Fellows Blog: Day 31

Our 7:30 am wake up time wasn’t the best this morning after having a few days of sleeping in, but we managed to get to our training venue by 8:45 for a long day of practical assessments and interviews. We prepared scenarios for our advanced trainees to practice their skills, with a checklist for specific actions and questions we were looking for. While one of us acted as the patient, the other two of us were leading and grading the scenario.

Kyrillos was our first patient, a young man with minor bleeding from the arm. After ensuring the scene is safe, putting gloves on and asking questions about the situation, the trainee must ask what’s going on with the patient, who responded he had difficulty breathing and chest pain. Upon palpating the chest, the trainee found a hole in his chest (a pneumothorax), and should apply an occlusive dressing. They also had to stop the bleeding with direct pressure, ask the patient’s medical history and ask about their pain. All of a sudden, the patient passed out and stopped responding. The responder should have assessed how responsive the patient was by talking to them (responsive to verbal) and pinching them (responsive to pain). But the patient was unconscious, so the responder needs to check their airway, breathing and circulation. After looking for breathing for 10 seconds and checking a carotid pulse for up to 10 seconds, they discovered the patient had no pulse or no breathing and hopefully realized  this means they need to start CPR. While there was one trainee tried to do compressions on the still very much alive in real life Kyrillos, we managed to tell most people in time to use the pillow to do compressions. After assessing the rate and depth of compressions along with chest recoil, Kyrillos miraculously came back to life (voodoo pillow!)

Haleigh was the second scenario: a person who was sitting on a boda boda when she started feeling weak and requested to get off. She also presented with a terrible headache, “the worst headache of her life.” At this point, we hoped the trainee would recognize possible stroke symptoms and perform a stroke assessment looking at balance, eyes, facial droop, arm drift, slurred speech and timing. We forgot to mention yesterday that we made our own sentence to assess slurred speech. The standard sentence we learned in EMT school is “the sky is blue in Cincinnati”, but we decided that “Ssemtamu swims at Summer Gardens” would be better. For reference, Kyrillos’ Ugandan name is Ssentamu, and our training venue is called Summer Gardens (we were very proud of this). Haleigh is also still called Amber straight to her face, but at this point realizes it’s useless to correct anyone. The two of them are pretty much the same person now and are mentally preparing for the severe separation anxiety when they get back.

Amber was the third patient, a 37 week old pregnant woman with abdominal pain. The patient started having stomach cramps and we wanted the trainee to look for signs of labor before helping give birth using our birthing model. They needed to ask for consent first, direct the mother to a sterile area, position the mother correctly, provide emotional support and deliver the baby. Upon delivery, the baby had its amniotic sac still intact, so they were supposed to puncture it with a clean sharp object. The baby then also had its cord wrapped around its neck (we’re not entirely sure if this would be possible, but we’re not doctors and nobody questioned it sooo…). Further mayhem ensued when the baby wasn’t breathing after birth, but all was well when they stimulated the baby to breathe by rubbing its back or toes. Lastly, they clamped and cut the umbilical cord and delivered the placenta. Hopefully most of them remember to get APGAR scores along the way!

We then had them do a brief interview on their thoughts on the presentation, what suggestions they had to improve, if they thought the curriculum should be presented to boda boda drivers, and how confident they were in their ability to treat medical and obstetric emergencies. Some of them had good ideas, like providing the slides or videos before the presentation so they aren’t seeing the information for the first time and more activities where they can teach others to solidify the material.

We had allotted half an hour for each person starting at 9 am, but that ended up being an underestimate and each one took closer to 45/50 minutes, depending on how long the scenarios lasted. This meant the hour and a half we had in the schedule for lunch became sending someone to get chapati and beans for us and eating it in the brief transition period between participants. It was still as excellent as ever, though.

This lasted from 9 am straight to 6:15 pm, upon which our last participant did not show up, so we decided to just go to dinner. Amber remembered our host Sammy had once recommended a hotel restaurant near our place, and we desperately wanted to try some new food. Unfortunately, our excitement wavered when we got to the restaurant to find out they had no menu, and the three options were chicken, liver, and fish with a side of either chips, rice, or potato wedges. We decided to live on the edge and go for the potato wedges, which turned out to be a rather immaculate decision. Although we waited almost an hour for the food, the first bite of the potato was worth it. It was a crispy, salty, soft crunch that tasted like potatoes in the US (most of the fries we’ve had here have a different flavor and texture). The chicken was also delicious and not fried, which was a win.

During this, we learned that Kyrillos normally eats his potatoes raw, “like an apple or a carrot”. Haleigh is intrigued by this and may try it back in the US. Kyrillos has also developed a habit of eating the vegetables on his plate. Haleigh and Amber yell at him every time, but he still does it, so if anyone else wants to contribute to our efforts for him not to get cholera, we would greatly appreciate it :)

This morning Kyrillos had to say “good morning duck”, which doesn’t have quite the same ring as “good morning chicken!”

Kyrillos skeptically watching Devir apply an occlusive dressing…

… and Kyrillos’ face when Devir almost cut his shirt while applying an occlusive dressing.

Haleigh demonstrating what the A in FAST, or arm drift, would look like in a stroke patient.

Amber gave birth 14 times today! She may have set a new world record….

PS: it was confirmed that even after being an emergency c-section due to a nuchal cord, baby Amber did in fact have perfect APGAR

Haleigh posing on the outskirts of Mukono town!

Amber and Haleigh’s creative contraption to ensure a few pesky flies didn’t end up in the bottle of coke.

The restaurant we went to had a very familiar looking hot sauce, much to Kyrillos and Amber’s delight (Haleigh claims she just doesn’t like hot sauce very much, but in reality she probably can’t handle spicy food…)