It isn't quite like riding a bicycle..........

January 16^th

So this entry of my blog has seen me face a few more challenges (as I knew I would). The obstetrics is going fine (well I don't feel out of my depth) but the gynaecology is proving more challenging.

As most of you know although fully trained in gynaecology I gave up practicing over 10 years ago when I became a Consultant, so it is all a bit rusty to say the least. Now add to this the need to practice in a completely different way due to resource limitations and that is where I am. This morning, I was faced with a woman with an ectopic pregnancy. Because she was very anaemic (from bleeding from the ectopic), the male anaesthetic nurse Abate (who I will tell you more about on another occasion but is amazingly skilled) felt that giving her a general or spinal anaesthetic was too dangerous and thus I had to do her operation with only local anaesthetic and some sedation. As is often the case she had also presented very late so that everything in her pelvis was very damaged, making the surgery difficult with the result that I was unable to stop her bleeding without removing both her fallopian tubes. Committing a young woman to a lifetime of infertility is serious anywhere in the world but here where there is no IVF and people depend on offspring to care for them in old age, it has left me feeling pretty terrible and wondering of someone with greater skill could have done a better job. However on the day I was her best chance and at least I managed to stop her bleeding

I was told to look for the uplifting part of any case when I feel down and in this case it is that she clearly has a very a supportive family (she is young and unmarried)- how do I know this? At 10pm last night her predominantly male relatives lined up to be checked to ensure they had normal blood pressure (and were HIV negative) before having their blood groups checked to see if they were a suitable cross-match for her. Thankfully two of them were (and had very high blood counts) so they donated blood without which she would not have made it through the surgery (with or without her tubes).

Otherwise today is quiet in the Hospital as being a Seventh Day Adventist organisation Saturday is the Sabbath and thus there are no outpatient clinics or other elective work. The labour ward has been quiet this afternoon or at least I assume so as I have had no visits from the guard (there is no bleep system or telephones and so if the midwives need me the compound guard who speaks only a little English is sent with a note to fetch me). Hopefully it will stay that way for a little while to allow me the time to post this message!