the clinic

I started working at the clinic last week on Monday.  The weeks are relatively consistent.  On Mondays, we have outpatient day when all the adult patients come for mild complaints.  On Tuesdays, all the antenatal (pregnant) patients come for checkups.  On Wednesdays, we have a children’s clinic.  Patients who are acutely ill can come on any day, but in general these are the clinic’s working days.  There are two maternity rooms and they usually have one birth a day (usually around 400 births per year), but I haven’t gotten to observe there yet.

So far, I’ve become proficient at taking blood pressures.  My third day, the few adult outpatients that came needed their blood pressures, so this was my first real experience with trying to do manual blood pressures.  I wasn’t very good at them though.  Last Friday, I practiced on Dr. Margaret since the clinic wasn’t so busy, and that was helpful for getting the technique down.  This Monday and Tuesday, I had to take hundreds of blood pressures and now I feel confident about doing them.  Whew!  I even got a blister on my ring finger from pumping up the cuff so many times and got sore ears from having the stethoscope in my ears for so long!

My first day I was on the ward, observing what the nurse does on duty and what the tasks are that are associated with that part of the clinic.  Mostly doing vitals, giving out drugs and prescribed food (milk, sardines, sugar, peanut butter – mostly for the AIDS or TB patients that have funding available to give them this food).  There are thirteen patient beds on the ward.  During the dry season, the ward is relatively empty.  When rainy season comes around (now) there are many patients that go in and out.  At the moment, the ward is completely full, but on my first day, there were only four patients on the ward.  Since my first day of orientation on the ward, I’ve been accompanying Dr. Jamie on rounds in the morning after prayer, so it has been a learning experience already.

The second day, I helped wrap drugs in the pharmacy.  The general stock of drugs is too large to keep all of them right by the dispensing counter, and only a few tablets are given out at one time.  The typical dose and course for the drug given out need to be wrapped in separate papers and labeled in order to hand out in a timely fashion.  For example, I was packaging iron tablets in sets of 6 and 12.  The pharmacist has arthritis and cannot wrap the tablets very quickly, so I was sent to package lots of drugs so that all the pharmacist had to do was hand them out.  The job is incredibly boring, but necessary for the smooth functioning of the clinic.

The third day, I helped in the waiting hall with weights and blood pressures.  Since it was children’s day, there weren’t as many blood pressures that needed to be taken, but lots of weights for all the children.  I find that Wednesdays are the busiest in the waiting hall because we have to call up several children up at the same time so that we can read the weights in a timely fashion.  This also creates a very hectic scene because we have three scales that the children can be weighed on depending on their size.  For this reason, I have to be paying attention on all sides of me to figure out which baby I am supposed to  be recording the weight for.  This makes for a very stressful morning.  The bright part of the  morning is that all the women who come with their children (as well as on Tuesday with the antenatal clinic) all come wearing their nicest outfit so it makes for a very colorful and festive-looking place.  I haven’t had an opportunity to take a picture yet, but I will post one soon so that you all can see how amazing it is.

Friday morning, there were few staff back at Sibanor (we had prayer day down at headquarters the day before, and many people stayed to finish up business or to just have the weekend off), so I was with Dr. Margaret seeing patients in the doctor’s room.  It wasn’t very busy; we only saw four patients, but they were all very interesting.  There are about three or four nurses who see all the patients and they refer patients to the doctor only if they don’t know what to do with them.  We drained two abscesses:  one behind the ear of a five-year-old girl, and one on an older woman.  Both patients were put under general anesthesia, so we had to watch them while they woke up as well to make sure that they didn’t try to get off the table before the anesthesia wore off.  Then we saw a boy with bilateral juvenile arthritis in his elbows.  This is too rare and complicated for our clinic, so he was sent down-country to the research center.  There was also a woman with undiagnosed diabetes with an enormously abscessed foot.  This one was too big to drain at our clinic, so Dr. Margaret sent her down-country as well to have it seen to.

This week Tuesday, blood pressures and weights were done early so I was placed in the lab to watch what they do on a daily basis.  I observed their phlebotomy station and learned how to do hemoglobin, HIV, pregnancy tests, and malaria smears (they used to have 40 patients in a ward at a time with malaria, but now see about two cases per year)

Today, I helped a little with the storeroom organizing.  We just received a shipment of medical supplies so they all needed to be accounted for and put in their proper places.  The clinic has to order supplies once a year and has to be thorough so that the supplies will last that amount of time.  It isn’t like at home where you can get a shipment of supplies from the company in a couple days; it takes months to be ordered and shipped here.  Wow!

Well, I think that’s probably enough of an update for now.  I hope you all are enjoying your summer.  Please continue to pray that I would be able to find my place here at the clinic and feel a part of the team.  There are a lot of transitions continuing to play out so we will need your prayers as we navigate those issues.

Random note:  For any of you who enjoy animals, the cows, sheep, dogs, goats chickens, lizards are wandering around all the time.  It is uncommon to see them tied up or fenced into an area so they wander freely in and out of the clinic compound (I have to chase chickens and goats out of the waiting hall a few times).  This also means that they are free to give birth on the compound.  Yesterday, I was walking back to my house and saw a goat giving birth to twin kids.  I couldn’t grab my camera fast enough, but got some pictures (and one video) of them in their first hour after birth.

the main part of the clinic (the treatment rooms). The pharmacy is to the left of the picture; the waiting hall is behind me; the ward is behind the treating rooms

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2 Responses
  1. Susan says:

    Emily,

    Sounds like you are staying really busy and learning a lot! We are so excited for you and hope you are enjoying this time in Gambia so far. Sounds like you are:) We will continue to pray for the transition time and your ministry there! Love, Susan

  2. Laura Jean Pulscher says:

    Fascinating! What a thorough experience in providing much-needed medical care. Thank you for the in-depth account. May God’s love continue to give you energy to do his work in Gambia. :) Big hug!

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