We had a fun weekend. Saturday was a trip to a hot springs. Swimming, picnicking, and a rope swing. A brief respite from the African heat was awesome.
On Sunday, we slept in and decided to attend Sunday services at the hospital chapel. It is a round open air building beside a massive tree and bell tower. The service was in Swahili but the music and singing was infectious. We were at the back, and as the services were drawing to a close a young lady with a warm smile came up to us. She welcomed us, explained the sermon was from the 1st Chapter of John, pointed out there would be English services at 0800 next Sunday, and walked with us out of the chapel for the final hymn around the tree. She held and never let go of Mrs. Tree’s hand. As the song concluded she began introducing us to everyone telling them we were her new friends. We met her new husband – they both work at the university nearby. It is likely we will not cross paths again – but her bravery to step up to us, smile warmly, and welcome us will be a moment not forgotten!
And on to Monday –
Morning report was scheduled for 0730. The residents were to be back in force, and indeed there were many new faces. The big screen was no longer working, so we made due with a computer at the front of the room. No major surprises in report, just what has quickly become average major trauma.
Today I chose to join in ward rounds. The holidays had seen ward round largely a hidden affair. Soon, a group of residents and medical students were being led from bedside to bedside by the ward interns. We lacked a clear census [ie, computer printout] and charting is paper on the wards. Brief presentations of each patient led to a discussion of formal plans. Again, the missing ingredient is mainly the organization of the approach to managing such a large group of patients. I have spoken with veteran volunteers who have noted this as well. The medical knowledge is fairly good, but an organized pyramidal structure of decision making and final plans leads to a bit more chaos than necessary. Patients ranged from spinal infections, neurological cervical trauma, upper and lower extremity trauma, and geriatric bone injuries. It is almost dizzying the trauma pathology to be seen. We rounded for several hours and then return to the computer to confirm xrays. We developed plans, and – hopefully – put them into action.
A quick break for lunch and then today I was scheduled to lecture the medical students on orthopedic physical exam and fracture naming/classification. I found the classroom in the orthopedic rehabilitation unit. I had been told there was no projection, so it’s an old school lecture. My family graciously ‘volunteered’ to serve as patients. At the start we had about 20 students but quickly this grew and grew. I think we finished with close to 50 students – many I hadn’t seen before. They were bringing in benches to sit everyone. Enthusiasm like that is contagious. We went over basic and advanced orthopedic exams, and then covered more fractures than I would have guessed possible. Their book knowledge was quite good, but – like any student – applying it is hard at first. We had a great chat. Afterwards, they wanted to keep my “notes” from the lecture and took pictures with the family. Definitely a rewarding experience!
We journeyed home for dinner and cards. Tomorrow brings a new day – I would love to say after a week I have a schedule figured out or understand my responsibilities but each day remains a mystery but I am starting to feel that each day I will find my place for that day.