LITMIR.BIZ

       Africa

      During a holiday in East Africa, I visited some old friends from medical school who were working in a small rural hospital in Kenya. Rob and Sally had been GPs in the Midlands until they decided to sell their house, quit their jobs and commit to three years in Kenya setting up and running a rural hospital.

      Rob proudly showed us round. They had been in Kenya for two years and had achieved an enormous amount for the local community. Thanks to their tireless work, there is now an organised maternity unit and a well-equipped medical ward. Rob has also set up an AIDS clinic with free testing and, most importantly, free access to AIDS medication. It is the only one of its kind in the whole region. Rob and Sally have also pushed hard for education and disease prevention and have spearheaded a campaign to encourage mosquito nets. As a result, they have significantly reduced malaria deaths.

      Not only had Rob and Sally been working hard treating patients, they have also been single-handedly planning and managing the changes and improvements to the hospital mostly with funds they have raised themselves. My targets in England for the year might be to get a few patients to lose some weight or cut my diazepam prescribing. Rob and Sally’s targets were to build a maternity ward and prevent 100 local children from dying of malaria.

      Rob asked me to help out with the HIV clinic for the day. There was no appointment system. The patients arrived en masse in the morning and sat patiently outside my room all day until the last one was seen at about 6 p.m. Not a single person complained about waiting and each one thanked me with genuine gratitude and warmth when the consultation finished. It truly was a humbling experience.

      My most memorable patient was Cynthia. She had set off from a neighbouring village the night before and, despite being weak with advanced AIDS and TB, she walked the entire 12 miles and spent the night sleeping in the doorway of the hospital along with many other of the morning’s patients. She didn’t speak any English so a nurse was translating for me. Cynthia was 24 but looked much older. Her two children had both died aged around 18 months and, although never given a diagnosis, they almost certainly died from AIDS-related illnesses. Cynthia’s husband, from whom she contracted HIV, left her once she could no longer work and he realised that she wouldn’t be able to produce any healthy children for him. Cynthia was alone and her only means of income was digging in the fields. She was still getting up each day and attempting to work, but her AIDS was advanced and she was too weak to dig. The medications for her AIDS and TB were free and were helping, but what she really needed was something decent to eat. ‘Where are you going to get your next meal?’ I asked via the interpreter. She shrugged her shoulders and then after a long silence looked me in the eye and asked me a question in her native tongue. Waiting for the translation, I assumed that Cynthia would be asking for some money or food. To my surprise, what she actually asked me for was a job. Even in her weak state, Cynthia clearly still felt that she should earn her way and hadn’t even considered a hand-out. One of the previous patients had given me six eggs to say thank you for the mosquito net I gave him, so I gave them to Cynthia and she left with at least some basic sustenance to help her muster the energy for her long walk home.

      As an idealistic sixth-former applying for medical school, I imagined spending many long years working in the poorest and neediest parts of the world. The reality is that apart from my brief experience in Kenya, my only other time practising medicine abroad was three short months in a hospital in Mozambique soon after I qualified. The reality of working in an African hospital was really hard. The facilities were limited, the bureaucracy made me want to tear out my hair and the extent of the corruption was terrifying. The experience was incredible and although it was some years ago, I think of that time often and it helps put both my work and life back in the UK into perspective. I’m a more experienced doctor now and could potentially be much more help back in that hospital in Mozambique, but the question is: do I have the motivation to go back?

      Rob is a GP with a similar amount of experience to me. The week before we arrived in Mozambique, a woman came to the hospital in the middle of the night in labour with an arm presentation. This means that the baby’s arm had been born but the rest of the baby was still inside the womb and basically stuck. Rob, like me, had spent a few weeks on an obstetrics attachment as a medical student but that was pretty much the sum of his experience of delivering babies. Suddenly, as the only doctor around and ten hours from the next nearest hospital, Rob had to do something. The woman needed a Caesarean section, but there simply weren’t the facilities at hand. He tried desperately to push the arm back in and deliver the baby but to no avail and the baby died. The mum was extremely weak from loss of blood and exhaustion. The baby needed to be taken out or the mum would die too. Rob cut off the baby’s arm and managed to deliver the remainder of the dead baby.

      Rob saved that woman’s life and I have the utmost respect for him. If he had decided to stay in England, that woman would have undoubtedly died. Throughout this book I’ve moaned a bit about the fact that I went to medical school to save lives and make a difference but instead I keep lonely old ladies company and dish out sick notes to the work shy. I haven’t ruled out the possibility of returning to Africa to practise some genuine ‘life-saving’ medicine, but right now I’m not sure that I have the emotional strength to hack the arm off a dead baby at three in the morning.