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Medical Thursday Doors Zambia

Working in the Clinic

I interrupted two antelopes, Puku, that were grazing near the lagoon, close to my house

My first tour of duty as a medical volunteer in rural Zambia was in 2014. The clinic hasn’t changed much over the past six years. All of the original staff have moved on, apart from a cleaner and some local volunteers. There have been some renovations – the ward ceiling which was collapsing from the weight of bat excrement has been partly replaced, the labour ward has relocated to a new block and USAID has built a six-room HIV/AIDS clinic. Some small rooms have been divided up into smaller rooms to provide dedicated space for counselling, family planning, HIV and malaria testing. It has had several additional coats of paint.

The clinic failed an inspection a few years ago. The list of improvements is still attached to the wall, and a few have been implemented. For example there is now a dangerous drugs cupboard. This has two lockable doors, but unfortunately someone lost the only key. The only “dangerous” drug supplied to the clinic is diazepam injection, which we use to halt epileptic seizures.

These are your Thursday Doors for this week. The Dangerous Drugs Cabinet.
Avoiding unprotected contact with wild animals is difficult where I live. The baboons clatter across the tin roof at 6am each morning, squabbling, screeching, mating and defaecating.

The covid-19 pandemic is just starting to take hold in Zambia. There are complicated posters on the clinic walls, in English, providing information about the disease. Around the clinic there are buckets of water, basins and bars of soap for people to wash their hands. We have tried to enforce a policy of mask wearing for all staff and patients, but it is difficult to refuse to attend to a sick patient whose mouth and nose are not covered. The main consulting room has three washbasins. I have no idea why, but only one basin has a tap. The tap usually has running water. I donated a towel to the clinic six years ago and remarkably, it is still here. Someone has used bleach to try and clean it, so it looks a bit piebald. I try to avoid using it and re-contaminating myself, but it isn’t easy pulling on latex gloves when your hands are wet.

The curtain arrangement provides basic confidentiality. My old green towel is by the middle sink.
Handwashing station. We have several of these around the clinic.

Many of the doctors who have volunteered here over the past twenty years have done some teaching. It is better to train nurses how to diagnose and manage patients so they improve their skills, than just seeing patients on your own. I taught nurses how to examine ears, throats and eyes using a pocket diagnostic set which I left behind last year. Other doctors have left shiny auroscopes and ophthalmoscopes. Doctors feel “naked” without these basic tools. I found two sets on a shelf covered in dust in their cases. Once I had replaced the batteries, they were perfect. I suppose the clinic doesn’t have funding for such essentials.

Medical equipment which is no longer being used, gathering dust on a shelf

The clinic has a graveyard of ear thermometers which have worn out or succumbed to the dust. They are very useful because they are quick. A more traditional thermometer tucked into an armpit takes a couple of minutes to cook – and then you find it has changed position and not recorded a true temperature.

There is an old mercury sphygmomanometer for measuring blood pressure, but I was told it was “not functional”. There were beads of mercury in the glass tube and I thought it should stay on the shelf because it was dangerous. The registration desk has an electronic sphygmomanometer, but the battery cover has gone missing and it has been replaced by sticky elastic strapping. The batteries were dead yesterday, so I brought some from my own torch at the house to help them out. Today I was surprised to find that someone had bought new batteries and we were in business again. But for the entire morning I was pestered by the staff for the replacement batteries I’d brought. They can wait until I have returned to UK!

Improvised cover for the electrical BP measuring machine, elastic sticky strapping tape.

Last year, the clinic ran out of bandages and gauze swabs, so this time, I brought a supply with me (thank you for the donation, Su). We needed to use some during the first week I was at work. Dressings do tend to disappear quickly so I asked the clinical officer to lock the supplies in the pharmacy store. I separated the kit into piles of dry dressings, non-adherent dressings, different sizes, bandages, tape, gloves and steristrips (thin bits of tape to get wound edges together when stitches or staples are not required). Today, I needed some steristrips to do a bit of first aid and was disappointed to see some of my supplies randomly stuffed into plastic baskets in the corner of the treatment room. I searched for five minutes before finding the strips, and sadly, that was the last packet.

Working in low resource settings isn’t easy. It is not for every doctor. The variety of drugs is limited and “stock outs” are frequent. The range of investigations is restricted, the nearest X-ray machine (when it and the radiographer are both working) is an hour away by car. Taking a history using an interpreter can be difficult, especially when patients don’t understand what you are trying to do – you’re a muzungu doctor, surely you know what’s the problem without asking all these questions? I rely on my physical examination skills and broad experience. This can be frustrating when communicating with specialists who rely more on the appearance of a CT or MRI scan, when I want to know what the chest sounded like to know if it has changed since they last saw the patient.

The nurses in the clinic use me as a consultant to help them with the most difficult clinical problems. This means that I often see patients with untreatable conditions. I can tell them the diagnosis but I cannot always offer treatment or cure. I am trying to improve palliative care here.

In contrast, when I am working in village clinics for children, I am most usefully employed in recording all the details of vaccinations on an incredibly detailed tally sheet. These sheets have been photocopied so many times, that the print is faded and the tiny font is difficult to read. The data we collect must be accurate as it will be scrutinised by headquarters. Injecting an infant with vaccine is easy by comparison.

Being cruel to be kind; vaccinating an infant in the open air, by a baobab tree in the village. 130 infants attended this clinic. Immunisation coverage is much better than UK, no anti-vaxxers here. The mothers know the vaccines protect their children.

It is important to keep calm, equanimity rules. Showing annoyance is considered very bad manners and even raising your voice can cause offence. Although the work can be frustrating, the patients really appreciate what is being done for them. Even if the “free drugs” are only free when they are in stock, else patients have to buy them at the local chemist.

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Life Thursday Doors

Thursday Doors in Cromer

Cromer is a pretty town on the north-east coast of Norfolk, famous for its dressed crab, its pier and its glorious beach. There has been a jetty, poking out into the North Sea, for centuries but the present pier was constructed in 1902. It houses the pavilion theatre and a lifeboat station. But I came to walk on the sand at low tide. At the foot of the low cliffs there are dozens of bathing huts, providing me with an opportunity to record their colourful doors.

“In the doghouse” means you are in disgrace

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Life

Thursday Doors – Love in the time of Corona 7

It is very difficult to take a bad photograph in Venice, although I managed a few during this short trip. The light can be wondrous, the atmosphere is magical and wherever you point the camera, there is a picture.

Barbershop
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Life Thursday Doors Venice

Thursday Doors – Love in the time of Corona 4

The streets close to the Piazza San Marco are cluttered with designer shops, high fashion and even higher prices. But their doors are boring. So I wandered, happily getting lost down alleyways, in pursuit of the perfect portal.

Again, the steel barrier against flood water. Four door panels, but only the centre two will open. Which knocker to rap?

Hotel doors can be interesting, too. Here is a hotel with its own canal and a German hotel shining and glistering in the weak spring sunshine.

Ambling down the side streets, stopping to photograph doors, suddenly you come across a massive church which seems to have been levered into position, dominating a small square.

Or a famous building, such as the Fenice, the Venice Theatre.

Ateneo Veneto, a cultural institute, formerly the Scuolo San Fantin.

But how about some really fancy doors?

And the photographer is artfully concealed behind the brasswork, legs revealed.
Doorway to an alley, inviting the casual observer to get lost, but delightfully lost.

And what about the bell pushes?

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Life Thursday Doors Venice

Thursday Doors – Love in the time of Corona 3

To get around in Venice, you need to know a bit of Italian to interpret the map. But it is complicated. For example, a piazza is a large, central open square, but the Piazzale Roma is a bus terminus. And there are two piazettas, either side of the Basilica San Marco. However, districts have squares, called a campo, which are urban and not close to canals. Not to be confused with a campiello and a campazzo. I thought I was walking to a swimming pool when I saw the sign “Piscina“, but it is actually a pond which has been filled in to make solid ground.

The Piazza San Marco is the heart of the city. The Doge’s palace, the Basilica San Marco, the campanile (bell tower), the national library and the Correr Museum form the boundaries of the piazza.

Tourists in short supply outside the Basilica San Marco
Doorway into the Basilica. The building is of Byzantine design, wonderful mosaics.
Boring doors, phenomenal portico entrance
The winged lion is the symbol of St Mark the Evangelist and Venice. The Doge (Duke) of Venice kneels in front of the bibliophile lion. The signs by the door explain why the palace museum has been closed.
The Palazzo Dandolo was converted into a 5 star hotel, the Danieli. This is the tradesmen’s entrance round the side.
This is a trompe l’oeil wooden door set in the wall of the prison. No tours allowed because of the Coronavirus.
Sneaky shot inside the portico of the prison
Green closed doors on the Piazetta dei Leoncini, shadows of the Basilica

Around the Piazza there are some fancy restaurants, with chairs splayed out into the square, but there were very few patrons. Not surprised, the cost of a coffee approaches $20 (strings attached – pardon the pun) when the orchestra plays for you.

The ugly steel plate on the bottom of this boring door is meant to keep out flood water during acqua alta
“Please don’t sit on the steps or take photos from the bridge”

Around the corner, there is a shop/museum showing the office machines made by Olivetti. The Museo Correr used to be the offices of Napoleon, who took over the city state at the end of the 18th Century.

You can now take a virtual tour around the museums of Venice free of charge.

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Life Thursday Doors Venice

Thursday Doors – Love in the time of Corona 2

“Other cities have admirers; Venice alone has lovers.”

There are 46 side canals joining the Grand Canal. Centuries ago, these side canals were rivulets between the mudbanks on which the city was built.

More Grand Canal door photographs. I didn’t have a telephoto lens, so you can enjoy the facade of the buildings as well as the doors.

We rode a virtually empty vaporetto water bus down the Grand Canal to St Mark’s Square. Vaporetti were driven by steam engines, now replaced by diesels, but the name stuck. Before vaporetti, people moved around the city in gondolas. In modern times, tourists enjoy the expensive charms of the gondoliers, but you can get a traghetto (ferry) in a gondola across the Grand Canal at seven locations for two euros.

Not all the buildings are beautiful. Some are elegantly sliding into decay. Others are being renovated, under cover – sometimes this is an image of the facade, a trompe l’oeil.

Not this building unfortunately

More Grand Canal-side doors:

I took more than 200 photographs of Venetian doors, so I need to pack as many as I can into each post or you will be viewing Venice for the next three months!

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Budapest Life Thursday Doors

Thursday Doors Budapest 12

Most of these doors are from the castle area, up on the hill in Buda, overlooking the Danube.

This is my last posting of the doors of Budapest, I hope you have enjoyed the pictures, but urge you to see the doors for yourself, in person, on the street.

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Budapest Life Thursday Doors

Thursday Doors Budapest 11

Posh restaurant on the Buda side of the Danube
In the Zona
Palace gates in Buda
Music Academy
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Budapest Life Thursday Doors

Thursday Doors Budapest 10

Now this is what I’m talking about…
Ubiquitous CC.
Cheeseburger, with free buns
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Budapest Life Thursday Doors

Thursday Doors Budapest 9

Anyone getting tired of these mittel European doors? This is the first grand department store in Budapest. Now it is a coffee house.

Looking up
Where’s the door knob?
Wedding shop