Monday.
It is going to be a busy day today; Mondays always are! Work starts as usual at 8 am, but it will do a lot of good to start earlier so one can do an appreciable amount of work. On the doctors' duty schedule, I am supposed to cover the outpatient clinic with one other doctor, while the other does other duties. This week, I am also on call, so I have to familiarise myself with all serious cases in the hospital.
After spending sometime sorting out any problems that might be in the wards and labour room, I went to meet the patients in the outpatient clinic. Two doctors consulting are expected to see between thirty to thirty five patients each. On arriving the OPD, the patients are registered, their vital signs (BP, temperature) taken and they are put on the queue. When the doctor sees them, he might either admit, send to the laboratory or to get drugs from the pharmacy straight away with instructions.
Infections and infestations are the majority consultations though there are also many non-infectious diseases. Malaria, HIV, Pelvic inflammatory disease and chest infections predominate. By now, I am used to the many patients coming to hospital only in advance stages of their diseases. It is always a very busy day as one consults, does HIV counselling (assisted by a counsellor), sorts out drugs available in hospital, takes calls from the wards and attend to all emergencies.
Consultations ended at about 3 pm, then I went  to the ward for a ward round; the nurses hate afternoon rounds because it is additional work on their already busy schedule! Besides working day ends at 3 pm but how can a doctor here afford to close at this when there's so much work at hand?
The round took another two hours, and I tried to make sure everywhere (especially the maternity) was quiet. I always involve the compound nurse in the clinical decisions as much as possible; else he/she will call immediately something is not clear. These done, I  went home, had a quick meal then I arranged a meeting with Ken about project Hope (he really is an asset in this work). As usual we discussed various things we have learnt from our numerous internet studies, and drew strategies of issues to implement. Of much important is putting out positions across to the hospital administration so they give us support.
I went to the wards at 8:45 pm to do my evening round. At this time the night duty nurses will be taking over so it is an opportunity to address important issues at once with the afternoon nurses. Also patients like coming outside working hours so they can avoid paying admission deposit. So this round is usually a busy one. I finally went home by about 10:45pm.
Was however called up at 1:30 am for an emergency caesarean section; patient having been referred from a neighbouring health facility. Surgery went on well, mother and baby are fine and I can get some sleep.

Tuesday
This is teaching day. The doctors organise teaching to the nurses taking turns fortnightly and today was my turn.  So I got very early to re-arrange the materials I had prepared the previous week. Then I  went to the maternity to review the woman of last night. Everything was fine and I was ready for lectures at 7 am. I analysed the 'nursing management of Congestive cardiac failure' and there was an active participation.

   I was not scheduled to be in the outpatient clinic today so I went to the wards, did a round and also supervised the ward of the doctor consulting. There were many discharges; the people don't feel happy staying in hospital so their hospital bills don't get high.
Then I had three patients for HIV counselling; this occupies the time of the doctor and we have insufficient counselling staff.
At 1 pm my colleague in the OPD called me; he had admitted a young girl with incomplete abortion who needed immediate uterine evacuation. The anaesthetists had been informed, patient was in theatre and I did the procedure. Such cases are very rampant here as abortion is illegal and the church is against it, so women do all sorts to get rid of unwanted pregnancies.
I went to the maternity and reviewed the women in labour. Of particular note were the women who did not attend antenatal clinic; many for no apparent reason. I reviewed all with the midwives and things were OK.
I then went to the Catholic orphanage which is a short walk away. I usually do rounds there twice a week, making sure the children are doing fine and looking out for anything that could pose a threat to their health.
At about 7pm I was called up to review some new patients. A man brought in from a traditional healers home in coma: this is common scenario here. Then there's a child of 2 years with severe malaria and anaemic heart failure. I ordered for an urgent group and cross-match and the relatives had to look for a suitable donor as the hospital does not have blood bank facilities.
Then I went to the surgical ward to review the patients booked for surgery the next day. Operation days are Wednesdays and Fridays and a staff doctor assists the surgeon in theatre; I am scheduled to be there tomorrow. The operation list having been drawn earlier on, I just made sure all is OK (though the surgeon must have done this).
It was a calm night as I was not called up.

Wednesday
I got up earlier than schedule because operations starts at 7:30 am, also the matron called me to tell me about a patient she would like seen. One has to take it easy with these sisters else you end up arguing all the time to the detriment of patient care. I got to hospital, reviewed some patients then was in theatre at 7:20 am. We had five cases today and all went fine. I called the ward in between operations to make sure all was alright and once I had to go there personally to sort matters out.
Operations were over by 4 pm and I reviewed new patients with the compound nurse. Nothing strange and the women in the maternity had either delivered or their labour was progressing normally.
I went home for a rest.
Back to the hospital at 8:45 pm for evening rounds. The patients' relatives seemed much arrogant today; but again you expect that from this region. Everything is settled and I went home.
Called up at about 3:30 am for a referral; a woman whose labour is not progressing adequately. I reviewed and ordered the appropriate protocol.

Thursday
This also is a busy day; well, they all are. It is my permanent consultation day and I expect to see about 35 patients with some assistance though. It is also the ante-natal booking clinic day; being the program officer in charge of mother-to-child-transmission prevention of HIV, Ken and I arrange voluntary counselling and testing of the pregnant women. It is a busy schedule we (Ken and I) have to personally do post-test counselling for those positive. I also book all patients on anti-TB drugs to be seen on this day; being the doctor in Charge of the national TB program in the hospital, this makes it easier to update the records and do an evaluation.
Consultation today went smoothly with Dr. Gladys doing a lot of the work. There were many TB patients whom I had to evaluate personally according to laid down protocols.
We had four women positive for HIV from the antenatal booking and went through the rigorous task of telling rural women who are healthy looking that they have the virus, how to deal with it, the possibilities for preventing transmission to the child, follow-up and so on. Many people out of medicine do not really appreciate how exhausting this is.
I finished at 3 pm and did an afternoon ward round to solve any problems; none today and I went home. Usually I dedicate Thursday afternoons for relaxation either at home or with the guys to distract myself from thinking about the counselling sessions. It is just not possible to block your emotions when dealing with an issue like HIV especially in people whom you know all odds are against them; poverty, high illiteracy rate, poor hygeine, poor nutrition etc.  I decided to watch a movie, got some sleep and back in the hospital at 8:45 pm for an evening round. Got two admissions in the afternoon, reviewed them with the compound nurses and I am through for the day.

Friday.
Today is also an operation day; the surgeon will be assisted by the other staff doctor, while I run the OPD and take care of the wards. This particular Friday is a Markey day here, so I expect the OPD to be less busy; the locals use this day to sell and buy, and especially to socialise in bars and other locations. However, the on call person has to be alert because there are usually alcohol related fights and accidents on market days. Drink driving is a very big problem in Cameroon as a whole and the law is rarely employed. It is also my study day.
I started off in the OPD, and then by 12 noon, I went to the ward for a quick round. It was  relatively calm.
I then had meeting with the reverend sisters who carry follow up visits to women recruited to the mother-to-child-transmission prevention program and their babies. We try to give them a lot of physical, psychological, sociological, financial and spiritual support; the sisters involved do a marvellous job! Volunteering is not popular with Cameroonians and they demand to get paid for every service rendered. Of particular importance in these meetings is planning ahead to accommodate the ever increasing number women and children being diagnosed.
Called up later that evening for an emergency caesarean section and then to review a man bleeding profusely, having been involved in a fight.

Saturday
Saturday is a full working day. However, one doctor takes the whole weekend off; the doctor on call takes care of all the outpatients while the other doctor takes care of the inpatients until 2pm, then goes off till Monday. It is usually less busy except there are emergencies.
I did the consultation and found time to sort out all the medications in the pharmacy together with Ken. Such informal discussions on knowing the medications available is very essential because prescribing what is not available is just saying the patient should travel 60 kilometres to get it, because the nearest pharmacy is in Bamenda.
I closed earlier today, went to the orphanage to make sure nothing was wrong and also to be with the kids.
That evening I founnd time to do some of my hobbies and as usual did my usual evening round.

Sunday
I only go to the hospital on Sundays if a serious case arrives or if there are serious cases in the wards to review. I called this particular morning and everything was alright.
By mid day, I went to the maternity to review the women and the babies; all was also fine.
I got called up at 3 pm for a young girl with an incomplete abortion; I did an evacuation and put her on medications, seized the opportunity to review some patients and got home by 5 pm.
It is a quiet night and I am able to get enough sleep and looking forward to the end of my call period come 8am tomorrow.