A post-call rant.

On calls can, like at home, be so variable. But this one is a bad one. I barely slept last night and am totally exhausted. But I am also just tired of some of the things that happen, or don't happen here;

It all started at half 3 yesterday afternoon, I was just sending everyone else home early as the department was quiet (almost unheard of) when a rape case arrived. I began by counselling her on her risks of exposure to pregnancy, STIs and HIV and prescribing her appropriate prophylactic drugs for all of these, only to discover that we don't have emergency contraception in our emergency drug cupboard. And with the current pharmacy situation, we don't have an on call pharmacist. So I was faced with using an unlicensed (and less effective) treatment or having the poor girl wait 60 hours for contraception, by which time it's effectiveness has greatly reduced.
An hour later, I was finally completing the rape evidence kit when maternity rang to say they had a cord prolapse. This is an absolute emergency and involved rushing the woman to theatre for a c-section. In the UK, the baby would be out in a matter of minutes but here there can be difficulty impressing such urgency upon staff and everything takes longer. When we finally got the baby out 45 minutes later, he reassuringly cried and I hope that the delay hasn't adversely affected him.
During the section, the theatre sisters enquired how maternity was looking as with no water this week, we haven't been able to sterilise and so only have enough theatre sets for 3 c-sections. Apparently we are unable to borrow these from our nearest hospitals, so have to wait for a central supplier to send some out.
Just as I was closing up, the OPD sisters came to seek me out to tell me that they had a baby with enema poisoning who was shut down. This is a common problem here; people believe in using them on everyone, even very young, healthy babies, and they use anything from herbs to washing up liquid. This can create terrible imbalances in electrolytes causing respiratory compensation and often ultimately death. We actively discourage it but are fighting against a commonly held cultural belief. Ultimately it is child abuse and potentially man slaughter.
An hour of struggling and we finally managed to get iv access in the baies scalp to give fluids to try to combat the imbalance but the child is still very sick.
My final frustration came at 3am when female ward phoned to tell me that a patient had died. She was a 57 year old lady who had been admitted last weekend. When I saw her on Wednesday it was apparent that she was bleeding profusely from her gastrointestinal tract. I rang our referral surgeons to arrange a scope where they could find the bleeding point and stop it. Sadly their scope remains broken and they could offer no help. We rang on to their referral centres in Durban but were told that they weren't accepting patients in readiness for the start of the World Cup. Despite all available medicines and blood transfusions here, the lady bled to death, with what essentially should be a treatable condition.

I knew when I came here that I was coming to a place with less facilities than I was previously used to but I find that 9 months on, I am still totally frustrated by this. Particularly when it seems more logisitcs than just money that is affecting patient care.