It is a well known fact that I'm not the most patient of people in particular circumstances. My father said just before we came out here that it was a good thing I didn't follow him into surgery because I didn't have the right personality for it - which was his way of saying certain things would annoy me like hell! Personally, I think I would be too upset to tell people they are going to die or tell families that their loved one has died. However, I can't really argue with the patience comment.
Having been to Africa a few times before, I had steeled myself for the change of pace and different way of thinking about things that can be frustrating to British people coming out here for the first time. At the beginning of the week in Pharmacy (I've been doing full days there this week) I was doing well. Abraham was getting annoyed and complaining to me about some of the lax things that were going on! I was calm and stoical and got on with entering things in the computer.
I'd also found a useful sideline in being able to tell people in the Mess about the things I'd found that day. So yes, Fi, we do have Salbutamol inhalers (43 off), and I've found some Granisetron (a drug that stops chemotherapy patients from feeling sick) which none of the guys giving Chemotherapy (nor the Pharmacist) knew we had. It was a little frustrating that it was sat next to two vials of chemo that had gone out of date..... criminal given that it's used every day here and we often run out!! [We run out because the drugs are comparatively expensive and the rural health centres have realised they can save money by not buying any but sending all their patients here, which is great for them I'm sure, but less good for the patients]
Wednesday was a turning point though. I got to Pharmacy a bit after 9am. I probably wasn't in the best mood because I'd done my run with music for the first time and hence run a bit faster than normal, only to get back to find no water pressure inside. So I had to lug the water from outside and quite frankly didn't have the energy to make the 6 trips needed to get enough water to wash my hair. So I was hot (because even the shower I did have didn't cool me down) and annoyed about having sweaty hair.
Sande was busy booking out that morning's requisitions from the wards so Abraham suggested I start the stock take of the general store myself. The place doesn't even look like organised chaos, it is literally chaos. I asked where to start. No answer was forthcoming so I chose the shelves nearest the door so that, in the unlikely event that Medical Stores Ltd came later, I wouldn't be in the way. This is the catheters.
Before I can start I have to get to the shelves. There are 4 boxes of assorted Anti-Retrovirals (ARVs for HIV) in the way. Shouldn't these be on the shelves? No, they are for Outreach. Fine, but shouldn't they be in the chilled rooms? [Three rooms of the stores have air conditioning units that battle valiantly to get the temperature to 21 degrees when they are on and people remember to shut the door - it's an attempt to keep the drugs properly that doesn't always work. The doctors report that sometimes the antibiotics don't work and I'm going to guess it's temperature related!]. Anyway, it was made clear that they were happy with the drugs where they were and they weren't going to move them. So I kicked them out of my way with my foot.
The shelves are overflowing. 'Oh, you don't need to count these, they are all out of date'. Why have you let so many go out of date?? When are you going to remove them from the stores if they aren't going to be used? I start to count the packs that are in date. I spot some individually wrapped self catheters for intermittent use!?! They look expensive and go out of date in 2 weeks. 'What are these?' One of the assistant pharmacists responds with 'Oh, them, they are not important...'. Silly me, I thought that if you were running a hospital reliant on donations that everything was important. It's time to leave stores and go somewhere else.
Abraham suggests we go to the other store room to count the things in there that weren't counted last week. For some reason the man in charge of that store decided only to count the things he gives people and not everything else! I set about persuading him that we need to count everything. He doesn't look pleased. 'Why are we counting the buckets? We aren't going to get any more, they were a donation'. 'OK, but they are still here, they could be used?' 'But we won't get any more!' Yes, I got that bit but I still don't really understand why we can't use them - I said if he felt like that we should take them to the market and sell them and use the money to buy drugs.
My day isn't improving. There are literally thousands of needles in here that have gone out of date. Everything is jumbled. Lots of stuff has been attacked by termites. I find some BD items that are in date and look valuable - I get them stacked neatly and note down what they are. A ray of light perhaps? I'll see what they say in the Mess later. Another find is some type of fixing plaster from Holland that is priced at 250Euros per box. The guy says no one ever asks for it. Funny that, given they don't know you have it. I translate the cost into Kwacha - it's more than his monthly salary.
After lunch we are back to data entry. Sande has counted all the easy things in room 1 and room 2. I point out to him that I know he hasn't counted the sutures or the ORS or most of room 1. He's even forgotten the 3way catheters I was stood in front of that morning. But, there's always tomorrow.
Today I arrived a little more hardened to the task. If the staff didn't care about the messy shelves then I could still tidy! I got the step ladder and started to stack the shelves properly from the top. This shelf was mostly easy because the items on it are ordered frequently and used - gauze roll, gauze pads. I corralled all the paper packs of gauze that had fallen about the place. The next shelf was more tricky it looked as if someone had just thrown things from a box onto the shelf many months or possibly a year or more ago - it's always quite dusty so ageing by the amount of dust is unreliable. Sande looked at me concerned. I suggested that we sort all the mess out. 'But there are only a few of each thing, no one uses them, there is no point putting them in the computer.' I agreed about the computer but still thought it was worth arranging things so that people can see what there is and use it. Otherwise, I said, we might as well take it all outside now and burn it because it's taking up space. We set to!
After a while he started to join in properly and ask me about things and take an interest. He even found another box on an adjoining shelf to start organising. When we finished Sande even exclaimed at how much space there was now! I had made a list of all the good things we'd found so I could ask the others what they were worth. Then Sande wanted to go on a break - I realised we'd been at it for nearly 3 hours and it was well past his usual break time. Still a bit early for me to leave to organise lunch I had another look around. There was a box on the floor that said 'Oxygen concentrator' on it.... surely it was just a sturdy box that could be used to pack other items, there wouldn't actually be an oxygen concentrator just sat in its box would there? 'That's an oxygen concentrator and there's at least one more over there'. Next to this is a box that says 'Cold light operating lamp' - yes, you guessed correctly, theatre 3 has no operating lamp... .Time for lunch, definitely time for lunch. This place is enough to drive anyone to drink.
Abraham says the oxygen concentrators are meant for Theatres. They will definitely be out of their boxes within 24 hours, I don't care where they are but they will be being used.
The afternoon is spent organising the sutures. I know now why Sande didn't want to count them before. The shelves were a mess and the sutures spread across lots of mixed boxes. It's also in the darkest part of room 2 where there is no bulb in the lamp fitting. [The electrician was in fitting a smoke detector - I asked if he could remove the bulb fitting because we are missing the one in our bedroom and that one's not being used ;)]. Together we devise a system for sorting the sutures between the two shelves and start unpacking and stacking and counting. The result is great imho! And I'm sure it will give the guy from Theatres a shock when he comes to pick them next time :D. Sande looks pleased and keenly makes new bin cards for them. And starts to open up about how hard his job is when people just come and take things and leave the stores a mess. I said that I appreciated that, and he must have heard me saying exactly that to the Pharmacist. I think together we can make a good change here.
We also find some misplaced bowel cancer drugs.... and with that, I'm off to let the medics know the good news!
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