day eighty one

Sometimes it's hard to explain to someone exactly what it's like being me, being here, doing this. I know that sentence was rather vague and ambiguous, but that's what I mean - I cannot describe just how hard, exciting, heartbreaking, fulfilling, lonely, soul-destroying, amazingly incredible this journey is. Every day I wonder am I really cut-out for this? Can I really be a development worker? Am I too soft, too aggressive, too bossy, too arrogant, too needy to make it on the field? Or should I just go home and do my PhD in something? 

But then I go to work and someone has requested one of the new methods and I think  maybe they are listening to me? Maybe I am making a difference? Maybe at the end of all this the laboratory and public health teams will have benefited from my knowledge and not just my jokes? 

You'll see what I mean in a minute... apologies in advance for the intense laboratory/medical jargon. 

Last week I gave a talk to the staff here at my hospital about some new laboratory methods we're now performing and how they will increase their ability to prescribe appropriate drugs rather than just empirical treatment. We're now going to be performing Gram staining for all urines that have ++ or +++ pus cells (i.e. an indicator of infection) to differentiate any potential bacterial pathogens. With that I explained the importance of collecting a mid-stream urine (MSU) early in the morning. I also reminded them that we can Gram stain almost any sample - sputum, pus, high vaginal swabs, urethral swabs... anything that might be able to give any helpful information where we can differentiate from normal flora and potential pathogens. I also explained how we're now going to be performing auramine staining for faecal samples for the detection of Cryptosporidium spp, and also titrate the serological samples rather than just provide results as "slightly/moderately/highly reactive". 

Those that attended seemed to be attentive - thing is none of the clinicians were there. None of those that treat the patients, that prescribed the drugs, that read the laboratory results, that deal with treatment failures... they weren't there. None of the Public Health officials were there, those that look at the data, look at outbreaks, look at the trends, that recommend changes... they weren't there. I'm sure that there was something else important going on that morning, 

Even those that were there hadn't listened - we're supposed to now titrate out any positive samples for serology, but rather than actually perform the titrations, the lab staff are visually assuming the ratio according to the amount of agglutination. So basically instead of saying "highly reactive" they're assuming that is "1:320"... 

I know that change takes time. But how can you change when you don't even listen?! Assumptions, quick fixes, band-aids... how can they be broken and removed if there are so many excuses? 

For example, anyone with a fever automatically gets a blood smear for malaria and serology testing for S. Typhi using the Widal technique - even if they have diarrhoea. See, if someone has Typhoid fever, the majority of cases are constipated. So why aren't they collecting a faecal sample to determine the cause of the diarrhoea? A myriad of reasons... the laboratory don't like testing, the patient doesn't want to pay for it, you can't just ask a patient to poop on demand, it's what the patient is asking for, you can't expect me to ask every patient with diarrhoea to be tested...

I have replies to all of those reasons, but they are falling on deaf ears. Possibly because in trying to get this across I'm probably coming off aggressive and know-it-all. Possibly because I'm female, white and not medically qualified. Possibly because people just don't like to be questioned, to be seen as doing something wrong. 

Then this morning I came in and when dealing with a rape case the Doctor had taken a high vaginal swab and requested not just the ordinary wet prep, but also the gram stain. So maybe they are listening? Maybe change is coming? As Peter (my awesome boss) keeps telling me "pole pole Anita, this is Africa". 

That's why I came for twelve months - because change takes time. Rome wasn't built in a day, but it was built eventually yeah?