Monday, 25 March 2013
First day at work
"Where do wars and fights come from among you? Do they not come from your desires for pleasure that war in your members? You lust and do not have. You murder and covet and cannot obtain. You fight and war. Yet you do not have because you do not ask. You ask and do not receive, because you ask amiss, that you may spend it on your pleasures. Adulterers and adulteresses! Do you not know that friendship with the world is enmity with God? Whoever therefore wants to be a friend of the world makes himself an enemy of God. Or do you think that the Scripture says in vain, 'The Spirit who dwells in us yearns jealously'? But He gives more grace. Therefore He says: 'God resists the proud, but gives grace to the humble.'"
The person who was sharing drew examples from real life; as mentioned in my previous post, South Sudan had only recently emerged from decades of conflict and violence. However, what struck me the most was his closing statement:- "God opposes the proud, but gives grace to the humble. So don't be proud, even if you're a doctor". That sure woke me up! All thoughts of self-congratulation of making it here evaporated at that instant. All the more potent that I was the only doc there (the other two were at some administrative pow-wow). I can't say that it was directed at me but I think I would be foolish not to take that to heart. One of the biggest pitfalls of missions is certainly the area of pride, likely stemming from a 'Messiah complex'.
Moving on to the nuts and bolts of the day itself...
It was interesting, to say the least. I felt like a medical student all over again! I basically shadowed the on-call GP and did not make any clinical decisions or perform any procedures, even if it was only a lowly cannula or IDC. So different from the hustle and bustle of my last job (neurosurgery at a tertiary centre). Rather disorienting as well as I had fully expected to be thrown into the deep end upon arrival. The on-call doc encouraged me instead to not focus on the medical side of things during my first three weeks here, but to 'soak up the culture' and concentrate on learning as much as possible of the language (Juba Arabic) and local customs before I leave on my short break. Entirely reasonable but frustrating at the same time; I forgot how disempowering it feels to only be able to watch!
The hospital was better equipped than I expected; it has a proper operating suite with huge UFO-like lights, a three-bed labour ward with obstetric ultrasound and CTG monitoring as well as a path lab and X-ray facilities. But, no biochem! The nurses/lab techs (the staff take the definition of multitasking to the next level!) are waiting for some external training (the actual machine is already ready for use). However, without an anaesthetic machine, the docs are limited to regional anaesthesia and ketamine for sedation. Even with that, they manage to do plenty of Caesarean sections, closed reductions, incisions-and-drainage, and the like.
E.g. today we attempted closed reduction of a supracondylar humeral fracture for a 10-year-old girl; unfortunately, the post-reduction X-rays didn't show much improvement so we'll probably make another attempt tomorrow. Decisions like this are based on two salient observations: the first, that patients here frequently present very late. Case in point, the picture above shows an 18-year-old boy with a mid shaft of femur fracture FOUR years after the initial complaint. The second, that most specialty services we take for granted back home aren't available in town (at times, in the country).
Praise God for
- Understanding senior colleagues
- Continuous improvements in health care delivery. E.g. the hospital has pushed the viable age of premature infants from 36 to 33 weeks with tocolysis, dexamethasone, NG feeds and home-made CPAP.
Please pray for
- More health care workers from both the local and international community to rise up and serve the people of South Sudan
- Wisdom and guidance for everyday clinical decision making, especially when we are limited in what we can offer