It's hot in this!!









July 28th
Well this might be the last blog from me for a while. Ian arrives
tomorrow in Rumbek so this time I better be here to meet him and not
get sick as I did last year. I know how much Ian likes to talk so he
will be able to do a few entries so you will get a different angle on
this place.
Hospital-wise, still very busy, with more different cases admitted.

Yesterday a small child of about 4yrs old was sick at home. She lives
in a village about 5ks away. The father thought she had malaria so he
put her on a small seat on the back of his bicycle and set off for the
hospital. Not sure how far along the track they were, but the child
fell asleep and her foot got caught in the wheel of the bike and
amputated her big toe.

Poor little thing, when she arrived the father had wrapped her foot up
in an old rag and somehow held her to him at the front of the bike.
She was so brave. She was taken into theatre and cleaned up. Luckily,
she had not lost much blood but she will only have 4 little piggies on
that foot. Today, she was a little brighter and she was having
treatment for her malaria as well as antibiotics for the toe.

On Tuesday a woman of about 20+ was admitted with burns to the left
hand and right leg, second and third degree. She had fallen in to the
fire when she had an epileptic fit. She has old scars on her body from
other old burn sites. As you can imagine there is no chance of skin
grafts in this neck of the woods. Saline dressings are just about the
only thing you can do.

This seems to happen quite a lot here. Last year there was also a
similar patient, but she had been holding her baby so he was burnt
too; they were in hospital for months. The epileptics, once diagnosed,
are given medication, but they run out or they don’t take it, or live
too far away from the hospital to get help.

The students had their first practical exams yesterday and today. P
and I took two students at a time for one hour. They were so nervous
poor things. So often, you knew they knew what to do but they just
could not seem to get it right. BP cuffs on upside down, listening to
the heart beat when they should have been trying to hear the PB,
unable to read a mercury thermometer (yes we still use them); anyway,
in the end only one needs to re-sit.

It’s probably a good job that most are passing, because sometimes
there are problems in the schools when students don’t get good marks,
or papers get lost. Last week, at one of the schools a boy brought his
bow and arrow ‘to get the teacher’ for some error with his exam paper.
He started firing it into the playground. He was soon cornered and
taken to the police. No one was hurt, thank goodness. They are very
proud people and don’t take failure well!

The students sit their anatomy and physiology exam next week, so hope
they do well in the urinary system questions, or I will be hiding
under the desk.

Last week, in an exam I asked a question about the ear. The question
was: a) ‘Where is the auditory canal? And b) what is at the end of
it? (For those of you who are not medical, answers are outer ear and
the tympanic membrane)

Answer:-a) in the lungs b) the anus! Oooops!! I should stick to
nursing Thank goodness all the others got it correct.....

One of the students is not well this week - she has been diagnosed
with Guinea worm. The other name for it is Dracunculiasis, do check it
out in Google. It is a bit unusual in this area, so if it does turn
out to be this it will have to be reported. It was thought to have
been eradicated by the UN some years ago.

The cycle goes something like this. The person drinks some unfiltered
water, the water contains very very small Guinea worms. They then make
their way into the gut then bore their way into the top of the leg or
arm. They then slowly grow, which could take up to a year, boring
their way down the leg or arm until they get to the top of the foot or
hand. By now they are the length of the limb.

The person then may be walking through water or standing in water
doing washing and the worm will bore through the skin and expel out
hundreds of very small worms. So the cycle starts again. The only way
to treat it, I am told, is to wait till it pops out of the foot, catch
it, and fasten some string around it with a stick and slowly every day
turn the stick and wind up the worm. If it breaks, you have to wait
until it re-grows then start again. The thought of it gives me the
shivers. So at the moment the poor girl is waiting for the worm to
appear. Will keep you posted.
Let’s hope she has been mis-diagnosed and it is an abscess or
something. She is due to see the Dr tomorrow.