Shifting scenes

I’ve been somewhat neglectful of writing in the last couple of weeks largely because since moving from the outpatients to inpatient nursing role I’ve feel like I’ve been floundering around somewhat while I get reorientated to the new job – and I really, really want to write a post where I sound l

I’ve been somewhat neglectful of writing in the last couple of weeks largely because since moving from the outpatients to inpatient nursing role I’ve feel like I’ve been floundering around somewhat while I get reorientated to the new job – and I really, really want to write a post where I sound like I know what I’m doing for a change!

As much as it’s a relief not to have the pressure of the OPD handover solely on my shoulders anymore, I had at least got some routine established in my days there and it’s unsettling to consider that I’m nearly three months into my nine month mission here and feel almost like I’m just starting out again. However, thanks to the numerous weekend and night on calls that I have done, I’m actually settling in far faster than I anticipated and am beginning to get a feel for how I can contribute to the training and skills of the nurses and various paramedical staff that work here. Individual staff names are beginning to emerge from the blur, although on average it still takes me a couple of goes to get some people correct … “Hello Joseph – no, Gatloak!-  No, Koang!” and similar greetings take place on average every 10 minutes as I walk around.

I spent a dubiously delightful couple of days catching up with a bit of a backlog of materials and consumption monitoring – spreadsheets and tallys and coding, oh my! In my life to date, Excel spreadsheets have largely been something that I have diligently avoided and I pride myself on a cultivated ignorance of the meaning of terms like “formatting cells”, but alas those days are now gone. After couple of days spent behind the computer in the office I emerged slightly cross eyed from squinting at data tables a with a whole new respect for how meticulously MSF accounts for every penny of its donations spent – each department in the hospital orders supplies weekly, counts what is left from the week before and the needs and trends are monitored by pharmacists and supply logisticians who endeavour to ensure that we never run low on essential medicines and materials, which would be catastrophic for our project. All our supplies are flown in due to the lack of road access in most of South Sudan – bad planning or running out of essential  supplies would necessitate costly extra flights, but happily, this seems to be very rare!

Once that was done, I took to pottering from ward to ward, chatting to the national staff nurse supervisors and finding out where they want me to help them. Project one – grubby wards. In this dry and dusty climate any surface is coated with a thin powdery film of dirt within a few hours of wiping it and despite the best efforts of the cleaning team it’s pretty  hard to sweep and mop effectively around a ward full of patients and caretakers. And even though the mosquito nets and blankets are washed between patients bed bugs are pretty rife too, as the pattern of viciously itchy bites on the backs of my legs achieved from sitting on the edges of beds while doing consultations attest to. So the next day chaos reigned as nurses and caretakers and cleaners alike carried beds out into the sun and nets and blankets were shaken and spread out on fences to kill the bugs. I helped out untying and carrying out nets and then retired briefly to the expat house and removed a couple of stray bedbugs from my bra, clearly optimistically bent on hitchhiking to my tukul. No such joy!

The cleaners embarked on a no-hold-barred floor to ceiling scrub of the wards followed by vector control insecticide spraying. As much as this was needed, my timing for doing it was a little poor – half of the big central hospital compound which we emptied the wards into was roped off as the logisticians assembled a giant semi-inflatable tent that is going to serve as our operating theatre (OT) for the next few months while construction work is done to improve our somewhat elderly current buildings. The chattering mass of mothers and children off to one side watched fascinated as the team laid out a base and pushed and shoved enormous bulky bundles of tarpaulin into position. Our poor clinical officers picked their way through the sprawling crowd in the shaded verandas trying in vain to complete their ward rounds and consultations in the midst of chaos. The same 40 degree sunshine that was hopefully spelling death for our insect infestation was also beating down on the backs of the logistic workers and I could only watch and wonder as they kept going even during the hottest part of the day. The log team retired exhausted well past 6pm; the inflatable OT-to-be was laid out waiting to be finished on the morrow. By dusk, a semblance of order was restored to the hospital and things had finally quietened down– patients, mums and babies alike returned into the wards  although they all decided to sleep on the floor that night in order to allow the beds to stay out and cook another day. I couldn’t ever imagine that working in the UK but everyone seemed very content with the arrangement here!

Now a couple of days later the wards look (and feel too I imagine) much better. It’s possible to sit down to chat with a patient without picking up unwanted bloodthirsty hitchhikers and I capitalise on this fully during our ward rounds. I plop myself down on beds, shake hands, check how long cannulas have been in, palpate spleens and cuddle every cute baby going.

My only worry now is getting hopelessly addicted to hanging out in the wards. Already I find myself “just popping over” frequently in the evenings to check on a particularly poorly patient, or say hi to a nurse that has just come onto the night duty - “Good evening err... Simon? Bol? Gatwech!”. The OT is fully inflated and almost ready to go now – walking past it as I go from surgical ward to the ICU at ten one still evening, part of it began to move, spookily illuminated by my torch.  It bulged alarmingly in one wall nearly giving me a heart attack before the billowing fabric parted and gave birth to Eric, our French visiting logistician who backed out looking as startled to see me as I was him – turns out he was capitalising on the cool of the evening to do a bit of extra work too.

Nice to know that I’m not the only one unable to stay away!