Disaster!

So it has been topping forty Celsius for the last couple of weeks, and it seems someone forgot to keep on top of the ice cube supply [Quite, my G&T is getting warm... Ed]. My left ear has started to melt and I'm seeing oases on every horizon!

Seriously though, it is hot. I'm starting to envy the siesta culture of the Med, sometimes it feels just too hot to do anything! But work keeps coming. We returned from a stunning (if wet) trip to see the hippos to crazy amounts of work. My Monday list lasted from 8am to 10pm, with 14 cases (one abscess, fracture manipulations, two biopsies, skin grafts, a hernia, some skin tumours, three cystoscopies, two hydrocoele repairs and an amputation for a dead leg just to round things off).

Tuesday's clinic was crazy - there must have seventy patients, to be seen by me, a medical student and a student licentiate. Prof has been working hard to try and keep some patients in Chipata (the regional referral hospital that currently lacks a surgeon) and so spent the day there sorting stuff out. The good news from that is we should start to get fewer minor referrals clogging up the ward, outpatients and theatres when they could be managed in Chipata. Anyway, Tuesday was rounded off with the drainage of a flexor sheath infection before dinner. This is an incredibly painful abscess that in the UK presents very early, and is one of the few things that will get a plastic surgeon out of bed to operate. This chap had been ill for five days and the infection had destroyed all the tendons to one of his fingers, which could be very disabling for him.

Wednesday was a quiet day - only 9 cases on my list. Currently the Prof and I each have our own lists, as the Zambian registrar has left and the fully-trained licentiates are on leave. I have learnt to give some minor anaesthetics so I can do the minors list. Although "minor" is a little more stretched than at home. Probably the most stretched procedure was a sequestrectomy in a 7 year old boy. This was removal of his infected dead tibia and closure of the wound with a local flap - quite a big undertaking! The rest of the 9 procedure minors list was biopsies, skin tumours, fracture manipulations, a hernia and two above knee amputations (the last two under spinal, not sedation!)

Work here is hard. There is no disguising the fact that you could be on the ward or in OPD 24 hours a day and there would be work to do. Learning at what point to step away has been one of the big challenges and one with which I am only just getting to grips. But, if you are tired you make bad decisions, do bad operations and lose your temper with colleagues and patients. So sometimes stepping away and just saying no is best for all.

Anyway, today was quieter - just two minor emergencies (a para phimosis (look it up [ooo grumpy! Ed]) in a sixteen year old - they are the same the world over) and a foreign body removed from a foot in OPD. I also got to start trialling the new burns protocols and paperwork on Kizito and it was generally welcomed. And because everyone in Eastern province came to OPD on Tuesday (or so it seemed) clinic was quiet. Hence I am sat in the warmth, just about to get a G&T (hopefully with some new ice) and enjoy the evening.