Thursday, 30 June 2011

Last Day at Mosvold

Well, tomorrow we are off to Durban and then we begin our lovely twenty six day holiday. We are very much looking forward to Cape Town, Namibia and Kruger.

However, we feel great sadness leaving Ingwavuma which has been our home for nearly a year. The beauty of this place never ceases to amaze me. The Lebombo mountains, the magical sunsets (and sunrises if I am up in time), Fancy Stitch, the children playing, the cows and dogs surviving in the road and the hustle and bustle of life here. I will miss greeting everyone with ‘Sawabona’ or ‘Yebo’ and I will miss the laughter.

The past four weeks have been my busiest as a doctor. I have been on-call ten times in four weeks. There have been many sleepless nights but my highlight came on one of my on-calls. I was working a few weekends ago when a child was handed to me in my arms from one of the ambulance men. I was alone in the resuscitation room. I looked down to see a blue baby gasping. His mum was crying in the background. Both she and I knew he was going to die very soon.

I immediately took his clothes off to find non-stop diarrhoea. His Mum admitted to giving an enema a few hours earlier. I told the ambulance crew to stay with me and began to resuscitate him with oxygen and fluids. My heart always beats a bit quicker with the prospect of securing intravenous access on these four month frought babies. The child was shocked so his veins in his arms and feet would be hard to find. Often, it takes me seven or eight attempts before I get the cannula into the vein. IV fluids is the only thing that may save the baby. I did not have the time for several attempts. Amazingly (and very luckily), I was successful on my first attempt. I took some blood to send it for basic tests. We secured the drip with cardboard, bandage and tape. I asked one of the ambulance women to stand on a chair and squeeze the fluids into the vein. We drew up the necessary antibiotics and gave them to the child. He had survived the first ten minutes in hospital, there was hope.

The bloods came back thirty minutes later and they were dreadful. He had severe metabolic acidosis and his potassium was dangerously low. I gave him IV potassium. He survived for first hour and I sent him to the ward. The next morning, I went to see if he had survived the night. He had. Eight days after coming in – Wonderboy (his Mum named him appropriately) went home. I took a photo of him and me. He looked so well – unrecognisable to how he arrived. The Mum told me she would never give an enema again – I hope she does not.

I have so enjoyed my work here – the wards (Paediatrics, Isolation, Male and Female), the variety of our outpatient department and the clinics have been my favourite. Today at lunchtime, the staff on female ward are throwing me a ‘surprise’ farewell party – such a nice touch especially as many of them have so little. We will sing and dance and laugh. They have also invited Henry.

On Tuesday after my on-call, we had Sophie and her daughter over for one last lunch together. Sophie is our cleaner, handwasher of clothes and so much more. She is my Zulu mum here and I love her to bits. Henry and I decided to give her everything that cannot fit into our backpack. So, she received over half of our clothes, most of our shoes, our bedding and kitchen stuff. She and her daughter are thrilled. Yesterday, whilst I was busy on my ward, Sophie popped her head in and pointed to her feet. I looked down to see my very old shoes on her feet and a big smile on her face. She was thrilled. Sophie is an incredible woman. She has had a tough life but has never complained. She has raised four children who are all doing well. I will miss her very much.

Tonight we are having a farewell braai and we are looking forward to having all our friends around. This is what I will miss most about this place – the amazing friends we have made. Nat, Ty, Bee, Bird, Sarah, Bjorn, Kath, Emma, Donne, Toni, Marge, Megs, Ruth, Simon, Smah, Swifty, Bridget, Janet, Andries, Bernard, Pheobe, Daniel, Maryna, Holger, Sam - thank you for your friendship, kindness and generosity. We will miss you!

Friday, 24 June 2011

Leaving the mountain of the leopard

My last day at Ntabayengwe should have been a time of sadness. And it was. I will greatly miss the teachers and the grade 7 students. I know many of those that I taught this year will go next year to the nearest high school. There, the most able will rot. Many of the girls will become pregnant. Many of the boys will drop out. Much talent will never be fulfilled.

However, I have faith that at least one or two will overcome the obstacles. They will pass their matriculation (equivalent of A-level) and will get better paid jobs in the local community – as a nurse, teacher or policeman.

This helped me to overcome any feelings of despair.

Further cheer was provided by my parting gift to the school. As you know I have been in correspondence with a regional newspaper about the school’s water shortage. Thanks to pressure exerted by the Zululand Fever, a team arrived earlier in the week to investigate the problem. They identified the cause as being a broken pipe running under the playing field. Yesterday, they returned to fix the problem.

Today, I arrived to find children drinking from the tap and filling buckets for the classroom. So the school now has functioning electricity and tap water. And it only took one year!

Thursday, 23 June 2011

School chicken

With my last day at Ntabayengwe tomorrow, our South African adventure feels near its conclusion.

The school has provided me with much more than a year’s worth of interest and reward. And it has provided me with so many amusing moments. Yesterday I had another to add to the list.

Walking across the school I noticed a chicken being kicked by some of the children. It was surrounded and squawking. It looked greatly in need of help. I immediately ran to intervene on behalf of the bird.

One of the older boys saw me coming and, like the best turncoat, suddenly started protecting the chicken and fighting off his peers. When this failed, he dived on the chicken, putting his body in the way of the feet. As I reached the action, the boy scrambled to his feet with chicken tucked under his arm – like a rugby ball.

I demanded to know why the chicken had been attacked.

The answer was simple. It had been trying to eat the vegetables planted in the school plot. Thus a kick was the least it deserved.

Still feeling sorry for the chicken, I mandated its release. I began to explain that this would require the boy walking the bird out of the school gate to put it on the other side of the big perimeter fencing. However I didn’t finish my sentence. Instead I watched an alternative approach.

With his back to the fence, the boy with the chicken in his arms, suddenly launched it as high as he could skywards. Up, up, up, went the chicken. Higher and higher and higher. Until it was at least 35 feet in the air. And then the descent began.

The stunned chicken was clearly as surprised at me. For the first half of its downward journey it seemed paralysed by shock. But as the ground approached rapidly, it opened its wings and brought itself gently to earth on the other side of the fence.

The boys left the scene – disappointed not to have taught the chicken a more memorable lesson.

Sunday, 12 June 2011

Press campaign

I have mentioned in previous blogs about the problems we have at Ntabayengwe getting water. I discussed the problem with the incumbent local councillor in the hope that he might be able to sort out the situation. Unfortunately he has just lost his seat.

So now I have written to the local paper 'Zululand Fever' in the hope that they might take some interest. They have run recent stories on similar themes. I will let you know if they respond to my email, copied below.

'I'm writing in response to the article I read in Zululand Fever on June 3 2011 entitled 'School given 'filthy' toilets'. I am a secondary school teacher from the UK and have a volunteer teacher for the year at Ntabayengwe Primary School, teaching grade 7. The article about the school toilets at Umfolozi Primary School reasonated loudly given my experiences. At Ntabayengwe, we have school toilets built by a local NGO. These are often in a disgusting state. Nonetheless, they are not my primary concern. Instead, my great preoccupation is with our water supply. We have been without tap water since before Christmas. As a result we depend on water from jojos. This often runs out. We then rely on a water pump situated about 100 metres outside the school. This usually has water, but has run dry. When out of water here, I bring water down in containers from my jojo at the hospital.

Being without water in the tap and in our jojo results in appalling sanitary conditions for the children. We have no toilet paper in the toilets. And the children eat with their hands for their meal at 10.00. It also means that they must last through the school day without drinking any water. It is well recognised that being hydrated is an important factor in learning. For this reason, most children in the UK bring water bottles with them to lessons.

I would be very grateful if you were able to investigate why it is not possible to fix the tap at our school so that we have our own supply of fresh water. In addition, I am sure that we are not the only school in our area to be regularly without water. For this reason, I think it would be very helpful for you to press the munipality to set up a telephone line for schools to use to report a problem with their water supply.

Having spent a year teaching at Ntabayengwe, I am due to leave at the end of this month. It would be of huge comfort to me to know that I will leave the school with the water supply functioning again.'

Lesser spotted buggeralls and the ubiquitous pod mahogany

We have just returned from a glorious two week holiday with Mary’s parents-in-law. In 14 days we visited Tembe Elephant Park, Kosi Bay, Kruger Park, the battlefields and the Drakensbergs. Having visited and written about most of these locations already, I’m not going to spend any time describing each one. Instead, I have a list of moments from the holiday:

Eating leaf for aphrodisiac – The power of a game ranger to make tourists do stupid things is immense. It is a trusting relationship. They decide where it is safe to get out the vehicle. They decide when an animal – or more precisely an elephant – is posing a threat to the vehicle. And they can even decide what bits of the bush to feed to their guests. In Tembe, we all showed ourselves happy to munch away on leaves supposedly used by local healers as aphrodisiacs. Well, either our guide picked the wrong tree or Zulu bodies behave very differently. For the rest of the evening, I had intense stomach cramps followed by running stomach. Needless to say Aphrodite (or Mary) wasn’t on my mind as I lent over the toilet seat.

Into the jaws of the lion – Some camps in wildlife parks are electrified. Others are not. Those which are often create a superficial sense of safety. Tembe’s camp is electrified. But the biggest elephant in the park knows how to trip the circuit without shocking himself. He did this during our first night and spent an hour of it terrorizing mum and dad’s tent. Those camps without electric fences are obviously open to all. These camps, especially if private, usually have lots of safety precautions about when and where guests are allowed to walk. All of these are fine if you have a sense of direction that allows you to navigate yourself from the bar to your room. But dad fell foul of the ‘toddler’ danger by heading off out of the camp in search of his room. Fortunately, he was saved by his watchful companions.

Can we go home now – Africa isn’t usually associated with cold. And rightly so. We have been hot for about 9 months of the time we have been in SA. However, early mornings and evenings in winter are not warm. They are even colder when doing game drives. We seemed to experience particularly cold nights for our evening game drives in Kruger. The result was that we ended up dressing like Eskimos – only allowing our eyes and nose to be visible. We also seemed to have particularly bad luck for two of the nights spotting animals. Thus we spent many hours driving round the bush, in pitch black, seeing only the Lesser Spotted Buggerall. We consoled ourselves with the comfort that at least we were providing some amusement for the animals.

More trees please – Most people visiting Kruger Park have greatest interested in seeing ‘the big 5’ and friends. As a result, the guides are attuned to finding them. They consider success or failure to be based on their ability to deliver. Unfortunately, some are less good when having to adjust their focus. In other words, they were not prepared for Roger Toulson. Daunted by the need to demonstrate some knowledge of flora and fauna, the less good guides hit upon a strategy – ‘it’s a pod mahogany’. In a devastating blow to the biodiversity of the park, all of the trees suddenly became one species.

Chemistry – What some of our game guides lacked in knowledge, they made up for in their wonderfully ill-judged remarks. One revealed that he had an only sister who was studying law. Poor thing, he commented, ‘Who would want to spend their life stuck with the head in legal books?’

Dangerous walks – We had a couple of stunning days walking in the Drakensbergs Mountains. The views were magnificent and the colours incredible. However, there was one small safety risk. State licensed arson. Winter is the burning season. Understandably, this is done to prevent devastating summer fires. All well and good. Except if your route happens to take you through the middle of a blaze. Our walk on the first day did just that. Arriving by the flames, we were greeted by some very friendly locals walking round with paraffin sprays on their backs. They cheerfully encouraged us to walk through the fire and carry on yomping. Being wimpish, and concerned by the swirling wind, we decided against.

Sunday, 15 May 2011

It's good to walk

On Friday, our car was finally ready for collection from Richards Bay. So, with great excitement, I set about finding transport to get me there (it’s about 220 km from Ingwavuma). None of our friends were heading down. So I ‘opted’ to take a lift with hospital transport.

Hospital transport runs patients from Mosvold to other hospitals in KZN. Transport doesn’t necessarily go every day. But I got ‘lucky’. On Thursday evening I found out that a driver would be going down, departing at 0400. Despite the unpleasantly early wake up time, I immediately signed up. I took little notice of the warnings from other doctors about the quality of the drivers.

Well the journey was memorable. We began uncharacteristically, by leaving on time. But my relief diminished when we headed left, instead of right (direction of the main road), out of the hospital gate onto dirt road. The driver spent the first hour driving round Ingwavuma honking at bushes. I assumed he had instructions to pick up patients. But nobody emerged from the undergrowth. Eventually, having forced our way all the most impassable roads, we then returned to the hospital. There some of the patients who’d got in an hour earlier, got out and left. Seemingly, they had just come for an early morning drive. My amusement at this helped offset the frustration of having wasted an hour of sleep. After ten minutes, we set off again.

And very quickly I remembered the warnings from the doctors.

I’m not sure how many times I have cheated death. I remember a near encounter with a motorist, while cycling on a country road in France. Rounding the bend in the middle of the road, I met on an oncoming voiture. Despite the speed of the approaching vehicle, I somehow managed to manoeuvre into the hedge – accompanied by the beautiful sound of Renault car horn. Mon dieu et sacre bleu! I had survived.

On the hairiness scale – that was high. It was matched by the fear I felt on my journey to Richards Bay. Several factors contributed to my sense impending death. The first was our vehicle. It was a bright yellow mini van dating to somewhere before the South African declaration of independence. It looked ancient, even by African automobile standards. Indeed, I have seen several vans abandoned around the local area that look more roadworthy.

Yet, despite the appearance of the vehicle it could still reach top speed. Just over 140 Km/h. I know this for certain, for I was seated, next to the driver. Except I wasn’t really seated. For there were no seat belts. Instead, I and the rest of the passengers, spent most of the journey airborne. They were completely anaesthetised to the danger – either through habituation or because of the ketamine still in their bloodstream from Mosvold.

Driving 140 km/h in a dilapidated vehicle on excellent and straight roads during the daytime would have been dangerous. But we were driving down mountain roads, often occupied by animals or people, covered in pot holes, in pitch darkness.

Sitting beside the driver, I did attempt to explain to him that we’d all rather arrive alive. However, each time he tried to respond to me, he turned to face me. Keeping his foot flat on the pedal. As his concentration was all that kept us from oblivion, I decided to shut up.

Hoping to be distracted by some escapist literature, I got out my book. But my idea failed spectacularly. Somehow I completely forgot that I had just started reading J. G. Ballad’s ‘Crash’. For those who haven’t read it, it is a dystopian novel centred on characters that seek sexual kicks from partaking in road accidents. The obvious thought crossed my mind. I looked across at the driver trying to decipher any eroticism on his face.

In the darkness I could not tell. Perhaps. Perhaps not. Was there a smile of excitement as we narrowly avoided going over the mountain edge? Was there a hint of a thrill as we drove through a herd of cattle with the horn on full blast? Was there a whimper as we overtook two cars, going downhill on a steep mountain pass? Perhaps. Perhaps not.

At least it gave me a possible explanation for the way he was driving. For the speed we were travelling bore no relation to the urgency of our business. This soon became abundantly clear as, half way into our journey, we ran close to empty in petrol. I pointed to the gauge and suggested we needed to stop. Pulling in, we filled up with petrol. And then our driver paid. Except he couldn’t pay. He had left the petrol card in the hospital. So somebody from Mosvold would have to bring it to us.

Two and a half hours later, somebody from Mosvold arrived. And off we went again. On better roads and in daylight, the journey became less dangerous. Could I sense boredom from the driver? Perhaps. But his boredom was my life. Leaving the minivan in Richards Bay, I vowed to walk back to Ingwavuma if our car was not fixed. Thankfully, it was.

Thursday, 5 May 2011

Kate who?

As the BBC’s Ingwavuma correspondent, I can report (belatedly) that there were no excited street scenes in response to recent world events. On the day itself, I heard mention of the royal wedding on a Zulu radio station on the way to school. In addition, patients and doctors (mainly Mary) at the hospital were able to watch coverage on the televisions in their wards. But there were no other signs of the madness taking place in Britain. (This should be comforting to the royal couple as they fret about the likelihood of finding a honeymoon destination away from the media glare. They could walk completely unnoticed down Ingwavuma high street.)

News of the death of Osama Bin Laden was equally low key. (How he must now wish he had sought out the anonymity offered by Ingwavuma.)

The news of interest to Ingwavuma is all provided by the upcoming local elections. These are a very dirty affair. One of the hospital staff was instructed to attend a ceremony to open a local school. She was expected to provide specialist auditory assistance. On arrival she found that there was no school opening. Instead it was a front for an ANC rally.

We happened to come upon (it was staged outside the hospital gates) a t-shirt rally for the IFP. Their candidate is the current incumbent and was present at the clothing give-away. I was successful in securing a promise from him that he would organise for water to be delivered to Ntabayengwe. I am hoping that the proximity of the elections and his desperation for votes will result in some action.

Our car situation remains unresolved. It is eight weeks since the computer in the car failed. I have been on the telephone to one or other garage almost every day trying to fix it. Below is an outline of events:

1. Car breaks down
2. Car is towed to Jozini (R3000)
3. Car computer is sent to Jo’burg to be fixed
4. Car computer cannot be fixed and is sent back from Jo’burg
5. Second hand computer is ordered from Durban (R2500)
6. Computer is towed to Richards Bay to have computer fitted (R1000)
7. Car is delivered back to us
8. Car is clearly wrong and I drive it back to Jozin
9. Mechanic in Jozini cannot find the cause of the problem
10. Car is driven to Richards Bay Ford specialist
11. Richards Bay Ford specialist say wrong computer has been fitted to the car
12. Second hand computer is taken out of the car and sent back to Durban
13. Durban man tells me that he only has one second hand computer for our model of car but it may not work as it is very dented

(Rand to pounds = 11:1)

We are currently giving Durban man some more time in the hope that he can identify a second hand computer that isn’t dented. If he can’t locate one, then we will either need to gamble on the dented computer (R600 at stake) or buy a new computer (R7000).

We have loved our time in South Africa but we will not miss the politics or dealing with car mechanics.