Psycho in Africa

HI all again sorry that our posting has been slightly sporadic, however the walk into town takes at least 40mins, and while I understand the needs of the audience, I’m sure that you will appreciate the dust and the heat is a major factor in only posting every few days – however in order to make sure that the posts keep flowing I am now writing the posts on my laptop, and then every few days traipsing down to the internet cafe to place a massive post – hence the delays.

Tomorrow, we have a day off (YAY!), which is normally used for revision – one of the medics has loaned me a text which high-lights greatly the short-comings of Kumar and Clark, to say the least I will be acquiring a copy on my return – with that in mind I will attempt to place another post that day (which is now actually today) because over the sat, sun, mon and tues we are going on a Safari to the Serengeti, Ngorogoro crater, and Arusha national parks, with the hopes of seeing the Big Five game animals. During that time I’ll take the laptop along so that I will still be able to give a large post when I return.

As for today in the hospital, our first true day working, we had quite an *interesting* day – to begin with there was a visiting American Ophthalmic surgeon who was running a charity clinic in the area, looking for patients with cataracts, whom he could take to the nearby large hospital where they have more advanced equipment. The surgeon however turned out to be a significant learning opportunity, as we had a lady on the labour ward with significant proptosis and exopthalmos, (for those of a none medical background, that is her eye was bulging out of her head by about 5cmx5cm overwhich she was unable to close her eye-lid) as wel as this obvious problem there was a constant watering of her eye

Initially I had not seen this case, although from the description given by the medical students who had viewed it in person, I initially thought it might have been a retinoblastoma – a cancer starting on the back of the eye. However when I finally saw the woman, this could not be the case as she had had the problem for 8 years (the problem was only picked up due to her coming into the hospital for a caesarian section) and there did not appear to by any great destruction of the eye. The surgeon presumed that it was a tumour of the lacrimal gland – which also explained the watering of the eye.

He commented that if the patient was stable he may be able to convince the surgeons at the larger hospital to operate to remove the eye the following day - although with the caveat that he does not know whether the mass would be malignant or benign. His urgency in suggesting the following day was due to the fact that i) as said he did not know if it was malignany or not, and ii) the continal inability to close her eyelids puts the eyeball at a very high risk of infection

On return to my own ward, one of our patients, who has a history of Marijuana abuse had a psychotic episode, pulling down his mosquito net and using the screw previously attached to the ceiling proceeded to shred both the net and the rest of the bed – including mattress

The response to this was for everyone to stand around looking worried for 10 minutes, the collective opinion being – “he’s got a screw and now trying to cut his arm, I’m going nowhere near him!”
The consultant in the hospital opted to bring in five random people from the street to attempt to restrain the guy, although I have been suggested that these people were actually family memebers now - as here the family play a considerable role in the care of the patient, inclufing cookng for them, bringng them water, and generally looking after them in a way that the Tanzania health services cannot provide for. The men managed to wrestl the man to be bed – only managing to inject Chlorpromazine – an antipsychotic, which appear to have all the effect of trying to fly by flapping your arms repeatedly, as he threw off his captors and swung for them before returned to reducing his mattress to a collection of little foam lumps.

As he swung out at the men from the street, the entire medical staff leapt from the ward, followed by one of the other medical students, commenting "If the natives are running, so am I!".

Having steeled ourselves in the entrance to the ward, we cautiously returned to the where the man was now trying to score his arms. At that image, before he could draw blood, three of the men grabbled his limbs as I forced him bodily into the bed, holding his arm around the bed post to prevent him moving.

One of the nurses, then with glacial slowness, drew a syringe and slowly approached, in spite of my protestations to get her to hurry up – the man in question being somewhat annoyed at having a white medical student compressing his lungs, and holding his arm in full extension to allow for access to his veins. The nurse finally realised that the situation was not one you would want to be in for a protracted period of time and injected 10ml of Diazempan – which successfully knocked the man out – however not before reaching out from his bed with a shaking hand, in the true style of “not dead yet...” thankfully this was his final act as the drugs took hold and he passed out – a state I acutely wanted him to remain in and required continual affirmation of by my constant over the shoulder glances.

We have now booked and arranged our Safari, acting as a significant example of African bartering, successfully getting a 4 day tour for $40 more than a 3 day tour, rather than the original $80 difference. Something we are all looking forward to embarking upon is this true African adventure, as the Safari we will be using will have tents rather than lodges, which will allow us hopefully more flexibility to where we can travel

Everyone is now beginning to chatter about potential sighting and photographs of a life time – especially Mayhem, who has spent several hours playing with his new lens, and “papping” the women in our group, along with every other living or moving creature. However credit where credit is due, some of the portrait pictures he has managed to get both of the girls and myself, are of exceptionally high quality.

Incidentally Mayhem asked me to convey that he is still alive, although he is not feeling up to walking into town in order to leave a post.

On that note I’ll save this file on head to town

TTFN
Kaos