![\"Pikin](\"http:\/\/www.bmj.com\/columns\/icons\/pikin_hospital.jpg\")
I am happy and exhausted at the end of the first week of the new Triage system and Emergency Room at the Children\u2019s Hospital.\u00a0 Around 80 children present to the hospital each day and Triage nurses now briefly assess them and rush those with Emergency signs to the new 3-bedded ER.\u00a0 There they are assessed and given emergency treatment by a team of specially-trained nurses and the Medical Officer on call.<\/p>\n
After 4 days of training last week, the nurses are showing great enthusiasm.\u00a0 I have seen several cases where their prompt intervention bought the child crucial time, allowing a happy outcome instead of a tragic one.\u00a0 This is particularly the case with the hypoglycaemia associated with malaria and malnutrition.\u00a0 It is hard to describe the buzz you get when a grey, clammy, barely-breathing child wakes up after their dextrose infusion and starts screaming.\u00a0 The nurses had most of the skills and knowledge before, but the ER seems to allow everyone to focus their attention on the sickest children for the crucial first half hour or so after they arrive.<\/p>\n
That\u2019s not to say it\u2019s all been plain sailing.\u00a0 It quickly emerged that, despite recent payments to the hospital electricians to renovate the room, none of the plugs in the ER work.\u00a0 Our brand new oxygen concentrator tubing now stretches across from another bay and is trampled on every few minutes.\u00a0 The concentrator also has a two-pin plug; the nurses do a hair-raising trick with a pair of scissors to jam it into the three-pin sockets.<\/p>\n
There is no precise system for sharps collection or disposal.\u00a0 Although this part of Africa has a relatively low HIV prevalence, this is clearly still breath-takingly dangerous for all involved.\u00a0 As far as I have been able to ascertain, the standard method of waste disposal in Freetown is to chuck it over the nearest wall, which doesn\u2019t give me great confidence about where our lovely mixed clinical waste is going.<\/p>\n
But it\u2019s one day at a time\u2026 this weekend I\u2019m buying some plastic buckets so that water for hand-washing can be fetched when the taps go off.\u00a0 Maybe I\u2019ll buy an extension cable and a plug adapter too.\u00a0 At some point in the next few months, I\u2019ll spend a day following the cleaners and pondering how to make a sharps bin that has no resale value (else it will undoubtedly be emptied and recycled somewhere along the chain).<\/p>\n
Staffing the new ER was in its first week was complicated somewhat by it coinciding with the Sierra Leone Medical and Dental Association annual conference, in which several of our Medical Officers played a role.<\/p>\n
Amazingly for a country of 6 million people, there is only one fully-trained Paediatrician in Government Service in Sierra Leone, Dr David Baion, who is the Acting Medical Director of the Children\u2019s Hospital.\u00a0 The Ministry also allocates 10 other doctors, including 5 newly-graduated doctors on three month placements.\u00a0 The five Medical Officers, two of whom work part-time elsewhere, are the more experienced and mostly\u00a0 hope to stay in Paediatrics, although there is as yet no formal Postgraduate Training available to doctors in Sierra Leone.\u00a0 The Medical Officers graduated between 1 and 5 years ago and some have special roles in treating TB and HIV.<\/p>\n
One of the Medical Officers, Dr Freddie Coker, is on permanent night shifts.\u00a0 If you can imagine it, this means that Freddie works every night of the year, except when he can get a colleague to cover for him.\u00a0 What would the European Union have to say about that?\u00a0 With Freddie on nights, that leaves two full-time and two part-time doctors to cover the ER, Wards and Outpatients by day, with the help of the House Officers.\u00a0 When I collapse in a heap after a morning in the ER, I do wonder how they do it.<\/p>\n