Induction is much the same everywhere. There is the stuff you need to know which is some things, and they stuff they must tell you, which is a lot of things. Acceptance is a powerful thing. I accept now this is the way of the world. As it is when it comes to meeting the various great and good of a hospital. It is good to be always polite and good practice to remember everyone’s name, but it does someone become a blur of names and titles as I do my best to scribble them down in my notebook as we go.
I was surprised that my little project led to me meeting a sub-minister for health, but I think this is testament to King’s Global health partnerships work in the country, they clearly have the respect of everyone in the hospital and wider health community having been working at Connaught hospital for over 10 years. They in many ways the opposite to medicin sans frontiere that I have work for before. Small, embedded without local healthcare structures, working on developing local services rather than full-scale humanitarian interventions. This will be a very different type of gig than my work in refugee camps.
But these are not my places, not my people. I am not one to sit in offices or encourage meetings. I am an emergency doctor; I am about sick patients and getting things done. So, I deciding to shadow some of the family medicine doctors who staff there equivalent of an emergency department (there is no such thing as emergency medicine specialist in many countries of the world, including Sierra Leone).
On first glance there is nothing familiar. A large room with a mismatch of beds and a few consultation rooms. No resus or majors area, no waiting room and I cannot detect any particular urgency even for the most unwell of patients. This is partially because I don’t yet understand the system, for those new to A/E’s in the UK the overwhelming sensation is the chaos, but there is some order in that madness.
However, underneath it all there are the similarities to what I am used to. There are clerking junior doctors based in the department, there are the medical teams on take and there is the ward matron, making sure a junior doctor writes in the notes the patient can go to a particular ward ASAP as they have run out of beds (a oh so familiar interaction). I watch one of the see a patient with advance Tuberculosis and probable bacterial infection “there is not time to clerk the patient fully, I will just give the patient antibiotics and let the medical team sort it out.” I laugh, this was very familiar, I had found my people.
After work on Friday, on a tip from a WhatsApp group (google maps doesn’t work the same here), I went to visit a bike shop, I missed the freedom of easy movement that a bike brings. The way it makes a city smaller, the absent need for parking and the simple feel of wind on my face. I wasn’t sure what I would find as not that many bikes around, probably due to heat, poor road condition and borderline pandemonium which is the traffic system. What I found is a ramshackle shop with bike frames piled up the ceiling, a chair made from old inner tubes and some of the friendliest most enthusiastic cyclist I have ever met. Richard, the owner, had set up a cycling team locally and told me many stories about sourcing racing bikes and doing them up. My bike was constructed to order from a collection of parts, a sturdy touring frame, with new tyres, a change in seat, rack added, stand taken off and then trial run down the street. It was difficult to bargain with a smile on my face, but as he worked with a charity that brings bike to Sierra Leone from the UK, I wasn’t too worried. Here too, I had found my people.