• Fluid and air in the lung.

    A 52 year old presented to the outpatient department with one week history of shortness of breath. The family medicine resident text me the below Chest XR (Apologies for quality but we have film XR in Sierra Leone)   My first response “did have have any trauma” I was taught this pathognomic for hemopneumothorax. You would normally expect to see a curve to the fluid on the right hand of the chest, if you look closer you can see the absent lung markings which pneumothorax. On POCUS we can confirm lack of lung sliding sliding on right lateral aspect of chest. However, on the right inferior aspect where we would…

  • Office work, expertise and ultrasound

    I have spent most of the week prepping materials. We have a generously allocated office with intermittent Wi-Fi, this is quiet a luxury out here. There is even aircon (although I am loathed to turn it on when I am alone, imagining horrendous energy consumption in a city with daily blackouts). So, I spend the longest period of my life on Microsoft office; writing presentations, designing pre course assessment, spreadsheets of candidates and trying to plug the large amounts of holes in my knowledge. I am here to teach point of care ultrasound. This is the use of ultrasound by the treating doctor at the bedside with an acutely unwell…

  • Meetings, greetings, and your people

    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…

  • Departures and Arrivals

    Departures Airports are fundamental strange places. It is one of those things we collectively ignore as a society. They have only become stranger now I no longer take flights unless absolutely necessary(humanitarian work being only exception). It is not just the mass ignorance of how our individual impacts can build up and cause devastation. It is the way, during queues and security checks when group together everyone’s individual intelligence seems to dissolve and be replaced by collective inability to follow basic quiet clear instructions. These seems the most apt metaphor for some of the societal problems. Alas, needs must, the overland trip between Brighton and Freetown, although admittedly epic, would…

  • Outpatient management of suspected neonatal sepsis

    A review of some of the latest low-resourcs emergency medicine evidence Implementing WHO guidelines for unwell newborns. Management of possible serious bacterial infection in young infants where referral is not possible in the context of existing health system structure in Ibadan, South-west Nigeria Ayede A et al. Aim To test the feasibility of implementing an outpatient protocol for suspected neonatal sepsis when referral isn’t possible.  Rationale The WHO has developed guidelines that recommend a simplified outpatient antibiotic regime; however the implementation of these guidelines has not been examined.  Design An implementation study design (this I have not come across before but they used a reconcised framework of RE-AIM; Reach, efficacy,…