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"PRIMARY ART OF ATTENTION - ALL IN A DAY’S WORK"
I must have taken a cold shower at least three times and soaked my bedsheet in cold
water at least twice overnight, yet by 5am that morning, the bed was as dry as toast and
I was already beginning to feel hot again. The agitated and persistent knocking on my
door by 5.15 am was thus a welcome relief. At least it would serve as a distraction from
the stifling, dry and dusty heat of the night during hot season in the North country.
‘Likita! Likita! Zo mana, zo! Ya mutu ni?’ ( Doctor! Doctor! Come. Is he dead?)
I opened the door to see the community nurse at the doorstep. He motioned me in to
the ambulance where the hospital driver was waiting to transport us to a remote
settlement on the outskirts of the local government or county as you may call it.
Apparently, a homicide had occurred and the body needed to be certified dead by a
medical personnel. Being the closest qualified doctor for miles, I got to do the honors.
The police officer was already at the scene. The body lay by an open well pit and had a
huge, unslightly gash on the forehead. It had been found at the bottom of the shallow
well , of course, dry at this time of the year. He had a few bruises and an obviously
fractured leg judging from the odd angle it hung. Most likely the fracture was a result of
the fall, or push, in to the well; but the gash on the forehead? definitely a deliberate
assault. Well, that was not really my job to determine or decide. I would leave that to the
coroner and forensic team.
“No respiratory effort, no palpable pulse, no heart sounds, pupils fixed and dilated.
Patient certified dead at 6:15hrs.”
My job here was done. So rote, yet those few lines surely signaled the beginning of a
bleak future for a family somewhere. From the little information I could pick from the
conversations going on around me, someone was yet to claim the body having been
discovered by the owner of the well just this morning. The well owner said the tribal
marks on the face appeared to be from a neighbouring community. There was nothing
more for me to do, not even a grieving family to comfort or counsel. The medical team
set off on the journey back to town leaving the law enforcement to continue their work.
Nine o’clock , I was at the community hospital. Already a line of patients was forming in
anticipation of my arrival. A quick ward round with the head nurse for the two patients on
admission. A ‘primip’ who had a spontaneous vaginal delivery the day before and a four
year old with severe malaria admitted two days prior. Both were discharged home on
oral medications and I hurried to start the out-patient clinic.
My interpreter arrived on time at 10 sharp today much to my delight as my faltering
Hausa made the clinic slow. The head nurse who would have stood in till he came was
busy with immunizations. The clinic ran with the usual gamut of cases showing up;
malaria, gastroenteritis, hypertension, dermatitis, colds, the occasional antenatal case,
minor wounds. By 12.30pm we were slowly winding down when a motorbike sped up
with a man and a heavily pregnant woman as passengers. Hmmm, that could mean only
one thing; imminent delivery, probably complicated.
The expectant mother was hurriedly taken in to the examination room. She was rather
pale, obviously dehydrated and her pulse was racing at 120 beats a minute. The
pregnancy was about 36 weeks. She had gone in to labour early this morning starting
with passage of the mucus plug. The mother had expected to be delivered at home by
the local midwife as had been with her first three children. However the midwife had
asked she be taken to the hospital when she started having heavy vaginal bleeding 2
hours prior to arrival. This was her first visit to a hospital in this pregnancy.
Placenta praevia, I suspected, maybe abruptio, although the abdomen was soft and
there was no pain. Intravenous rehydration was commenced at once.
Contractions were weak but regular at 15 minutes apart. The fetal heart was 160 beats a
minute with the pinnard stethoscope. Speculum exam showed a bulging patulous cervix
at least 2cm dilated with fresh blood trickling from the os. There was no ultrasound to
confirm the diagnosis. She would likely need a section and definitely need blood. Her
PCV was 22%. She must have already being anemic even before labour started. No
blood bank here. I could screen the husband and have him donate, but unless I was also
ready to section her there was no point wasting that time. It was only a matter of time
before both mother and child went in to full crises.
It was time for a transfer. The next town 20 minutes away by a fast vehicle, had surgical
services and a blood bank. Once again, the ambulance and driver were called out and
the patient and husband accompanied by the head nurse headed off, while I and the
other nurse held fort.
Four pm. I am finally back home. The heat is so bad, you just want to stay indoors. Four
other youth corpers come around to while away the after work hours. MTN, one of the
major telecom providers hadjust extended its GSM network to our local government and
as the community doctor earning the highest among the corpers, I can afford to get an
external antenna to boost the signal. I therefore, understandably, get quite a number of
visitors. That I also have a TV, refrigerator, DVD player with lots of movies and a
generating set is definitely not a bad incentive to visit either!
Unfortunately, my pay can only do so much and with the epileptic fuel supply in the
country, I can only afford to switch on the generator three hours a day. So, I still dread
the upcoming night and the most certain attendant heat. Hopefully the National
electricity company might give us power tonight, so I can at least have the fan swirling
the heat around!
Seven pm, I am able to get a call through to Jamaare, the next town. The pregnant
woman indeed had a major placenta previa and had been sectioned shortly after arrival
at the next hospital. She and the baby were stable. Good news!
Whoosh! Boom! Whoosh! Whoosh! Crash! Whoosh! Boom!
We were just rounding up our movie when it seemed like hell had been let loose!
Actually it was more of ‘heaven’ being let loose. It was a thunderstorm! It was actually
raining! Wow! Oh Thank God! We quickly rushed to turn off the generating set and bring
it in. Shut all the windows tight. From out of nowhere the rain came. And it came. And it
came. It just poured and thundered and the wind blew and lightening lit up everywhere
for two hours non stop. It was almost 10pm before the rain slowed to a steady patter.
We peeped out, there were a few downed trees and brushwood and debris were
scattered everywhere, but, oh it was a glorious sight. The air was cool, in fact cold. The
electricity had not come on, but no one cared. Tonight, no need for ‘water beds’. We
would actually sleep using our coverlets!
The first rain had finally come. The hot/dry season was over. From tomorrow, at most
next week, more rain would fall. The hard baked earth would soften. Planting would
soon begin, then the land would be covered in green again. Life breathed afresh in to
the savannah. Born anew like the placenta previa baby after a long difficult gestation.
Of course, Just like the slightly premature previa baby would have it’s challenges, the
rains too would bring its own. Some areas would flood with the torrential downpours and
the malaria incidence would definitely rise with the resulting stagnant pools of water that
would surely form. All in all though, It is a cycle of life we have come to know and have
learnt to cope with and daily improve on our systems, till we don’t just cope but thrive.
Tomorrow is Saturday. No clinic till Monday. I have an appointment with the Emir of the
town as an entry point to speak with the towns’ women. We have to encourage more to
avail themselves of the antenatal facilities so that we get fewer surprises like the previa
as we did this afternoon. We have more women personnel now, so they should feel
more comfortable to come in. That is one major impediment we noticed they had.
Maybe we can even get him to fund the procurement of an ultrasound machine. I know
how to do a basic antenatal ultrasound after all. Come to think of it, that could actually
be our youth corper parting gift to the community. The one year National Youth Service
Corp program was more than half way done and the corpers had been thinking what to
give. I would probably end up paying a quarter of the whole thing. Oh well, I do earn the
most anyway.
I’ll miss this town when I finally leave for home. But, I have really learnt a lot by being at
the fore front of my profession here. The daily attention I give my patients as the first
point of call for the community; the gatekeeper to formal health care, has impressed on
me more than ever, that what happens at the primary care point, sets the foundation for
the rest of the health system.
I think I will pursue family medicine as a specialty when I get back home. Then, I just
might come back here to finish what we started.
Hmmm, all in a day’s work. What a day.