get it off my chest...(kimmy's comments)

I never realised coming here that I'd end up doing neonatology as well as everything else. I am currently posted to maternity ward on a day to day basis. It is weird being the only doctor on the ward (in the Uk there would be a whole flock of you). I can call a senior for advice if they're around but much of it can end up being over the phone advice. So the ward is busy busy right now. Lots of pregnant women who tend to have complications. The biggest one being checking their HIV status and syphilis status, two common infections which affect the babies outcome. Frequently they're HIV +ve but not on any medication to try to reduce transmission to the baby. It's heart breaking really as it is the worst start to life you can give your baby giving them HIV.

The maternity ward also doubles as a neonatal ward, so for example I have a 3 day old baby with hypoxic ichaemic brain injury (not enough oxygen at birth) who is well, basically, pretty gubbed really, and has only me to look after him. So I now do neonatal resusc, put drips in tiny babies heads and take bloods, insert tiny tiny nasogastric tubes to feed them. So I put all this effort in, and then they inevitably die, so I do wonder what's the point sometimes doing all these things.

Today consisted of a busy ward rounds of about 25-30 patients, then trying to get blood off tiny babies and putting drips in them, then I put the anaesthetic in a womans back (spinal) in theatre and assisted one of the seniors in a tubal ligation(TL). TL is basically having your tubes cut, and is female sterilisation. About time for this lady since she had just popped out her TENTH baby at 42...she must be very fertile. Seems mad to have so many kids when you probably don;t have money to feed them all. ON the plus side she wasnt HIV +ve which was a refreshing change! Anyway, so we try to do these elective operations for TLs whenever we can since they are a good thing if your family is finished.

I'm oncall overnight tonight so prob will be a sleepless one, though sometimes you can be lucky. there always seems to be someones head to stitch up or someone or other dying. At least I know the maternity ward well because it my turf, it helps for the night shifts and things usually kick off there.

On a more positive note, it is another long weekend tomorrow and we are goign to explore Mdumbi which is another hippy backpackers place. I can't wait. after the mega hike of last weekend I need some chilled out book reading time.

I do wonder how I will react to the UK patients when I get back. It will be nice to be able to speak to them first hand rather than depending on a translator, and I think I'll appreciate the organised-ness of the UK health system a lot.

Oh yeah, I didnt get paid today either, which sucks, and I only got paid half last month. Apparently loads of drs in the other capes are striking, like properly NOT working at all and so tonnes of people have died as a consequence. Seems rather unethical to me, as emergency providers we can't really strick. it isnt on, but as doctors you do need a way to protest if things aint right....someone here suggested refusing to write death certificates, and interesting idea because it would fill up the mortuaries and so the authorities woudl maybe listen, but it wouldnt risk lives (since they'd already died). An interesting idea.

Sorry for this misery pants morbid whinging post, but I feel better for typing it! Kim