23rd September: 6th operation day; 17-19th patients

I had my best sleep so far and awoke to my 0615 alarm, sleeping through dogs and cockrels etc... Anne-Marie had a bad night because she is used to 4 hours of physical activity daily as she coaches old folk through exercises, or has long walks at the weekend. She got the only exercise today as she left at 1430 to pay the tailor. The rain started an hour later, so she may have just avoided getting wet.

Theatre sister Agnes was admitted to Dreamland with her malaria, having scrubbed for the last two cases yesterday. Matron Gile spent today in theatre with us, doing the "running", and recovery. Evelyn and Sally scrubbed for the three ops. Bjorn assists Tony for each op having helped me with induction, intubation and cannulation. Usually he does he World Health Organisatoon Surgical Safety Checklist, Sign-in, before he scrubs, then the Sign-out at the end as he watches over the extubation and transfer to recovery. And at key moments he is also praying, when he sees me struggling with tiny veins or difficult airways. He and Anne-Marie are key members of this team. The wards run smoothly with Ann's organisation, which includes porridge-making for the naso-gastric-fed patients at 0630, the premedication and fasting times in co-ordination with me, and the pre and post-op photo taking which are essential for the Smile Train funding. We have heard that the first six patients' details have been accepted by Smile Train so that funding will come to Dreamland to help pay the October salary cheques.

We plan to do the longest case first, and have a tea/coffee break. Then the second patient and take lunch. Today, Gladys, the cook, has malaria, but she still came in to work! Lunch was served a little late, so I visited the wards to time the fasting and premeds for tomorrow. Lunch was in full swing in the theatre vestibule when I returned. Just as tasty and filling as usual!

The rain started close to 1530 so at 1645 the Landrover left with 14 adults and a 1-year old cadging a lift. There was no electricity at the guesthouse, and it was fairly overcast so I showered and changed, and came out to the verandah to read and then to write my blog. It will be dusk at 1830 when supper is served, and dark when we come out. Ann is sorting photos on her computer by candlelight, taking three or four different photo SD cards from their camera to transfer the images for Tony to compile the discharge papers, for Becky to submit to Smile Train. Two more discharged yesterday and a further two today, so our first ten have gone home, and we have done 19 ops so far. The turnover is faster than the Gambia because they are healing better in this better-run hospital and climate -despite the malaria! The fields are so fertile; on Saturdays walk, the maize was still on the stems, and the new bean plants were flourishing betwee the maize plants in the rich brown and well-watered fields. I am surprised that the two hailstorms haven't done more damage though!

We are doing at least one palate each day this week and moving into the younger more-malnourished babies for their lip repairs. So the last one today was 4.9kg. So we hope the feeding programme is making a difference for the smaller ones, who are only just over two months old.

Sue's text came through last night with two others. A couple who are planning to move from Eaton Bray to Swanage took the opportunity to give Sue a meal out after work. Today Sue is Granny in St Albans, enjoying Josie's company, and a 12-hour plus day from leaving at 0700 and getting home at 2100hrs. The things we do for love! This mini-iPad has a wonderful store of family pictures going back thirty or more years, so it helps me think of those at hone.