Casualty Ward

Casualty Ward is the equivalent of the ER in the states. It is a dark lobby with where motorbikes and cars constantly arrive carrying bodies. There are ambulances here- usually an old small toyota truck with a siren on top. The medics sit on the sides of the truck- but they do any interventions till the patient gets to the hospital. Even then the doctors yell at us white girls constantly "leave him", "let her rest".... then maybe we can treat the bleeding, painful, complete femur fracture in like an hour. That didn't happen once- it has now happened 4 times. It's Africa- things are done "slowly slowly" or else people feel uncomfortable. I've also seen matatus crammed full of people and one half dead. Sometimes there is nothing but public transport.
Anyway- the casualty ward is F*****!.
Day one begins like this... I walk into a room with 3 men all on old rickety metal gurnies crying out. One has obviously fractured both femurs and they have been dressed but there is still about 1 liter of blood on the floor and that is a conservative explanation. This blood remains there for the next 3 hours till someone mops it away- no disinfectant. The man is obviously loosing too much blood. I mean obvious. It is not until we suggest that the man get some blood that they take some blood to then crossmatch for a unit for him. For example: in the states. The second a trauma comes in vitals are taken, a monitor is hooked up, lines are placed for ressusitation, blood is taken for crossmatching, .......... and also- pain is managed. Here we give a strong NSAID (the equivalent of 4 ibuprofens) as an IM injection in the ass after your fracture has been reset. I have seen so many open fractures from Boda Boda accidents in the past few days it's crazy. There is no morphine in the ED. The Ugandans just grin and bear it like soldiers. I am positive I would be swinging if someone did the things they do without explanation. The orthopedist walks in tosses a piece of cardboard (a splint) on the patient, lifts the leg, sets it- done. He does this with the same facial expression of someone tying their shoe. I got to do some stitches on a man beat by the police. Stitching the scalp takes a lot of muscle. That's the other one I see a lot- people beat by the police.
BUT here's the best one.
I could smell him the minute I walked on the ward. When he opened his jacket I saw a growth like a hollowed out mushroom cloud on his chest. The center was necrotic and inside - what is that crawling all around? magots.
I have also seen a penis that is unrecognizable due to genital warts.
A nose that is necrotic to the bone.
Text book things in my face, so much blood on the floor, and doctors that say "this man is giving me a headache with all this carrying on" and "leave him". (not that they aren't compassionate.. it's just very different).