The father looks at me like we have asked the impossible. “Does she menstruate already?” Her mother died during childbirth. He is the only one taking care of the children, how could he know such women’s business? Because saying that he doesn’t know is not always culturally accepted (something quite difficult when asking for directions...), he just keeps quiet and stares at us. His 14-year old daughter was admitted with severe abdominal pain caused by litres of urine collected in her bladder. It turned out she had actually started to menstruate, but even she herself did not know. Due to an imperforated hymen her menstrual blood was collecting in her vagina unable to get out and pressing on her urinary tract. A small and simple operation was all it needed to be solved.
The last month I have been taking care of the surgical patients together with the local surgeon. With decades of experience in this hospital, all operations seem simple for his hands. I really enjoyed doing surgeries again. Surgery can often be very satisfying: although very simplified, the patient comes in with a problem, you do a surgery and the problem is solved (hernia inguinalis, appendectomy, fribroma’s of the breast, etc). But as you might expect, in Makunda that is not quite the case. Patients come late, very late. After days of excruciating abdominal pain and distension their relatives bring them in to the hospital. By that time surgery is hardly enough anymore, and sometimes with or without surgery the chances of survival are almost nil. We find cancers growing through organs, large parts of intestines that have been cut off from their blood supply or litres of puss. But still we try, and fortunately for some it is the ‘fix’ we were aiming for, or at least an improvement of the quality of life that is left.
According to Inge’s weather app it is around 38 degrees here now, which feels like 46 degrees due to the humidity. The operation theatre has air-conditioning however, just another reason why I like spending time there. Nevertheless, during a quite complicated caesarean, I found myself asking the nurse to wipe my forehead because my sweat was about to drip unto the wound. Who needs a workout when you can just do a caesarean!
The hospital has been in the highest gear the last couple of weeks, working towards an accreditation of the national board for hospitals. Besides men working day and night to give the hospital a fresh dash of paint, we suddenly are wearing nametags (“It’s a patient’s right to be able to identify staff”), and literally everything in the hospital has a sign. From the very practical numbering of locations in the hospital (number 2 is the counter, number 31 labour ward, number 8 the lab etcetera), to every single dustbin and sink (‘hand washing area number 1’). You could easily teach yourself English just by walking around here for a while; there is no object without a tag.
Very much like my own habits during university, it is remarkable how much can get done in view of a deadline. The hospital now has a fire drill, complaints committee, and well-written guidelines for employees. Two years of work and decent sprint towards the deadline has resulted in a leap forward for the hospital, the inspector has only given minor revisions to achieve the first level of quality. Makunda really is an example of what hard work and dedication can bring!
By now I have come to the point that it is difficult to think of what I should write. I have become used to life here and the funny little different things that come with life in a different country. Within a few days one of the doctors that will take our place will arrive. So cliché, but it feels not too long ago that I came here. On the other hand, if I think of all I have done and learnt, it could have easily been much longer than 6 months ago. Anyways, it is not over yet, I first have few more weekendless weeks of work ahead of me... Makunda life, that is!