Bye Bye Bulawayo

So, first and foremost, in the most important of African news huge congratulations to the Cnoc na Gaoithe senior ceili band who are once again Munster Champions! Honestly gutted I wasn’t a part of it but that direct flight from Bulawayo to Shannon hasn’t quite been sorted yet…

In things that have actually happened in Bulawayo this week, I’ve spent most of my time here in different clinics and I think what has struck me most is the difference in how time is treated in the West compared to Africa. I had anticipated this but seeing it in action is another thing entirely! In the West we are enslaved by time. We wake up at a certain time, work at a certain time, have tasks that must be done in an allotted time. There is never enough time and we are always running out of it! Here, time is nobody’s master. What time does the bus go? Well that’s a stupid question, when it’s full! Obviously. Although, in Ireland we are slightly more relaxed about time than the UK (Gareth and I have had many the ‘discussion’ before a party or night out – “But it starts at 7!” “Oh come on, everybody knows that 7 means half 8 at the earliest!” "That doesn't even make any sense!""Neither does sitting there like a pair of planks for 2 hours" You get the picture. Hi G!😁).

It's the same when seeing patients. In the UK and Ireland other than walk-in or emergency clinics people are given an appointment date or time and often get slightly(!) irate when there are delays. Here there is no such thing. People either walk in to all clinics or they are told to come back in 6 weeks or so but never given a time. Patients turn up, are checked in by reception and then sit in the order that they were checked in and just wait their turn. There is no allotted time per patient, it takes as long as it takes. Nobody calls patients in, when one leaves they leave the door open behind them and the next one walks in. If one consultation takes 20 minutes longer than everyone else’s no one complains, they just wait their turn. There are also no hospital notes. Every person has a brown covered copy book that they buy themselves, keep and bring with them when they are seeing a doctor, nurse etc. and it is filled out by whoever is seeing them each time. This means that no prep time before each patient is needed to look up letters or results as you have no clue who is next and what they are there for! There are definitely some good points about it – consultations can take as long as they need to without the pressure of knowing that there will be complaints made to reception or managers, that just isn’t the culture here. Patients are seen and sorted there and then as much as is possible and no matter how long it takes. The nurses running these clinics all consult, diagnose and prescribe so more often than not onward referral isn’t necessary but is also done by the nurses if warranted. Also, it eliminates our problems with notes going missing or computer systems not working meaning you have access to nothing and a patient expecting you to know everything about them. Not ideal.

Me & student nurse Max who wanted to hold hands for the photo, as you do.

Northern Suburbs Clinic where I spent today

I did find it odd though that most nurses working in these doctor-less clinics prescribe and have total responsibility for their patients but as soon as they are in a hospital setting they rescind that power. Nurses in hospitals rarely prescribe even if they were doing it for years in the community which is very frustrating for the ones who move jobs and must then wait for doctors to do something they are completely capable of doing themselves.

One of the most interesting clinics I’ve spent time in this week is called the VIAC clinic. It stands for Visual Inspection with Acetic Acid and Cervicography. It’s the cervical cancer screening clinic. Anyone who doesn’t want to read about female anatomy for the next few minutes look away now (Emlyn, if you’re reading this, STOP NOW!!) They can’t afford Pap smears in Zimbabwe so here they dehydrate the area using acetic acid which makes any abnormal cells clump together and more obvious, then take a photo of a woman’s cervix using a dead fancy camera and treat or not based on visual assessment.

The  nurses running the VIAC clinic

The treatment is also different. If abnormal cells are found they either use a heat treatment using a thin wire heated with electricity or they freeze the area using nitric oxide. I got to see the latter and seeing a solidly frozen cervix before lunch was the weirdest thing I’ve seen at work in a while! Although, I guess working in ENT if I was seeing cervixes on a regular basis I would be doing something very wrong. The criteria are also different. Because of the problem with HIV and other sexually transmitted infections cervical screening starts not at 25, like in the UK and Ireland, but when women (often girls as young as 13 or 14) become sexually active. If they are HIV- they are reviewed every 3 years, if they are HIV+, every year. The differences in how care has to be delivered here because of the prevalence of HIV is astounding. It is slowly getting better but is still a huge problem. Nurses here have to be experts on so many things – tropical diseases, sexually transmitted diseases, adults, children, prescribing along with all the normal day to day stuff! Although many clinics have counsellors on site who specialise in HIV and AIDS which is a huge help when someone is diagnosed and needs to begin treatment.

Brenda (from the VIAC clinic) brought me on a tour of the Khami Ruins after work

I’ve been staying with a family here in Bulawayo who, as usual, have been so welcoming and helpful. I leave tomorrow for Harare, the capital where I will again be hosted by a family. Harare is my last stop in Zimbabwe, aside from a day trip or 2, so I’m excited to finish this stage of the journey in the capital and see what city life is like here as, though Bulawayo is pretty big, it’s also very chilled here. Speaking of chilled, it’s feckin freezing here compared to Hwange - jeans and jumpers weather! I definitely know one or two people back in Nottingham who are melting so I am trying to be grateful and enjoy it!

Off to Harare tomorrow – 6 hours on the bus counts as sight-seeing, right?

Slán go foill

Kate 😊