Unfortunatly, 2 weeks ago, a Dr Samunto, who was working in Outjo, (about 130 km from us) died in a terrible car crash. He was driving between Otjiwarongo and Outjo, and hit another car. It is thought he had a broken leg, and apparently bystanders were trying to help him get out of the car. He phoned his wife (who is also a doctor in Outjo) and they spoke. The ambulance was on its way. But before they got there, a truck ran into the group - killing Dr Samunto and a woman who was helping him! Just awfull. It's thought the truck driver was drunk.
I'd only met him once, casually, outside the grocery store in Outjo. He was from DRC, so we spoke french. Everyone spoke really highly of him.
We had a gathering in Khorixas hospital, prayers and singing, for him, last Monday. And we've been sending releif doctors to Outjo. (There were 3 docs there, so they are 2 down, as his wife is travelling back to Congo for the burial. They have 6 children.)
It's my turn this week, to go to Outjo, but I've been waiting for the transport for 4 hours now, and still nothing...
Monday, June 29, 2009
Saturday, June 20, 2009
Traditional authority
Now, within a few days of Mark and I handing in our letter of resignation, a few things happened. I found it all a bit disturbing and scary, but it's all worked out fine. First there were rumours that the location would "strike" and protest in front of the hospital, complaining against the PMO. And then, on Friday last week, we received a letter, an invitation to meet with the traditional leaders, to explain our "unusual resignation".
I was really upset. I didn't know how many people were going to be there (would it be in front of the whole community? was there going to be anger, threats of violence? I know it sounds melodramatic, but there were stories, from a few years back, of the people of the community lifting a doc's car and preventing him from entering the hospital) Apart from that, there was the difficulty of explaining ourselves. It was a really hard decision to make, and some of the reasons were very much about personal relationships at work making work quite unpleasant, and clinical decisions we were struggling against. We had no intention of making that public.
Mark wrote a fantastic letter. I wish I could reproduce it, but he's away in Spain (at a wedding) with his computer. It was very honest, heartfelt as well as diplomatic. It acknowledged the difficult working relationships without blame, and without making them the main reason for our resignation. It was great.
I managed to get 10 copies made for the meeting, and that is about how many people were there. There was the chief of the #Aodaman tribe, the mayor of Khorixas and a bunch of councillors. What a room full of intelligent and locally powerfull people. And Namibia being so small, they probably can talk to the president easily enough (well, they implied that, and I believe them).
It lasted about 1 hour and was nominally conducted in Damara, through a translator (tho' the translator seemed really powerfull too, and seemed to run the meeting, with the traditional chief's ok). Having things translated was actually really helpfull, to sort of diffuse emotional content, and time to think about answers.
Suffice it to say, it went well. For which I am very gratefull.
I was really upset. I didn't know how many people were going to be there (would it be in front of the whole community? was there going to be anger, threats of violence? I know it sounds melodramatic, but there were stories, from a few years back, of the people of the community lifting a doc's car and preventing him from entering the hospital) Apart from that, there was the difficulty of explaining ourselves. It was a really hard decision to make, and some of the reasons were very much about personal relationships at work making work quite unpleasant, and clinical decisions we were struggling against. We had no intention of making that public.
Mark wrote a fantastic letter. I wish I could reproduce it, but he's away in Spain (at a wedding) with his computer. It was very honest, heartfelt as well as diplomatic. It acknowledged the difficult working relationships without blame, and without making them the main reason for our resignation. It was great.
I managed to get 10 copies made for the meeting, and that is about how many people were there. There was the chief of the #Aodaman tribe, the mayor of Khorixas and a bunch of councillors. What a room full of intelligent and locally powerfull people. And Namibia being so small, they probably can talk to the president easily enough (well, they implied that, and I believe them).
It lasted about 1 hour and was nominally conducted in Damara, through a translator (tho' the translator seemed really powerfull too, and seemed to run the meeting, with the traditional chief's ok). Having things translated was actually really helpfull, to sort of diffuse emotional content, and time to think about answers.
Suffice it to say, it went well. For which I am very gratefull.
Tuesday, June 16, 2009
Survival of the most adaptable...
We've been here 4 months now, and for the last month Mark and I have been talking long and hard about how things are going. What follows will sound like a justification of why we have decided to resign early, and it is, but perhaps you'll understand us.
The goal of VSO is to accomplish sustainable development: sharing skills, changing lives. We felt, since the beginning, that what we are doing is not sustainable. We have been filling a post they could not fill otherwise. That was a bit annoying, but we still felt we had something to offer the hospital and the community here.
We've been stressed, again since we arrived, about licencing. Rather dull stuff, but it takes years to get a license here in Namibia, and we had (have) real concerns that Mark (and maybe me!) might not be able to work in Canada without being properly registered here.
And working with colleagues as a team... Oh dear. There have been storms and storms. We all have our strengths and weaknesses, and 2 of our colleagues aknowlegde, for the most part, their own weaknesses. Mark and I (we hope) know when we are out of our depth and ask for help.
When patient's lives are at stake, it's not the time to be self reliant. It would be different it we were really out in the middle of an untracked jungle, we would have to do the best we could. But here, we are 4 tarmac'd hours from our referral center, where there is an ICU, and actual laboratory investigations can be done regularly, CT scans and everything. Conflict about referral of really sick patients has come up again and again. Conflict about treatments. It's unpleasant.
So we've re-evaluated our priorities. What we came to do is something we believe is not only valid, but also interesting and fascinating. I love caring for patients who are actually sick! (The worried well are few and far between her) But not at the cost of our ability to work together in the same country.
So we handed in our resignation last week (we'll work till Aug 15th). This, or something like this, we would like to do again. But we'll look into our placement with different priorities next time.
The goal of VSO is to accomplish sustainable development: sharing skills, changing lives. We felt, since the beginning, that what we are doing is not sustainable. We have been filling a post they could not fill otherwise. That was a bit annoying, but we still felt we had something to offer the hospital and the community here.
We've been stressed, again since we arrived, about licencing. Rather dull stuff, but it takes years to get a license here in Namibia, and we had (have) real concerns that Mark (and maybe me!) might not be able to work in Canada without being properly registered here.
And working with colleagues as a team... Oh dear. There have been storms and storms. We all have our strengths and weaknesses, and 2 of our colleagues aknowlegde, for the most part, their own weaknesses. Mark and I (we hope) know when we are out of our depth and ask for help.
When patient's lives are at stake, it's not the time to be self reliant. It would be different it we were really out in the middle of an untracked jungle, we would have to do the best we could. But here, we are 4 tarmac'd hours from our referral center, where there is an ICU, and actual laboratory investigations can be done regularly, CT scans and everything. Conflict about referral of really sick patients has come up again and again. Conflict about treatments. It's unpleasant.
So we've re-evaluated our priorities. What we came to do is something we believe is not only valid, but also interesting and fascinating. I love caring for patients who are actually sick! (The worried well are few and far between her) But not at the cost of our ability to work together in the same country.
So we handed in our resignation last week (we'll work till Aug 15th). This, or something like this, we would like to do again. But we'll look into our placement with different priorities next time.
Saturday, June 6, 2009
May I recommend
davesboringblog.wordpress.com
How do I show links beside my blog? I'd also like to do a hit counter, but anyway, when I'm smarter...
Dave is David Cutting, he's VSO in Opuwo, and his blog is very funny (as is he, don't you know).
How do I show links beside my blog? I'd also like to do a hit counter, but anyway, when I'm smarter...
Dave is David Cutting, he's VSO in Opuwo, and his blog is very funny (as is he, don't you know).
A typical day
Hullo!
I thought I would try and describe a typical day, now that there are typical days…
Well, we wake up in separate beds (2 single camp beds tied together by the legs), and crawl out from under the mosquito net. Actually for the last week we have forgone the mosquito net as it is bloody cold- I’m not sure what temperature it is in the middle of the night, but less than 20 C at 7 AM. I’m wrapped up in a blanket inside my down sleeping bag, and am nice and toasty. So we’ve separate beds and separate sleeping bags. Then Mark has a freezing shower (I only shower every 2 days, and I turn the hot water on for about 45 minutes before I get in.) We have breakfast, usually porridge these days, and coffee from our fantastic Bodum-type cafetiere, that Anne and Andy gave us when they visited. Then go to work, walking 15 minutes to the hospital.
At work we each do ward rounds. Currently I am on Paediatrics, Male and Tb wards, Mark does Maternity and Female ward. We start around 8.20. Tb ward only is done 2ce a week: Monday and Thursday. These are confirmed cases of Tb who are in the initial intensive phase of treatment. In other hospitals they are only kept as inpatients for 2 weeks, then followed weekly, but here we tend to keep them for the full 2 month intensive phase.
After that, I’m now on “CDC” as in “Centre for disease control”. Tho’ the only disease we control is HIV (well, we’re working on Tb prophylaxis too…) and Mark is in the out patient department. I’m seeing all and sundry who have HIV in the Khorixas area. Everything is very much about following guidelines, which are, on the whole, very sensible. It requires so much concentration!! I’m prescribing nearly the same thing to every one: 3 drugs for the HIV, 1 to prevent Pneumocystic jirovecii pneumonia, 1 to prevent Tb and 1 to reduce the side effects of the Tb drugs and multivitamins. But then, not all are on the same 3 drugs for HIV, not all need the PCP or Tb prophylaxis, do the have anaemia? Is their liver ok? Do they have Hep. B? All makes minor variations, and luckily, I’ve the guidelines to tell me what to do!!! I just have to remember to read the guidelines.
At 1 PM it’s lunch time, till 2. If we’ve walked to work we have lunch there. Sometimes I’ve remembered to bring leftovers, but often we eat fat cakes: balls of dough that have been deep fried. Don’t knock it till you’ve tried it.
We knock off at 5 PM and walk home. Evenings aren’t very exciting: sometimes we visit the rest camp a few km out of town, and use their pool, having a beer or cider afterwards. Rarely we eat there (the food is basically alright, but not more than that). The exercise is nice, but it is getting colder now. No problem for Mark, but I’m a bit wimpy… otherwise the sun is setting at 5.15 these days, so we are eating, watching movies or shows (friends have given us electronic versions of all sorts: the first 3 seasons of Seinfeld, How I Met Your Mother, and movies galore… ) and bed is quite early: 9 PM, often enough.
I thought I would try and describe a typical day, now that there are typical days…
Well, we wake up in separate beds (2 single camp beds tied together by the legs), and crawl out from under the mosquito net. Actually for the last week we have forgone the mosquito net as it is bloody cold- I’m not sure what temperature it is in the middle of the night, but less than 20 C at 7 AM. I’m wrapped up in a blanket inside my down sleeping bag, and am nice and toasty. So we’ve separate beds and separate sleeping bags. Then Mark has a freezing shower (I only shower every 2 days, and I turn the hot water on for about 45 minutes before I get in.) We have breakfast, usually porridge these days, and coffee from our fantastic Bodum-type cafetiere, that Anne and Andy gave us when they visited. Then go to work, walking 15 minutes to the hospital.
At work we each do ward rounds. Currently I am on Paediatrics, Male and Tb wards, Mark does Maternity and Female ward. We start around 8.20. Tb ward only is done 2ce a week: Monday and Thursday. These are confirmed cases of Tb who are in the initial intensive phase of treatment. In other hospitals they are only kept as inpatients for 2 weeks, then followed weekly, but here we tend to keep them for the full 2 month intensive phase.
After that, I’m now on “CDC” as in “Centre for disease control”. Tho’ the only disease we control is HIV (well, we’re working on Tb prophylaxis too…) and Mark is in the out patient department. I’m seeing all and sundry who have HIV in the Khorixas area. Everything is very much about following guidelines, which are, on the whole, very sensible. It requires so much concentration!! I’m prescribing nearly the same thing to every one: 3 drugs for the HIV, 1 to prevent Pneumocystic jirovecii pneumonia, 1 to prevent Tb and 1 to reduce the side effects of the Tb drugs and multivitamins. But then, not all are on the same 3 drugs for HIV, not all need the PCP or Tb prophylaxis, do the have anaemia? Is their liver ok? Do they have Hep. B? All makes minor variations, and luckily, I’ve the guidelines to tell me what to do!!! I just have to remember to read the guidelines.
At 1 PM it’s lunch time, till 2. If we’ve walked to work we have lunch there. Sometimes I’ve remembered to bring leftovers, but often we eat fat cakes: balls of dough that have been deep fried. Don’t knock it till you’ve tried it.
We knock off at 5 PM and walk home. Evenings aren’t very exciting: sometimes we visit the rest camp a few km out of town, and use their pool, having a beer or cider afterwards. Rarely we eat there (the food is basically alright, but not more than that). The exercise is nice, but it is getting colder now. No problem for Mark, but I’m a bit wimpy… otherwise the sun is setting at 5.15 these days, so we are eating, watching movies or shows (friends have given us electronic versions of all sorts: the first 3 seasons of Seinfeld, How I Met Your Mother, and movies galore… ) and bed is quite early: 9 PM, often enough.
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