The Knock at the Door

by Rachel

I can’t remember if we’ve blogged before about the phenomenon of being “on call” here in a land of erratic electricity and no phone lines but I thought it was worth an interesting glimpse into this facet of our lives.

The classic American doctor is never seen without his or her pager.  In fact, in residency most of us had two pagers, sometimes more.  I have a classic picture of my best friend in surgical residency wearing something like 5 pagers on her scrub pants.  That’s availability.  Always reachable, all the time.  Another friend said that in his residency the RULE was that you needed to return a page within 60 seconds, no matter what you were doing at the time, and the senior residents would sometimes page you with a timer in hand to check up on you.  It was a rather freeing moment to turn in those pagers on the last day of residency.

We weren’t sure what to expect when we arrived in Kenya but were surprised to find that Tenwek issued a pager to every doctor, and there were phone lines connecting the hospital and surrounding homes.  Of course, this was an adventure of another sort.  When I would get a page from one of my interns at 2AM, it was usually a challenge.  Our Kenyan interns, while very good (accented) English speakers, were notoriously “low talkers.”  This is usually in reference to the volume of their voices, although sometimes also the tone.  I would frantically push the phone against my ear as hard as I could, blocking the other ear with my finger, close my eyes, and try to concentrate as hard as I could to figure out what was going on.  And the less I could hear, the louder I talked (and probably they would then hold the phone farther from THEIR ear, making it even harder to hear).  Usually if they were calling in the first place, I needed to go in.  It was always easier to figure out the problem in person.  Carlan actually had the best method I’ve heard of to get people to talk louder on the phone.  The less he could hear, the softer he talked on the phone, getting the person on the other end to hold the phone closer (so THEY could hear) and thus they became louder.

Upon arrival here at Kibuye, we confirmed the assumption that there are no pagers (you need phone lines AND constant electricity) but assumed that most people would just call us on our cell phones when they needed us.  It was a pleasant surprise to discover that the Burundian generalists share the overnight calls (mostly C-sections), and we “specialists” are reserved for emergency situations.  I had had visions of doing C-sections in the hospital every night, so this was a relief.  Then we found out that no one actually ever calls us on our cell phones (too expensive?  no cell minutes?  bad connection/network?  who knows why).  Perhaps this is for the best, as French is even harder to understand on a crackly cell phone than accented English.  If someone at the hospital needs us, usually Jason but I (Rachel) am the next more common, they send “the worker.”  Someone up at the hospital will write down the problem on a sheet of paper called an “Ordinance.”  They hand it to the travailler (worker) who walks down to our houses, 5-7 min away.  The worker knocks on our door, sometimes at 3am, and waits until he gets a response.  Sometimes we can write a response and send it back, but usually the paper says something like, “we need you for an emergency” and we walk back to the hospital with him.

You can see that in this case, an “emergency” will not actually get a doctor to the hospital in less than 20-30min if you factor in the time to write the message, find the worker, send the worker, wait for the doctor (who sometimes needs to change out of their pajamas), and walk back to the hospital.  We have a rather slower pace of life here!

Jason especially has more than his fair share of knocks at the door.  Sometimes the guard/worker actually knocks at the bedroom window (creepy). :)  Monday night I had one of the most dramatic wake ups, inspiring me to write the blog.  (backdrop: the power had gone out at 4pm earlier that day and was out all night long, so it was pitch black with no outside lights, or the possibility of turning on inside lights either)  A woman was transferred to Kibuye with a postpartum hemorrhage, so the doctor on call told the nurse to get me.  The ambulance (Land Cruiser) was fired up to drive the 1/4 km to my house.  But after dark, the gates are padlocked shut.  So at 3:40am I heard a terrific banging and yelling as the hospital worker tried to get our night guard to wake up and unlock the gate.  Then there was a long conversation at the guard shack (right outside my bedroom window) and finally the telltale flashlight bobbing along down the sidewalk to the front door, followed by the pounding on the door to wake me up (if I wasn’t already awake after all that ruckus).  Stephanie (4 houses further down) told me the next day that she had woken up and wondered if there was a robbery or something going on. :)  Unfortunately this time I couldn’t go, as Eric has been in Congo and I can’t leave the kids alone, obviously.  I laid in bed feeling guilty about the poor woman dying because of me and never went back to sleep.  Fortunately, I got my chance later in the AM, as she was still alive and still bleeding, so I did surgery for her retained placenta and she seems better now, although not yet out of the woods.  

Just another night on call here at Kibuye.