A&E has been altogether more of a culture shock than anything else I’ve seen or done during my time in Mwanza. The thing about the oncology department was that they try to do things in a way that’s really fairly Western, so far as they can be considering the global lack of staff, money, or resources. A&E is not like that. A&E is a different world.
You hear people from back home, mostly people who write for the Daily Mail, talk about A&E departments in Britain and compare them to being in a third world hospital. They have no idea.
In my department, there are often two or three patients to a bed.
In my department, patients have to go through a nominal triage system to get as far as a bed, but, after that, it’s up to them to fight for a doctor’s attention. This means that the sickest and most disenfranchised patients are often the ones who wait the longest.
In my department, sharps disposal is first onto the patient’s bed and then into a sharps bin whenever someone might happen to remember.
In my department, there is no ECG machine. Or facility to do a blood gas. Or defibrillator. There is one oxygen tank, which is administered at 0.5 litres through a nasal cannula so that it doesn’t get used up too quickly.
In my department, sheets are grey and stained and full of holes. If there are sheets at all.
In my department, it isn’t unusual to see a cockroach crawl across an open wound.
In my department, a patient with febrile seizures has a psychiatric problem and a patient with cerebral malaria is put into metal restraints.
In my department, everyone seems to get certain procedures done without anyone stopping to think about whether they’re necessary or appropriate in this particular patient. Like, everyone gets fluid resuscitation. Everyone. Yesterday, I had to stop a doctor and a nurse from giving a half-litre fluid bolus to a patient whose systolic BP was 210mmHg. A brief argument ensued between them, after which the nurse removed the fluid and said to me, “Yes, it is very bad to give this to a hypertensive patient. I had forgotten.”
In my department, patients have to pay before they get through the door.
I think about the A&E departments that I’ve been in in Britain, as a medical student and as a patient and as the friend who accompanied whoever in the early hours of a Saturday morning, and they’re cathedrals. They’re palaces.
My mum asked if all of this meant that I’d found oncology a better experience than I’ve had in A&E. I don’t know if better is the right word, exactly. Certainly, I found oncology to be a more comfortable environment. Even with all the things they don’t have, their attitudes and their philosophy were more within my comfort zone. A&E isn’t. But does that mean it was a better experience? I don’t think so. A&E has forced me to re-examine my own attitudes and think about my own clinical reasoning. It’s been an emotional and a mental challenge. It’s been worth it, all of it, every single minute. And that was what I came for.
If I’d wanted to stay in my comfort zone, I’d have gone to Australia.