Apatient who changed my practice

My home for six months, a busy Tanzanian medical ward, was bustling with relatives who had arrived to provide lunch for the patients. At each mealtime every bed space becomes a temporary home to whole families, who are expected to provide food. The ward fills with chatter as families use the mealtime to catch up with the events of the morning.

On this particular lunchtime I was captivated by the scene at the bedside of an elderly woman who had been admitted with a stroke, resulting in swallowing difficulties. She was sitting on her bed, propped up by a young woman sitting behind, whose legs wrapped tightly around her. This arrangement held the patient firmly upright while another woman carefully fed her tiny mouthfuls of porridge.

I had spent some time over the preceding weeks teaching the nursing staff about the basic care of stroke patients, emphasising the importance of safe feeding. Without the benefit of expert advice from speech and language therapists (of which there are none in Tanzania), the nurses and I had focused on improving simple measures such as positioning. The family had understood this problem and devised a solution that worked for them, and that they could sustain upon discharge.

Now back in the UK, I think of them when I see anxious relatives on the ward, unsure of what they can do to help. The natural tendency for a family to be practically and physically involved in the care of a relative is sometimes constrained by the systems in place in our hospitals. In Tanzania, no such constraints exist, and mealtimes offer the opportunity for moments such as the one described. These moments are important for patients, but also for relatives, who may otherwise feel sidelined in a medical environment.

Victoria North, core medical trainee year 2  Bristol Royal Infirmary, Bristol, UK

[email protected]

Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.