Daily Routine

We’ve started to settle into a routine, which is nice. But it’s also busy. Once you know how a day usually runs, it’s easier to pack more and more into it.

6-6:30 AM: The night guard asks to be let out of the gate.

The door is secured from the inside, so nobody can leave without being escorted and having the door closed from behind. Actually, when I leave the house and Rachel is cooking, I lock her in.

We eat breakfast, commonly pancakes or eggs (we eat SO many eggs), read worship and emails. We rarely shower in the morning. Not having a water heater makes it too cold to shower.

7:50 AM: The day guard asks to be let in. Rachel and I walk to the hospital.

It only takes about 5 minutes and I really enjoy the walk. The air is cool, there are swarms of children in uniforms, people commuting to work on motorcycles, and there’s a small girl who screams across a field “HEELLOO!” Greetings are important, so everyone should be greeted as soon as possible. On the way to the hospital we always greet the canteen owner, Linda, the various hygienists who are cleaning the hospital, as well as patients and their families who are sitting in the common areas.

8:00 AM: Meet with the CHOs (Community Health Officers).

The CHO’s are similar to the concept of NPs or PAs in the States. They have medical training designed to be used in underserved or rural areas, or to augment and assist the work of physicians. At AHS, they serve in every department: outpatient, mobile clinics, and they round on patients admitted to the ward both days and nights.

During our meeting we discuss all the new patients overnight, all the calls on the patients overnight, and any interesting cases. They teach me about things that are rare in the States: Quinine, Schistosomiasis, witch guns, the burial practices of the paramount chiefs. Apparently not many people are invited to these funerals. But rumor has it that the recently deceased has his head removed and replaced with the preserved head from the prior chief, who probably died decades ago. Then the recently deceased’s head is preserved for their successor. I teach much more boring stuff: diabetes, hypertension, fluid management.

8:30 AM: Morning worship

All the staff come together for worship. We sing a hymn together. Often times the organist is late, so they just jump in and try to figure out what song and what key we are singing in. Then there’s a small thought presented by the staff (everyone rotates through). Three days a week it’s a worship thought, two days a week it’s a health talk or policy talk. Afterwards is announcements, which last anywhere from 2 to 40 minutes.

9:00 AM: I try to do as much work before anything actually starts.

Every day after worship there are ~5 impromptu sidewalk meetings. I look around, see if I have questions for anyone, then I escape to my office or the wards. This is the time that the staff go for breakfast. So I’ve got about 30 minutes before anything happens and I can see any urgent cases, organize my office, do administrative work, etc.

~9:45 AM to whenever afternoon: Work, work, work.

Often times, it doesn’t feel like I’m a doctor. I feel like more of a firefighter. There are constant interruptions and little ‘fires’ to put out. I’m learning this is cultural. I can be in an exam room with a patient and a nurse will come in to show me a normal lab result from the ward. Accounts will come ask questions about bills. Nurses who are changing shift will interrupt my office consultation with a patient to say good afternoon. Patients I’ve already seen will come back to ask a few more questions. Sometimes the patient who I’m seeing will provide feedback, translation, or medical advice on whoever has interrupted their visit!

Sometime during the day, we sneak up to the canteen to eat lunch. Linda cooks very well and it is delicious. It’s usually less than $2 for both Rachel and I to get food and a drink. Although with the prevalence of typhoid, we are starting to eat there slowly. We will increase in the future. Since Rachel works part time, she heads home around 2:30. She’ll go to the market, cook food, clean the house, organize the laundry, all the things that allow me to live.

As things slow down in the evening, I wander through the hospital. I look at all the patients, without opening their charts: Do I know their story? Do they look sick? I chat with all the nurses: Is there any trouble here? I’m paid to worry, so I’m always looking for trouble. I find that if I don’t do this, I get stopped 4-5 times when I’m actually trying to go home.

About 5:00-9:00 PM

I walk home to the house and greet the outgoing day guard. Rachel and I eat supper and are usually interrupted by the night guard. After we’re tired of being sweaty, we shower and retreat to the bedroom which hosts the only air conditioner in the house. We do most of our communications at this time: email, whatsapp, facetime, so that our recipients are awake.

9:00 PM to 6:30 AM

Our night guard patrols around the house. It’s not uncommon to wake up with the crunch of gravel just outside the window and a flashlight shining through the frosted glass. It was unsettling at first, but has become more and more reassuring over time.

In the US it always seemed like the limiting reagent was time and schedule. Spontaneity was crushed by planning. Since being here, it seems that my limiting reagent is energy. Since time is fluid, I can prioritize anything I want. But it means that when I’m worn out for the day, somebody might ask for more. Both have their advantages, but so far, I’m really enjoying not having a strict schedule.