Giardia & Dancing it out

“Spell the name of the pharmaceutical company on the packet again for me?” I called out to Janna. If we were playing scrabble, the name would have put the player on a sure road to victory. Unfortunately, Janna had been unwell and was in no fit state to play snap, let alone scrabble. Depressingly, a notable number of the few mentions of the said drug manufacturer revealed in my quick google search were in relation to investigations exposing sub-therapeutic or incorrect doses of medicines exported to the African Continent. After just over a week of being unwell, Janna had finally succumbed to the embarrassment of allowing me to take a stool sample the twenty metres from our house to Philip, the technician in the hospital laboratory; a suggestion the resident medical doctor had made on the third day of very little being kept inside her digestive tract. The scrunched piece of paper Philip handed to me later that morning had the words “Giardia trophozoites +++” on it. (A parasite that can be asymptomatic or in Janna’s case leave you feeling worse for wear for several weeks.) I thought this would be a turning point as the treatment of Metronidazole tablets was available in the hospital pharmacy. But now, a couple of days further on without much improvement and a less than reassuring google search, I was beginning to question if there was anything of any use at all in the white tablets I had been giving her. For peace of mind I travelled the 30 miles to the nearest big town to find an alternative brand of Metronidazole the next day. However, more significantly I began to doubt whether I’d been doing any good for the countless patients I had prescribed that particular medicine to over the last month- a less straightforward problem to assess and resolve. Interestingly, the rumour on the hospital compound was that the cause of Janna's sickness was due to her being pregnant; whether this originated from Mamma Kabba’s wishful thinking is unclear but I was quick to correct the assumption! 

Thankfully, after what had been a challenging few weeks, where I probably failed to excel at any of the attempted roles of husband, dad, doctor and carer, Janna is now better (and well enough to be satisfied with resultant weight loss, even if the approach is not one she would recommend). Incidentally she has sportingly approved the sharing of her medical details and declined the offer of a divorce lawyer. 

Trying to explain a need to prioritize looking after your children when gender roles are still very defined was a difficult one. Particularly when the boundaries between ‘work’ and ‘home’ are only the 50 yard walk from our house to the maternity ward (I can see the light on in the delivery room as I sit here and type). Boundaries that are blurred further when relatives of patients turn up on your door step to ask for advice or an update and where there is little concept of ‘off duty’. Someone who was interested in coming to work at the hospital once asked me what the rota was like- it was quite difficult to explain that there isn’t really one. When you’re here you’re available to work, when you get called or someone knocks at the door if you are able to, you go. This is only made possible by a significant amount of nurse and midwifery led triage and treatment but nonetheless the chronic intensity of being persistently available whilst on site can be exhausting.

One Sunday morning, I got out of bed at 6.30am and dragged on a fairly dirty but comforting grey t-shirt. I had the intention that it would be replaced with a cleaner item of clothing following a cup of tea and a bucket wash. Fifteen hours later I took off an even dirtier grey t-shirt and finally had a much-needed dousing with cold water. 10 minutes into the cup of tea, a chart had been brought to the door of the house by a nurse with an emergency maternity case to be reviewed. The patient had subsequently required an operation lasting several hours, preceded by a series of negotiations about which relatives would be sent for from their village to donate the required blood. The woman survived but had a bumpy immediate post-operative course that kept me busy, interspersed with several other admissions and problems across the hospital. (For the record, I had changed into and out of sets of scrubs during the day and haven’t reverted to operating in dirty tee-shirts). This is not to say all days are so busy. Sometimes I find myself sitting reading a book on a Tuesday afternoon at 2’o’clock or building a Lego car with the boys and feel like a fraud. 

Even with considerable efforts to try and remain accepting of the difficulties here, the daily interactions and encounters do produce an undulating emotional response.  The shared joy of safely delivering twins breech and knowing that her care was improved with information gained from the introduction of basic ultrasound, to the sorrow of looking after that new mum in a bed on a ward next to a woman that has had her second still birth (the space to try and kindly separate those with a pregnancy loss from mothers who had successful outcomes is not possible.) The satisfaction derived from the child admitted in our first few weeks following a serious road traffic accident being discharged after making a full recovery balanced against the almost unnoticed chart of another 4 year old boy on the table at the end of the ward  with the briefest of nursing entries; “12.06am child arrived. IV line sited. 12.12am child passed off.”  The sense of purpose in diagnosing and managing a woman in extremis with a ruptured uterus to the challenge of knowing where the balance of sustainability and compassion lies when her husband abandons her and won’t pay for the transfusion she needs. 

Often the answer is not simple but I’m very thankful for Benjamin and his recent intervention one evening where he said ‘Dad, sometimes you just have to dance it out!’ Advice that may have been more valid if either of us had a rhythmic bone in our body but as evidenced by the video below, we tried!