And so we begin work....

It's at this point in particular that our experiences and working days diverge a little. Geoff (who will take over in a minute) has slotted straight in to the routine of Surgery with its ward rounds, Outpatient clinics (in the OPD) and operating lists.

Whilst he's off doing these things, I have slightly different tasks. I know of some areas where my help is needed or Geoff and I want to do some work but these are all reliant on other people. I either need them to explain things to me or help me get data or just give me permission to assist and make suggestions.

I have been told to work slowly and build relationships slowly. So on Monday I set myself 3 tasks

1. Find and introduce myself to Dr Chisi - he is the Medical Superintendent and overall boss
2. Find and introduce myself to Mr Mwale - he is the Manager Administration
3. Get the hot water fixed

I was going to be lucky to complete all of that between 7.30 and 5pm. I know it sounds crazy but that's how it is. As it happens, I was lucky. After a few false starts ('You keep just missing him') I find Dr Chisi outside the eye clinic (he's an ophthalmologist). Well, I say that I find him, I'm actually wandering a bit bemused about whether I can just march into his clinic and, even if I can, I won't know who he is because I have no idea what he looks like. I pause by 3 men in white coats and one of them says 'Are you Charlotte?' Perfect! This is Dr Chisi. He asks me to come back 'this afternoon'. Any particular time? No, just this afternoon...

I try to find someone at the mess that can sort out the hot water (they seem to sort the accommodation) but I am directed to Mr Patrick who then says that another lady is in charge. She's currently away getting curtains made. Can I wait in the house for her? I can, but there's no indication of whether I might be waiting 10 minutes (unlikely), one hour (still unlikely) or half a day (highly probable). I settle down with a book under a tree. After a while I get bored of this and decide to search for Mr Mwale.

Located in his office I explain what I do back home and that I'm here to help in whichever way he feels would be most helpful. He says he'll think about what I can do and perhaps we can discuss tomorrow [tomorrow comes and goes but I don't go back to his office - pretty sure it can wait another day]. In there I also meet the man in charge of accommodation proper. We have a nice chat about where we'd like to move to and when. Casually I ask where he's going to put the couple that's arriving in a few days...... what couple? Aaaahhh, I sense that perhaps I might need to up the pace of my relationship building rapidly! Unless huge amounts of mould are to greet all new visitors [Note: it's actually highly unusual, we were just unlucky!]

At lunch a lady finds me and tells me she will come to look at the hot water at 14 hours (2pm). For a second at 14.02 I worry that I might miss her! Then I remember that I'm in Africa and settle myself under a tree. After 25 minutes she comes. Takes one look at the system and decides it's broken and she needs a man from the workshop. I think this is the equivalent of ringing the IT helpdesk and them telling you to turn it off and on again. I don't bother to mention that I have a Masters in Engineering and am able to identify a broken immersion heater!
After an hour (of intermittent labour) it's fixed (in theory). We can't check if it's really fixed because the water pressure isn't high enough to get the water into the feeder tank (about 5m off the ground) to feed the hot water tank. Perhaps in the evening we will have hot water!

Now I'm not sure what to do on Tuesday - I don't want to hassle people! The hot water wasn't very hot - I climb up to fix it myself - and then realise this is pointless because the pressure is not going to be enough at any point in the next two months to fill the feeder tank fast enough. I must accept we don't have hot water in this house (all the more reason to move!)

I start to read the WHO paper on Cost Effectiveness Analysis in developing countries. This is not a holiday - it's actually quite complicated - discount this, annualise that, use the life expectancy by age, convert costs from domestic to international prices... it's going to take me a while to get this work right! Thankfully I get a call from Geoff that we've been invited for coffee at the Professor's house. He and his wife are lovely! I feel even more at ease!

At the end of the day I've read over 70 pages, some Private Eye, cleaned some more, sent some emails and sat in the sun for a while. Happy times!

While Charlotte has been sunning herself, I've had an exciting couple of days. It is fair to say that theatres here are the most efficient in terms of patients per list that I have ever seen. On Monday, we had just finished doing an abdominal biopsy when the paediatrician arrived with a baby just born with a Gastroschisis (all the bowel outside of the abdomen through a defect in the umbilicus). Following some anaesthetic difficulties, we managed to reduce this - the baby is now on the Special Care Baby Unit (SCBU) and we have our fingers crossed. The rest of the list consisted of some paediatric hernias, fixation of a fracture and a laparotomy for bowel obstruction. All finished by half past five!

Tuesday is a ward round day (OPD doesn't start until 11am), so I took some time getting to know what was going on on my ward (Mukasa, the female surgical ward) which I am to look after with the other Geoffrey, who is one of the Clinical Officers. Again, there are lots of fractures, but this also houses the paediatric burns unit. These are mostly hot water scalds, but the children receive little or no first aid, so the scalds are deeper than seen in the UK. There is one two year old who has just received a horrible pan-facial scald - I'm going to tidy up her blisters in theatre tomorrow and we'll be able to judge how bad things are, and whether she has any ocular involvement.

The rest of Tuesday was spent in Surgical OPD. There is no appointment system - patients turn up every day of the week to be seen, and just wait in line. We have one room, with two doctors sharing a table, a translator and an examination couch. There is no privacy for the patients! Every history includes a question about HIV status, as it is ubiquitous and impacts on a lot of our surgical pathology. Clinic is however somewhat "quick-fire" - a patient with a fractured limb appears, you check the injury, look at the X-ray then send over for a plaster, or admit for MUA, all in 5 minutes. I think I saw in the region of 50 patients today, the final one was an 8 year old who fell out of a tree and had a stunning supra-condylar fracture of his humerus and no blood supply to his forearm. We called the theatre team in and manipulated it under anaesthetic, with partial success. It then turned out we needed to put a difficult catheter in under anaesthetic, then site a chest drain for a poly-trauma patient. So a late night, but another interesting day!

Tomorrow, we have 24 cases booked on two operating lists and have just added an exploratory laparotomy to the start of the list. I'll be amazed if we get it all done, but we'll just have to see!