Starting on the wards

Following a final day of sorting ourselves out with some kitchen stuff and a nice lunch in Chipata, I thought some clinical bits and pieces might be interesting... I'm just about getting my head around the male surgical ward, which accommodates somewhere between thirty and forty patients (the number of beds, and precise number of patients, is irrelevant, as there are a variable number on mattresses on the floor!) most of our patients are currently orthopaedic, with femoral, tibial, humeral or forearm fractures in various states of recovery from open repair or in traction.

There is really little that can be done in terms of post op care, so oxygen, antibiotics and fluids are the mainstay (and the limit!) of managing everything from fever (likely to be malaria) to chest pain and in between. There are a few peri op abdominal cases as well, mostly hernias, typhoid perforations and appendicectomies.

One major trauma (with stunning surgical emphysema from the waist up, pneumothorax and pneumomediastinum) has got a chest drain in, which I spent a bit of time sorting out this morning. There is no advanced imaging and no endoscopy, so we have no idea what he has injured and are very much hoping for the best...

My project for the six months is going to be sorting out the burns unit. This is a four bed side ward, which at the moment is full with patients with epilepsy and sizeable, ungrafted burns. One patient has his tibia exposed from knee to ankle. Looking at what is currently done here (minimal grafting with a Watson knife, no adrenaline infiltration and variable dressings) there is significant room for improvement. I'm quite excited that in six months things could be a lot better!

Tomorrow is my first day in theatre, with a mix of wound management, hernias, manipulation of fractures and a laparotomy for large bowel obstruction on the cards. How much we will achieve is yet to be decided - no one has a haemoglobin of greater than 8 and the blood bank is currently empty! We are now off for roast dinner in the mess!