Some more...

Hello there

I thought it was about time for another post. There's not too much to report actually, so this is more of a "life in Juba goes on" kind of affair. We're still working hard and the days go by: it's not all glamorous life-saving! :o)

We have our team from St Mary's here who are having a good time, and it's been really nice to see some familiar faces. We'll have a guest posting tomorrow from the team, providing I can get some of their photos to illustrate.

The room was full of keen nurses for an 11:00 start, and most were there before we arrived. Amazing.

One of our recent projects has been some research looking into the mortality figures for the hospital, and in particular their chronological distribution. In other words, not just who is dying but when. We've generated some very interesting results actually, which basically demonstrate quite clearly that the bulk of mortalities occur within the first 24h of admission. This is partially expected given the characteristic late presentation of patients, but it also very nicely justifies our focus on improving the delivery of acute care as an area of priority. There's plenty of scope for such improvements, and it's occupying most of our time at the moment (outside of basic clinical work of course.)

So we're looking at the structure and staffing of the A&E, have set up a steering committee with representatives from the various departments including senior consultants and nursing staff. When we work out a definitive solution (of which triage will certainly be key - see the earlier post on triage) we'll present it all to the MoH and try and get them on board.

Part of delivering good quality acute care is the recognition of the unstable patient. This is basically done by simple vital signs (together with their proper interpretation and subsequent management). Hence we're working on training (or perhaps 'refreshing' is a better term) the nursing staff who need to staff the emergency wards in basic ABCDE, obs taking and recording. They're doing really well actually - they're very receptive, which is a real pleasure. They're incredibly keen, and I was stunned that today they were early for the session. I cannot emphasise enough the significance of this fact in this culture.


The House Officers all rotate around this time, so we'll be getting a new bunch in Surgery soon. I see this as a positive thing as I can focus on getting the basics of acute surgical / trauma management right with them from the outset. (And reuse teaching material hence saving time in preparation!)


That should do for now, I hope you liked it.

James