care for in each place, how late we left work on that ward, or this ward. We have to belong to some sort of team, so we make our own, ever changing one.

So what DO you see , all of you ? I'll tell you what you don't see. You don't see me. 

Sunday January 12th 2014

Thought I'd just post a few things about life back in the NHS before signing off for a while - after all, "Travels with my Stethoscope" doesn't really have a great deal of relevance when I'm not actually GOING anywhere..(for now).

Being back in the system is much harder than I thought it would be. Working for an agency is fine - I get to choose where and when I work, which is a big bonus, and the pay is OK, but the work is really really hard. I really don't want to sound like a bleeding heart, but I'm finding it really difficult not to snap at complaining relatives, angry at the time they have had to spend in A&E because the hospital is oversubscribed and understaffed - yes, Brighton people, it's endemic. It's the same everywhere.  I want to tell them about the young boy who died in Juba from an asthma attack, because the hospital had run out of oxygen. I want to tell them, when they complain that Dad's medications are 20 minutes late because their nurse simply has too many patients to care for, about the 40 year old man who died from a hypoglycaemic attack (low blood sugar) because he was too far from anywhere that knew what to do . I want to tell them, when they complain that their relative has not been seen that day by the tired, harassed junior doctor , about the young girl with advanced malaria, who was almost certainly going to die because her family did not have the money needed to get her to a hospital that could look after her, or the money needed to pay that hospital even if they did get her there. My tongue is becoming quite raw from all the biting of it I am doing.

Back on the shop floor of nursing, working as a junior staff nurse again after so many years spent being in charge, has reminded me of how bloody hard these nurses work. This is no surprise to anyone, I suppose, but experiencing it first hand again, hour after backbreaking hour is actually making me a bit sad. Sad , that as a junior staff nurse, your main job seems to be ticking boxes on the endless " yes Mr Cameron, I have ticked that box to show I care"  reams of paperwork . There are piles and piles of it. Tick a box to say I asked my patient if he was comfortable every hour. Tick a box to say I have looked at his pressure areas every 2 hours. Tick a box to say I've managed his pain every hour. Boxes for food, drink, positioning, happiness....... By the time you've ticked all these boxes for your 8-10 patients you are caring for, it's time to start again. The sad thing is, the health care assistants are actually DOING those things. They are the ones washing your patient, looking at their skin, feeding them, turning them. As a staff nurse you are just the box ticker. There simply is no time to actually carry out the care yourself.  You are relying on second hand information, because you are doing the drug round that takes 2 hours, or placating the annoyed relative because your drug round has taken 2 hours and their Dad was at the end of it . I've worked in Care of the Elderly, Orthopaedics, Surgery, and the Acute Assessment Unit so far, and it's the same everywhere. Too many patients per nurse, too much paperwork, and not enough time to actually CARE . Having worked for so long as part of a team of senior nurses, who were all brilliant at their job, I had forgotten what it's like to go home every night wondering if you'd actually signed for that drug that was prescribed to be given 5 minutes before the next shift started, or if you'd remembered to tick all your boxes, or if you'd remembered to tell the next shift all the things you hadn't managed to do ( and hear them sigh with annoyance).

There is a certain amount of relief, not having to keep an eye on everyone else, and make sure they're doing their jobs properly, frankly it's exhausting enough, keeping an eye on myself,and making sure I'm doing my own job properly. And the sad fact of it is, I'm not. Not to my own satisfaction, anyway. I'm experienced, organised, and sensible, and I can't manage to leave work these days feeling that I've done a good job. My heart goes out to the juniors, who must think that this is the way it will be for the rest of their careers. The sad fact of it is, they're probably right. With the advent of the compensation culture and the tide of opinion directed against the public sector by the popular press, the decline in numbers of decent, practical, caring people applying for nursing, is bound to continue to fall. It makes me very sad.

So, happy days ...... hopefully the aviation medical course I am doing in February will open up some avenues into flight repatriation, and I may get the odd contract as a medic at Shepperton Studios if I'm lucky - quite frankly, I can't do this ward work for ever or I will become one of those embittered, uncaring, miserable nurses that exist on every ward. And that was never why I did this job in the first place.

It may not be Juba, but the NHS is a different kind of war-zone.

Wednesday 8th January 2014

Well, what a whirlwind that was..... How to put into words the last few months - I'll give it a try..

I feel able to be a bit more honest about my time in Juba now, as it really is so far away. The  month after my last post was really tricky. Things at the clinic were certainly not all sweetness and light. I discovered that managing difficult people was not my forte - sad though it is, I would prefer to be liked than disliked, and prefer not to make unpopular decisions. Strange one that, as having been a Clinical Site Manager for ten years, I was used to making unpopular decisions daily, the difference being, I had the support of my team. In Juba, I had the support of my Deputy, and that was it. As so many people point out, it's not a popularity contest, but I hated it. My senior Doctor and I fell out irrevocably, to the point that we stopped speaking to each other unless it was to do with direct patient care. I admire her immensely - being a South Sudanese female doctor is not easy, in a male dominated culture, and she is a strong and opinionated woman . Sadly, so am I, and that led to stubborn clashes that just could not be resolved. She had strong family ties to the local dignitaries, and the government, which meant she was invaluable to keeping the clinic afloat in a society that relies on such ties. It also meant she was untouchable - when faced with a flat "No" to any request I made of her, I had nowhere to go . The on call rota became a bone of contention, with the local staff complaining that they felt it was unfair the amount of on-calls they were expected to do, despite me painstakingly writing out exactly how many everyone was doing to show that it was equal (except for mine, as I did almost a third more than everyone else) . It didn't matter - they didn't live on the compound and ( I suppose quite reasonably) felt that nights away from their family sleeping in the clinic were harder for them .

The security situation began to deteriorate, with reports of robberies on Kawadja cars out at night - the suggestion was that no-one went out later than 10pm, even then, there were reports of cars being held up not 200 yards from our compound earlier and earlier. This was not surprising really, the police and the army ( those responsible for most of the robberies) had not been paid for 3 months, and had just heard that they would not be paid in the foreseeable future as the government " Needed to pay its debts" first. They were hungry, desperate and had families to care for. We Kawadjas were an easy target, with our mobile phones, and our wallets full of dollars for an evening out, that would feed a family for weeks .

Andrew went on leave for a month, and pretty much everyone else that I could have a laugh and a joke with, went on leave at the same time. I was left at the clinic on my own, virtually in prison due to the security situation, with staff who resented me - it was a very long month. I was bored, and couldn't wait to come home on leave. On average we saw about 20 patients a day in the clinic, which, when we were all there, was about 3 patients a day each. There is only so long you can chat to a patient who has come to clinic because he stubbed his toe on the way home the night before - really. The Malarias and Typhoids livened things up a bit, but at the end of rainy season, they were becoming far and few between. The odd repatriation kept me up all night - I volunteered just to break what was swiftly becoming monotonous .

Reports started coming in of armed gangs breaking into Kawadja compounds and stealing everything - the people were left unharmed, but laptops, cash, personal possessions, all gone. The situation was becoming more desperate as we approached Christmas. One friend of mine who was an old hand in Juba, was lying in his bed one morning when someone crashed through his window and landed on the floor of his room. It turned out that a Boda Boda driver had been run over and killed, and an angry mob was chasing the driver through a compound hell bent on revenge - this unlucky mobee had taken a wrong turn in all the excitement. Luckily my friend was fine, and the mobee went back out the same way he had come in, leaving my friend unharmed, but very shaken. He moved out of the city to a compound on the outskirts the following day.

I greeted Andrew with enormous relief on his return, and gaily fled the compound for my leave in the UK, safe in the knowledge that I would only be returning for 10 days in December, to honour the end of my contract( although I had only been required to give 30 days notice, I had given 60, knowing that the clinic would have no-one to run the place over Christmas if I didn't come back).

After a lovely holiday in the UK, I was driving back from the New Forest from a weekend break, due to fly back the following day, when I received a text from a friend saying " Look at the news - Juba is in trouble". It turned out that all hell had broken loose the day before, with rebel factions of the army fighting forces loyal to the Prime Minister. Our clinic was in Tong Ping, the very epicentre of the fighting. Emails flew back and forth - what should I do? I was very uneasy about returning with the situation so unstable. The management told me to wait on standby to see how things progressed - Andrew gave a very different story and advised me to not come back at all. I was asked to fly to Nairobi, and wait in a hotel there for further instructions - after consultation with a few of my friends  it looked like I could be there for a while - the airport in Juba was closed until further notice, and the fighting was now in the streets of Tong Ping, with Andrew reporting heavy artillery fire and tank fire just outside the compound. I declined the offer of Nairobi, and told them I would wait it out here . The clinic staff were turning off the lights and keeping their heads down, praying that the clinic would not be the target of hungry, broke looters. Our neighbours, the Norwegian Army, had offered safe haven (although, like all the peacekeeping forces there, they did not carry weapons). Although they were next door, it was too dangerous to actually go outside the compound, so a cunning plan was developed as an escape exit strategy - and here I do not joke. We share an adjoining wall, and on our side of the wall there was a ladder. On reaching the top of the ladder, there was a fishing pole and line, which was to be used to hook up the matching ladder on the other side, to make good their escape . Cunning indeed. That was, in effect, the exit strategy. With South Sudan being landlocked, all the borders were closed, the airport remaining closed,  they really did just have to wait it out.

The company eventually hired a private plane to evacuate the ex-pat staff as soon as the airport was functioning again. A plan was made, and they got ready to leave, being allowed only to take a small bag of possessions each. The day before, I received another email asking me to remain on standby, and would I consider working another month to get the clinic up and running again - there seemed to be a bit of a lack of joined up thinking here....

Off they trotted to the airport, feeling slightly smug about the private plane, when the tiny airless waiting room was full of hundreds of ex-pats, all waiting for seats on scheduled flights, desperate to flee. Can you imagine what it must have been like, to see a plane land, and nose-dive on the one runway, its front wheel completely collapsing. No-one was hurt, luckily, but  nothing was landing or taking off until the runway could be cleared - it was by now about 3pm, and there being no landing lights, the airport simply couldn't function after 6pm due to the light. Somehow, a tank was commandeered to clear the runway, and planes began to furiously take off and land every few minutes to stay ahead of the curfew. Thankfully my team got out, and I breathed a sigh of relief upon hearing that they had all arrived at a hotel in Nairobi, and were sleeping without fear for the first time in 10 days .

Andrew has returned safely, having managed to salvage some photos for me that me that were irreplaceable, although that was about all he did manage to salvage - I envisage several South Sudanese running about in my shorts much to the amusement of their friends...
The clinic was locked down, and no-one really knows if it is still in one piece. The local staff have all returned to their families, and we have heard from most of them that they are OK. With so many ex-pat companies pulling out of Juba, it is unlikely that they will have any work in the future, and I feel desperately sorry and worried for them .

So my adventure was cut short by a few weeks, but what a few weeks, and I couldn't have asked for better timing of my leave - although there is a part of me, now that I know everyone is safe, that wishes I had been there, and it would be my story to tell. Still, probably for the best !

Who knows what will happen there next, and whether URG will open the clinic again - I suspect not, although they do not appear to have given up hope yet.

I, on the other hand, am back to ward work, for an agency, and it's killing me - but that's another post, this one has been long enough already.

Goodbye Juba, it certainly was an experience.