Over the past 48 hours, I seem to have spent a fair amount of time on the labour ward. This is usual as the three busiest places over the weekend seem to be OPD (assessing new patients), Paeds Ward (there are some very sick children) and Maternity (the number of deliveries seems to be phenomenal – the doctors here state that there is nothing much else to do but have babies).
My main role when I arrive onto labour ward (which consists of two beds and lots of women outside the room) is to assess the woman in labour. This is mainly done by reading her notes, looking at the CTG (the partogram which records the state of affairs of both foetus and mother) and conducting a PV (per vagina) examination.
However, while I have been carrying out this task, I have often been present at the birth of uncomplicated deliveries. These are very public affairs as the curtains are much too short to give privacy to the mother. This though, is the least of her concerns. From stage 2 of labour (10 cm dilation up to delivery of baby) there are around eight woman in this small room of a labour ward (some midwives and others are friends). The women surround the pregnant lady (who is silent throughout despite no analgesia) and start encouraging her to push. Some of the woman grab the patient’s legs, other fondle the patient’s breasts, one presses down on the uterus, another one smacks the woman on the face and then wipes her sweat.
This all happens with great amounts of whooping, giggling and dancing. Eventually the baby is delivered and I put some gloves on and have a look to make sure the baby does not need suctioning or oxygen.
What an ordeal!
Sunday, 29 August 2010
One Angry Gogo
Still working through my on-call weekend … it is now Sunday and I am very much looking forward to our first fillet steak that Henry is currently cooking me. I have just woken up from my nap and showered and awaiting my last night on-call.
Last night was busy. I worked from 20.30 until 04.00 flat out. There was a c-section at 02.30 am so I needed to wake up my colleague Holger to assist me. Well, I am not yet doing the c-sections by myself so in fact I work as the anaesthetist. This job includes giving the spinal, monitoring the vital signs, writing up the operation notes and drug chart – ladies here do not get any analgesia during labour – and my favourite aspect is listening to the wonderful singing from the pregnant woman and fellow theatre sisters – the harmonising is lovely. During the operation I received a phone call from OPD to say one patient has arrived at the department. So, after the c-section was complete (it went well), I wandered over back to OPD. I quite enjoy walking around the hospital at night as it is so peaceful. There are always one or two people out and about who welcome me with ‘Sawubona’. This makes me happy.
So, I arrive to OPD to find six young men (in their early twenties) drunk and giggly. These are the friends of my patient. The sister is unimpressed describing them as ‘stupid drunk boys’.
I find the patient waiting in the consultation room. He is smiling away with a small laceration to his left armpit. He has been hit several times on his head (alleged assault) by a frozen coca cola bottle. Working in A+E in the UK, you often find yourself in these consultations in the middle of the night. However, in contrast, this young man is very polite (as are his friends who were trying to help out by wearing latex gloves and applying pressure to his small laceration). They are giggly but in no way aggressive.
All is in control. Until… Enter the patient’s Gogo (grandmother). In typical Gogo Zulu fashion, she had a towel around her head and a great array of clothes on. She begins to wail to me about how her grandson is at college and she cannot believe he is drunk. Gogo is unimpressed by my attempts to reassure her about the behaviour of her grandson. She starts smacking him and telling him what an idiot he is. She looks up at me for reinforcement so I too start saying he is an idiot. At this point, the sister (who had said nothing) started screaming at him telling him he was an idiot. The sister and I were not smacking him – we left that up to the gogo. All this provides excellent entertainment for the patient’s friends who fall about laughing.
Eventually, after treating the patient, I lodged him to male ward. I left the hospital and walked home for some much needed rest with a smile on my face.
Last night was busy. I worked from 20.30 until 04.00 flat out. There was a c-section at 02.30 am so I needed to wake up my colleague Holger to assist me. Well, I am not yet doing the c-sections by myself so in fact I work as the anaesthetist. This job includes giving the spinal, monitoring the vital signs, writing up the operation notes and drug chart – ladies here do not get any analgesia during labour – and my favourite aspect is listening to the wonderful singing from the pregnant woman and fellow theatre sisters – the harmonising is lovely. During the operation I received a phone call from OPD to say one patient has arrived at the department. So, after the c-section was complete (it went well), I wandered over back to OPD. I quite enjoy walking around the hospital at night as it is so peaceful. There are always one or two people out and about who welcome me with ‘Sawubona’. This makes me happy.
So, I arrive to OPD to find six young men (in their early twenties) drunk and giggly. These are the friends of my patient. The sister is unimpressed describing them as ‘stupid drunk boys’.
I find the patient waiting in the consultation room. He is smiling away with a small laceration to his left armpit. He has been hit several times on his head (alleged assault) by a frozen coca cola bottle. Working in A+E in the UK, you often find yourself in these consultations in the middle of the night. However, in contrast, this young man is very polite (as are his friends who were trying to help out by wearing latex gloves and applying pressure to his small laceration). They are giggly but in no way aggressive.
All is in control. Until… Enter the patient’s Gogo (grandmother). In typical Gogo Zulu fashion, she had a towel around her head and a great array of clothes on. She begins to wail to me about how her grandson is at college and she cannot believe he is drunk. Gogo is unimpressed by my attempts to reassure her about the behaviour of her grandson. She starts smacking him and telling him what an idiot he is. She looks up at me for reinforcement so I too start saying he is an idiot. At this point, the sister (who had said nothing) started screaming at him telling him he was an idiot. The sister and I were not smacking him – we left that up to the gogo. All this provides excellent entertainment for the patient’s friends who fall about laughing.
Eventually, after treating the patient, I lodged him to male ward. I left the hospital and walked home for some much needed rest with a smile on my face.
Are you Dr Toulson?
So, I am in the midst of my first weekend on-call and it has been OK. (I am writing this on Saturday afternoon) Nothing so far as harrowing as my first on-call nine days ago. There has been some interesting medical cases, some sick children to admit and manage and some suturing (I met my first Zulu drunk this morning at 03:30am).
It was a busy night and I was relieved to get to bed at 4:00 am. At 6:45 am, the internal phone in our house was ringing (usually it is the on-call phone which wakes me up!). I quickly jump out of bed and answer it. The conversation goes as follows:
‘Are you Dr Too-son?’ Yes (I reply softly – I am used to no one being able to pronounce the word Toulson I think the difficulty lies with the letter ‘l’ but then I certainly do not complain given my limited and at times unpronounceable Zulu)
‘Are you Dr Too-son? Yes I am Dr Toulson.
‘This is the Charge of his commander at Ingwavuma Police Station.’
‘Are you sure you are Dr Too-son?’
At this point my heart stops and I think this ‘Charge of his commander’ – whatever that means is about to tell me that Henry has been killed on his way to Sodwana Bay or in Sodwana Bay itself!
I suddenly can’t breathe. My brain becomes fuzzy. I feel sickness. I can’t concentrate. As I snap out of it, I am told that there has been a burning overnight in a house where one person has died and they would like me to come and examine the remains of the person in the house. It is a suspicious death.
I have no clue how to do the task he is asking me to do. What to say? What to ask? (Come on Mary! Think!)
‘What is the distance to the incident?’
The answer, ‘Approximately 45 minutes away’. I am sceptical about the reliability of this time estimate. However I am assured he can send transport to bring me there and back.
I explain that I cannot leave the hospital premises and if I do, I need to be close by to rush in to anaesthetise the c-sections.
‘Ummm’, says the Charge of his commander. ‘This will be a problem. I will bring the remains to the hospital’.
‘Thank you’ – I say.
Confused – I go back to bed.
Bay Day
Unfortunately Mary was on call this weekend. I was torn between keeping her company and joining some of the other doctors in a beach trip. After much agonising, I gave Mary a kiss and headed for the sand.
Our destination was Sodwana Bay. This is a 1.5 hour drive from Ingwavuma and is on the coast (as the ‘bay’ bit suggests). We set off Friday night for our hostel. Not having been told the name of our accommodation I was hesitant when we arrived. We slowed to enter the gates. A big sign read, ‘Natural Moments’. A moment of fright. Was I meant to have packed clothes? It quickly became clear that being ‘sans vetements’ was not expected.
Having unpacked we headed for evening entertainment at a local bar to sample South African beers. The ‘entertainment’ boiled down to playing ‘crazy’ pool. The ‘crazy’ dimension was provided by a giant super strong fan just behind the table. It blew all the balls to one side of the table. The only benefit of this was that it meant we got great value for every 2 Rand we put in.
There were only two South Africans in the bar. One was too drunk to be coherent. The other joined our pool game. I began to ask him (the first time I have done this in SA) about the possibility of watching premiership games, declaring my particular interest in Spurs. This immediately sparked a ‘natural moment’ as he tore off his top. Lo and behold a big cockerel standing proudly above the Latin ‘audere est facere’. I told him I reckoned the odds of him being an actual Spurs fan must just about equal those of THFC being involved in a clandestine operation to brand Africans with the club crest. He assured me he had not been tortured*.
Sodwana Bay is written up in the guide book as being a little slice of paradise. On this basis, God has made room in the after world for car thieves and vandals. Waking to go for an early morning dive, Nics – a teacher who drove us all to the Bay, found her car had been broken into. She was amazingly forgiving. I am already fearing the worst for our defenceless Ford Fiesta.
The biggest attraction Sodwana bay is the diving. Without Mary I decided to snorkel. I had a lot of fun paddling around marvelling at lots of funny coloured fish. I have no idea what I saw but they were red and yellow and pink and green, purple and orange and blue. Next time I will try to get some names.
At 1700 we headed back to the bar to watch a tri-nations game between Australia and South Africa. The first ten minutes of the game were extraordinary and resulted in five tries. By the end of the game South Africa had won. The bar bounced to a Boer beat as we left.
Nics and I then headed back to Ingwavuma. This involved a challenging night drive over some patchwork roads. Playing ‘spot the pothole’ and ‘avoid the cow’ were games that preoccupied us the whole way home.
Sunday – today I will be cooking Mary a fillet steak supper. I will tell you all about the South African supermarket in another blog.
(I didn’t tell South Africa’s Spurs fan that THFC have recently changed the club crest so his act of devotion is now out of date).
Our destination was Sodwana Bay. This is a 1.5 hour drive from Ingwavuma and is on the coast (as the ‘bay’ bit suggests). We set off Friday night for our hostel. Not having been told the name of our accommodation I was hesitant when we arrived. We slowed to enter the gates. A big sign read, ‘Natural Moments’. A moment of fright. Was I meant to have packed clothes? It quickly became clear that being ‘sans vetements’ was not expected.
Having unpacked we headed for evening entertainment at a local bar to sample South African beers. The ‘entertainment’ boiled down to playing ‘crazy’ pool. The ‘crazy’ dimension was provided by a giant super strong fan just behind the table. It blew all the balls to one side of the table. The only benefit of this was that it meant we got great value for every 2 Rand we put in.
There were only two South Africans in the bar. One was too drunk to be coherent. The other joined our pool game. I began to ask him (the first time I have done this in SA) about the possibility of watching premiership games, declaring my particular interest in Spurs. This immediately sparked a ‘natural moment’ as he tore off his top. Lo and behold a big cockerel standing proudly above the Latin ‘audere est facere’. I told him I reckoned the odds of him being an actual Spurs fan must just about equal those of THFC being involved in a clandestine operation to brand Africans with the club crest. He assured me he had not been tortured*.
Sodwana Bay is written up in the guide book as being a little slice of paradise. On this basis, God has made room in the after world for car thieves and vandals. Waking to go for an early morning dive, Nics – a teacher who drove us all to the Bay, found her car had been broken into. She was amazingly forgiving. I am already fearing the worst for our defenceless Ford Fiesta.
The biggest attraction Sodwana bay is the diving. Without Mary I decided to snorkel. I had a lot of fun paddling around marvelling at lots of funny coloured fish. I have no idea what I saw but they were red and yellow and pink and green, purple and orange and blue. Next time I will try to get some names.
At 1700 we headed back to the bar to watch a tri-nations game between Australia and South Africa. The first ten minutes of the game were extraordinary and resulted in five tries. By the end of the game South Africa had won. The bar bounced to a Boer beat as we left.
Nics and I then headed back to Ingwavuma. This involved a challenging night drive over some patchwork roads. Playing ‘spot the pothole’ and ‘avoid the cow’ were games that preoccupied us the whole way home.
Sunday – today I will be cooking Mary a fillet steak supper. I will tell you all about the South African supermarket in another blog.
(I didn’t tell South Africa’s Spurs fan that THFC have recently changed the club crest so his act of devotion is now out of date).
Thursday, 26 August 2010
King of Ingwavuma
Loud demonstrations outside the hospital today but all very peaceful. Most of the nurses are ignoring the strike and turning up to work. This cannot be easy for them.
My main task of the day was to get us registered as the owners of our new car.
I finished the paperwork last week. I have made two previous visits to the Post Office. Once I was thwarted by a power cut; the second time I hadn’t brought along all the required documentation. Third time lucky.
The Post Office is surrounded by disused public buildings. Each of the buildings has a big sign outside indicating its purpose e.g. Ministry of Home Affairs. Most seem to have ceased to function. The Ministry of Environment is particularly derelict. Trees are growing out some of the windows. Perhaps it is fitting that it has been reclaimed by nature.
Entering the Post Office I was immediately welcomed by Nicholas. Nicholas is in charge of the National Lottery in Ingwavuma. He sits in the corner and helps customers decide whether they want to be part of the main drawer or the thunderball. Top prize is 10 million Rand (about £1 million). Nicholas also helps to make sure customers stand in the right queue. He directed me to the only open ‘window’.
It took a while to be served. Nicholas and I passed the time by discussing how we would spend our winnings were we to get lucky on the lotto. He cautioned against me looking for more wives. ‘It causes so much more trouble. So much more difficult and complicated.’ Nicholas had managed to avoid marriage entirely but did have a son. He liked my idea of trying to become King of Ingwavuma. So did the two boys who had joined us. Of course I would need the permission of King Zwelithini – the Zulu King.
Finally I began to be served. It took about an hour to complete the vehicle ownership paper work. The line grew and grew. All remained very good natured at the nuisance I was causing. Then I was asked for R350 administrative fee (about £35). Embarrassingly I did not have enough cash and my card wasn’t working. Patrick helpfully pointed out that this would not be a problem if I played the lottery.
I left promising to return tomorrow.
My main task of the day was to get us registered as the owners of our new car.
I finished the paperwork last week. I have made two previous visits to the Post Office. Once I was thwarted by a power cut; the second time I hadn’t brought along all the required documentation. Third time lucky.
The Post Office is surrounded by disused public buildings. Each of the buildings has a big sign outside indicating its purpose e.g. Ministry of Home Affairs. Most seem to have ceased to function. The Ministry of Environment is particularly derelict. Trees are growing out some of the windows. Perhaps it is fitting that it has been reclaimed by nature.
Entering the Post Office I was immediately welcomed by Nicholas. Nicholas is in charge of the National Lottery in Ingwavuma. He sits in the corner and helps customers decide whether they want to be part of the main drawer or the thunderball. Top prize is 10 million Rand (about £1 million). Nicholas also helps to make sure customers stand in the right queue. He directed me to the only open ‘window’.
It took a while to be served. Nicholas and I passed the time by discussing how we would spend our winnings were we to get lucky on the lotto. He cautioned against me looking for more wives. ‘It causes so much more trouble. So much more difficult and complicated.’ Nicholas had managed to avoid marriage entirely but did have a son. He liked my idea of trying to become King of Ingwavuma. So did the two boys who had joined us. Of course I would need the permission of King Zwelithini – the Zulu King.
Finally I began to be served. It took about an hour to complete the vehicle ownership paper work. The line grew and grew. All remained very good natured at the nuisance I was causing. Then I was asked for R350 administrative fee (about £35). Embarrassingly I did not have enough cash and my card wasn’t working. Patrick helpfully pointed out that this would not be a problem if I played the lottery.
I left promising to return tomorrow.
Wednesday, 25 August 2010
Striking stupidity
I fear some difficult days ahead in SA. As already mentioned a public service strike is underway in the country. The action is being led by the biggest union in the country COSATU. Media reports suggest that things are likely to escalate over the coming days. The situation is not helped by the fact that President Zuma has embarked on a trip to China.
Based on information from BBC reports of the strike, the unions seem to be acting very unreasonably. The pay deal on offer is a 7% rise for workers (how the British Unions would love to be receiving such proposals). The unions are holding out for 8.6%. Yet the government is already offering a better deal than it can afford.
The strength of the union position is based on the predicament facing Zuma. He is in coalition government with some very left wing elements including a communist faction. Thus far he has defended their right to strike but not to use violence and intimidation.
Unfortunately, the strikes are becoming more violent. The following web page tells of recent unrest outside a hospital in Durban (http://www.bbc.co.uk/news/world-africa-11057690). There are local reports of attacks taking place against teachers that have tried to defy the strike ban.
As regards to our hospital, it has been one of the least affected. Periodically there have been demonstrations outside with loud trumpeting. The nurses in the hospital have largely defied the ban. However, a number of other hospitals in the surrounding area have closed. This has resulted in many more people coming to Ingwavuma. Many of these are seriously ill and there have been fatalities as a result of having to travel the extra distance.
I should reassure you all that we have good security at the hospital and the atmosphere is very relaxed. The doctors continue to work incredibly hard to keep things going. (The dispute does not directly involve the doctors but the unions are keen that everyone, including private sector workers, show their support for their action. They seem completely unconcerned by the resulting deaths.) Last night Mary was second on call and had to help with three caesarean sections. She is also on call over the weekend.
With the current national unrest I am left at a bit of a loose end. The strikes are open ended so nobody knows how long they could last. For the moment I am being kept company by the compelling Stieg Larsson trilogy of books (tip off from Adam Elliott).
Some light relief was provided by my debut in the weekly football game played at the hospital yesterday. This involves all ages and both sexes. I quickly discovered some differences in the ‘Mosvold’ laws of the game. Most conspicuously, there is no such thing as a foul. I discovered this after being scythed to the ground as I set off on an early dribble. Having dusted myself off I stood up to find a big zulu lady smiling at me coyly. This was one of a series of terrific spoiling ‘tackles’ she carried out during the game. I have vowed to be on her team next week.
Based on information from BBC reports of the strike, the unions seem to be acting very unreasonably. The pay deal on offer is a 7% rise for workers (how the British Unions would love to be receiving such proposals). The unions are holding out for 8.6%. Yet the government is already offering a better deal than it can afford.
The strength of the union position is based on the predicament facing Zuma. He is in coalition government with some very left wing elements including a communist faction. Thus far he has defended their right to strike but not to use violence and intimidation.
Unfortunately, the strikes are becoming more violent. The following web page tells of recent unrest outside a hospital in Durban (http://www.bbc.co.uk/news/world-africa-11057690). There are local reports of attacks taking place against teachers that have tried to defy the strike ban.
As regards to our hospital, it has been one of the least affected. Periodically there have been demonstrations outside with loud trumpeting. The nurses in the hospital have largely defied the ban. However, a number of other hospitals in the surrounding area have closed. This has resulted in many more people coming to Ingwavuma. Many of these are seriously ill and there have been fatalities as a result of having to travel the extra distance.
I should reassure you all that we have good security at the hospital and the atmosphere is very relaxed. The doctors continue to work incredibly hard to keep things going. (The dispute does not directly involve the doctors but the unions are keen that everyone, including private sector workers, show their support for their action. They seem completely unconcerned by the resulting deaths.) Last night Mary was second on call and had to help with three caesarean sections. She is also on call over the weekend.
With the current national unrest I am left at a bit of a loose end. The strikes are open ended so nobody knows how long they could last. For the moment I am being kept company by the compelling Stieg Larsson trilogy of books (tip off from Adam Elliott).
Some light relief was provided by my debut in the weekly football game played at the hospital yesterday. This involves all ages and both sexes. I quickly discovered some differences in the ‘Mosvold’ laws of the game. Most conspicuously, there is no such thing as a foul. I discovered this after being scythed to the ground as I set off on an early dribble. Having dusted myself off I stood up to find a big zulu lady smiling at me coyly. This was one of a series of terrific spoiling ‘tackles’ she carried out during the game. I have vowed to be on her team next week.
Monday, 23 August 2010
Tembe Safari Magic
What a weekend! On Friday afternoon we headed to Tembe Reserve Elephant Lodge. Tembe is a 30,000 hectare park containing all of the big 5 (and plenty of the mini millions). We were truly spoilt by the luxurious accommodation and the entertainment provided by the animals.
Our two days and nights in the park enabled us to go on three safari drives. Our guide for all three drives was called Patrick. The first took some beating. It is coming to the end of winter time at the moment in SA – a time of very little rainfall. This means that there are relatively few water holes in the park for animals to drinks. The principal beneficiaries of this are the lions. They are able to sit motionless around the scarce puddles waiting for their preferred meal to arrive. We arrived at a waterhole to find them in wait.
What we witnessed played out in two stages. Both were a great mixture of sport and war. The first stage was highly tactical. It involved an attempted entrapment of a young male Nyala – let’s call him Pietersen - by 4 lions led by an extremely cunning female warrior – we’ll call her Boudiccea. Female lions are the better hunters. Boudiccea is particularly formidable. Easily, she worked to position two other lions so that an unaware Nyala would walk into a space between three of them (the fourth lion was too busy feasting on an old carcass). With the trap set, Boudiccea could wait for Pietersen to give his wicket away.
Then all suddenly seemed ruined for the lions. The fourth lion, who had being paying little attention to the developing situation, stood up and walked across to the other lions. Pietersen bounded back. Boudiccea made a half-hearted charge but was easily out paced. Lions it seems are not very fast (imagine speed of a big dog, or Angus Fraser running in during his hey day). Our guide, Patrick, had been acting as commentator while all was unfolding in front of us. He had been carefully explaining each of Boudiccea’s moves. When the fourth lion stood up and walked across to the other lions, he became livid. Repeatedly he cursed him, ‘What a stupid lion! He has ruined the moment. I thought he would ruin it. He was not paying enough attention. What a stupid lion!’
Except the action had not finished. Boudiccea had not given up. She wandered over to the puddle of water and sat down beside it in an area of longer grass. Pietersen, not content with his initial foray into danger was still determined to drink. Pietersen sniffed forward carelessly to the waterhole. Suddenly Boudiccea leapt. This time the Nyala could not escape – trapped between the lions jaws. It was not immediately killed. Taking a Rumsfeld attitude to codes of warfare, Boudiccea sat down to torture her Nyala. After around 15 minutes Boudiccea seemed content that all information had been extracted.
We saw much else on our three hour drive though nothing else quite so compelling. We came across an elephant eating on his own. We came across a herd of buffalo. We also saw a couple of white rhino. I managed to clear up the answer to a question I had wondered for a long time but never quite formulated – ‘Why are white rhino called white rhino?’ Apparently they were originally called wide rhino on account of their wider mouths. Through mishearing this became white rhino. Their opposite number then became black rhino.
Our afternoon drive was less eventful. The main entertainment was provided by a pair of young male elephants frolicking together not entirely platonically. This caused great amusement among a German medical student. A more senior Italian lady was less amused (though it was unclear whether by the behaviour of the elephants or Martin).
Our drive on Sunday was highly dramatic, if bloodless. We came across a full pride of lions lazing about. We also came across a family of elephants including a couple of baby elephants. Hearts melted.
Two last abiding memories from the weekend. The first was eating a variety of new meats. May I highly recommend both warthog and Nyala. We tasted both in our evening meals. Look out for both when next in Tesco (sadly they don’t stock either in our local supermarket – I’ll tell you about Spar in another blog). More seriously, I think it is about time that the major UK supermarkets branched out in their meat selection. Far too much emphasis is placed on varieties of fruit and vegetables.
The second memory will be Mary’s attempts to correctly identify all the different deer variations in Tembe. Upon seeing each one Mary would shout out Duiker or Impala, or Nyala, or Bala, or Kudu, or water buck. This would then be followed by Patrick’s correction. All very endearing.
Finally, a note of thanks to the owner of Tembe lodge who generously halves lodge rates for medics wanting to visit. A terrific gesture of appreciation towards the work of the doctors in the area.
Sunday, 22 August 2010
Survived my first on-call – just!
Sorry this is a bit later than planed but I am writing on Sunday evening to say that I somehow made it through my 28.5 hr on-call which started on Thursday morning at 7.30am. I must admit that I was quite anxious about it. I remember working in A+E at Warwick Hospital last December when the staff grade doctor I was working with was useless and slept all night and I was the only doctor working from midnight to seven am in A+E. At the time, I thought it was crazy but now I look back at that quite fondly as I was the only doctor at Mosvold Hospital from 5.00pm on Thursday until 8:00am on Friday. Unsurprisingly, I was somewhat terrified. (There is a second on-call but the general principle is that they only come in if there is a caesarean section to carry out or another surgical procedure).
So, how did it go? Well, the first few hours of the on-call were spent in the outpatient department (OPD) - this is the equivalent of combining the UK emergency department, outpatients department and general practice into one. Two of the South African doctors we are working with have been trying to introduce a triage system but often the order of the patients is decided by the Zulus themselves not on clinical need (this is done in a very ordered happy way – it seems). So, not only am I the only doctor in the hospital but there is also no X-ray or pharmacy services from 4:30pm onwards and so you end up completely relying on your clinical skills. I can’t remember all my OPD cases for the evening but remember a few. (Only read on if you don’t mind medical stories)
One of my patients was a 32 year old woman who was very sick. She had HIV (but was not on antiretroviral drugs – ARVs - yet) and had completed her TB treatment last month. Unfortunately, arterial blood gases (an easy way of seeing how sick someone is) are not available and there is one pulse oximeter (a simple way of checking oxygen levels) but it was playing up. I decided she had a pneumonia and treated her as such – although I was not sure she would make it through the night. The antibiotics that are used here at Mosvold are different to those in the UK. Her blood tests came back and her kidney function tests were the worst I had ever seen. I was pleased to see that she survived until at least Friday!
When I returned to my OPD room (I move between OPD and the RU (resuscitation unit)), I found a patient lying on my couch. This happens a lot here which I find quite odd but also amusing. I understand why patients sneak into consultation rooms as they wait hours to see a doctor but still have not yet got used to it. In the UK, this would most likely be a drunk who had collapsed on your couch but here in Ingwavuma, I have not yet found one alcoholic (I am sure they exist) or someone smelling of alcohol. Anyway, he too had HIV but his CD4 count (the test we do to see if they need ARVs) was too high and so was not eligible for treatment. He had severe D+V (diarrhoea and vomiting) so I gave him lots of fluids which seemed to do the trick!
After seeing a good seven patients or so, I was feeling hungry and Henry had kindly made us spaghetti bolognese (Henry is determined to have meat five days a week which is something that might prove difficult given Spar – our only supermarket – has a random selection of meats). It was delicious but I was only able to enjoy it for 20 minutes before the on-call cell phone went off again. It was the paediatric ward – a baby had stopped breathing. I ran as fast as I could from our house to the paeds ward (less than five minutes) and found a 10 month old with no pulse or respiratory effort. I immediately started paediatric life support but it was futile. The baby looked dead. I asked the nurses to phone the second on-call doctor (who was in charge of the paediatric ward) but he told me over the phone that the baby was very sick – he had come in with pneumonia from a hospital near us which is on strike (more on the strikes in another blog). I continued for another few minutes and then confirmed death. I felt very sad. I broke the bad news to the mum who started wailing and my eyes welled up. I did not say much except how sorry I was. I also suggested that she came to see her daughter and hold her in her arms. I was involved in two resuscitations in the UK during my paediatric job (both with an unsuccessful outcome) but my experience here was so different. In the UK, you continue for an hour or two and there are many doctors around. On Thursday night, I was alone and no one particularly tried very hard. The nurses and second on-call doctor had seen it so many times before and new the attempt would be pointless. I phoned Henry who kindly brought me a cup of tea to OPD and continued seeing patients.
A sixteen year old girl came in with her left eye covered up with a gauze bandage. The story was that the patient’s sister put a stick in her eye by mistake. As I took off the bandage, I was worried what I was going to see. I was relieved to see that her eye was fine. The area between her nasal bridge and eye were not – there was a hole. With my fingers, I tried to force the edges together but could not see how it would work. I decided to call Shabana – the other UK doctor who started with me last Monday. She kindly came in to assist me (I also wanted to see another doctor as had been working alone for the past six hours). She inserted the lidocaine (anaesthetic to numb the area before inserting stitches) but the wound started bleeding heavily. We could not stop it despite applying pressure. We phoned the second on-call doctor who said not to worry. All I could think of was if lidocaine entered the blood stream it would cause cardiac arrhythmias (and the patient could easily die). In the UK, I had been so careful when I injected lidocaine during a procedure and now this was all going so terribly wrong and all we had was one dodgy temperamental ECG machine. The bleeding did eventually stop and Shabana and I continued. It was by no means the best looking wound – the two stitches simply brought the edges together but a small hole remained. We both felt very bad as she was only sixteen and now her face was somewhat disfigured. She lodged overnight in the hospital and came back to see me on Friday morning in the OPD where her face looked much worse. It had swollen up and was quite badly bruised. My colleague reassured me it would all settle down and look much better when it healed on its own. The patient did not seem to be bothered but then again my Zulu is not good enough yet! I saw one more patient after the sixteen year old girl and then went home to sleep. It was past midnight and I was exhausted!
After twenty minutes in bed, I received a phone call from labour ward. A woman who had previously had five vaginal deliveries was in labour and the baby was distressed (there was meconium). It was 12:50 am and what I feared most – obstetrics – was my next job. I rushed to the labour ward to see more meconium than I thought was possible. I examined the mama (zulu for woman) and noted she was only 5-6 cm dilated. I asked the sister (who had way more experience than me) to also examine and she agreed the vagina was only 6cm dilated! Ummm – what to do. I knew the baby had to get out but was not sure the next move. I decided to wake up the second on-call doctor (I told him I would for anything obstetric as my experience was so limited given I have not worked in obs+gynae since medical school. One minute into our phone call, the sister came to see me to tell me that the baby had delivered and was doing well. I was amazed! I got off the phone and saw a baby crying. I was relieved. I then looked at the mother and noted she was bleeding. The sister was slowly pulling out the placenta (which was intact) but the mama kept on bleeding. I thought to myself – this is what they call a post partum haemorrhage. I quickly asked the nurses to get another big cannula in (IV line) and gave her lots of fluids to bring up her blood pressure. I also gave her a few drugs to stop the bleeding but nothing was working and the blood kept on pouring. There was only one option – to bring the mama to theatre! I phoned the second on-call and he came in. He assessed her and agreed that we needed to go to theatre and stop the bleeding. At 2.30am, I acted up as anaesthetist (third time as had previously done so twice earlier in theatre) and administered ketamine, fentanyl and midazelam as the second on-call tried to stop the bleeding. He found many tears in the vaginal wall (this is what happens if you go from 6 cm to delivery in a couple of minutes) and sewed them up. It took quite some time and I felt tired. Eventually, the patient stopped bleeding and I was hoping to go back to bed. The second on-call doctor certainly was. However, I received a phone call as I was leaving theatre to say that there was a complicated case in OPD.
Sadly, it was an 11 year old girl who had been raped. She was with her mother and had been to the police station. (I had received a phone call earlier in the evening from a nurse in a clinic who asked me what happens in these cases – I explained the girl had to go to the police station and then come to the hospital). I started my consultation with the girl but she was very upset and it didn’t feel appropriate. I thought it was best to let the girl sleep and see her in a few hours time after we both had some sleep. I went to bed and managed to sleep on and off for three hours (I received a few phone calls but was able to manage the cases over the phone). I then headed back to OPD and continued where I left off with the rape case. Rape cases are taken very seriously in SA (as they should be) and take approximately two hours to sort out. We need to gather all the evidence and conduct a complete physical exam which I find hard. I also started the girl on ARVs, three different types of antibiotics as well as some analgesia. I finished the case and headed for tea at 10am.
I then continued until 1:15 pm in OPD and was relieved to finish my shift! Without doubt, it was the hardest thing I have done professionally but I am sure there will be many more challenging shifts to come. I was happy I survived my first on-call and decided I deserved a lunch at a place I had heard about called Fancy Stitch (I think this is the only place to eat out in Ingwavuma – more about this relaxing incredible place in another blog). I phoned one of our new friends up called Kelly (South African who teaches at a nearby school but schools are not open at the moment as they are on strike) and we enjoyed lunch together. They have the most wonderful milkshakes. I am already looking forward to many more! I then came back to our house and we packed for our first weekend away to Tembe Elephant Park! We had the most lovely time which Henry or I will write about tomorrow. But for now, I am tired and about to go to bed. Goodnight and hope you had a nice weekend.
Love M
So, how did it go? Well, the first few hours of the on-call were spent in the outpatient department (OPD) - this is the equivalent of combining the UK emergency department, outpatients department and general practice into one. Two of the South African doctors we are working with have been trying to introduce a triage system but often the order of the patients is decided by the Zulus themselves not on clinical need (this is done in a very ordered happy way – it seems). So, not only am I the only doctor in the hospital but there is also no X-ray or pharmacy services from 4:30pm onwards and so you end up completely relying on your clinical skills. I can’t remember all my OPD cases for the evening but remember a few. (Only read on if you don’t mind medical stories)
One of my patients was a 32 year old woman who was very sick. She had HIV (but was not on antiretroviral drugs – ARVs - yet) and had completed her TB treatment last month. Unfortunately, arterial blood gases (an easy way of seeing how sick someone is) are not available and there is one pulse oximeter (a simple way of checking oxygen levels) but it was playing up. I decided she had a pneumonia and treated her as such – although I was not sure she would make it through the night. The antibiotics that are used here at Mosvold are different to those in the UK. Her blood tests came back and her kidney function tests were the worst I had ever seen. I was pleased to see that she survived until at least Friday!
When I returned to my OPD room (I move between OPD and the RU (resuscitation unit)), I found a patient lying on my couch. This happens a lot here which I find quite odd but also amusing. I understand why patients sneak into consultation rooms as they wait hours to see a doctor but still have not yet got used to it. In the UK, this would most likely be a drunk who had collapsed on your couch but here in Ingwavuma, I have not yet found one alcoholic (I am sure they exist) or someone smelling of alcohol. Anyway, he too had HIV but his CD4 count (the test we do to see if they need ARVs) was too high and so was not eligible for treatment. He had severe D+V (diarrhoea and vomiting) so I gave him lots of fluids which seemed to do the trick!
After seeing a good seven patients or so, I was feeling hungry and Henry had kindly made us spaghetti bolognese (Henry is determined to have meat five days a week which is something that might prove difficult given Spar – our only supermarket – has a random selection of meats). It was delicious but I was only able to enjoy it for 20 minutes before the on-call cell phone went off again. It was the paediatric ward – a baby had stopped breathing. I ran as fast as I could from our house to the paeds ward (less than five minutes) and found a 10 month old with no pulse or respiratory effort. I immediately started paediatric life support but it was futile. The baby looked dead. I asked the nurses to phone the second on-call doctor (who was in charge of the paediatric ward) but he told me over the phone that the baby was very sick – he had come in with pneumonia from a hospital near us which is on strike (more on the strikes in another blog). I continued for another few minutes and then confirmed death. I felt very sad. I broke the bad news to the mum who started wailing and my eyes welled up. I did not say much except how sorry I was. I also suggested that she came to see her daughter and hold her in her arms. I was involved in two resuscitations in the UK during my paediatric job (both with an unsuccessful outcome) but my experience here was so different. In the UK, you continue for an hour or two and there are many doctors around. On Thursday night, I was alone and no one particularly tried very hard. The nurses and second on-call doctor had seen it so many times before and new the attempt would be pointless. I phoned Henry who kindly brought me a cup of tea to OPD and continued seeing patients.
A sixteen year old girl came in with her left eye covered up with a gauze bandage. The story was that the patient’s sister put a stick in her eye by mistake. As I took off the bandage, I was worried what I was going to see. I was relieved to see that her eye was fine. The area between her nasal bridge and eye were not – there was a hole. With my fingers, I tried to force the edges together but could not see how it would work. I decided to call Shabana – the other UK doctor who started with me last Monday. She kindly came in to assist me (I also wanted to see another doctor as had been working alone for the past six hours). She inserted the lidocaine (anaesthetic to numb the area before inserting stitches) but the wound started bleeding heavily. We could not stop it despite applying pressure. We phoned the second on-call doctor who said not to worry. All I could think of was if lidocaine entered the blood stream it would cause cardiac arrhythmias (and the patient could easily die). In the UK, I had been so careful when I injected lidocaine during a procedure and now this was all going so terribly wrong and all we had was one dodgy temperamental ECG machine. The bleeding did eventually stop and Shabana and I continued. It was by no means the best looking wound – the two stitches simply brought the edges together but a small hole remained. We both felt very bad as she was only sixteen and now her face was somewhat disfigured. She lodged overnight in the hospital and came back to see me on Friday morning in the OPD where her face looked much worse. It had swollen up and was quite badly bruised. My colleague reassured me it would all settle down and look much better when it healed on its own. The patient did not seem to be bothered but then again my Zulu is not good enough yet! I saw one more patient after the sixteen year old girl and then went home to sleep. It was past midnight and I was exhausted!
After twenty minutes in bed, I received a phone call from labour ward. A woman who had previously had five vaginal deliveries was in labour and the baby was distressed (there was meconium). It was 12:50 am and what I feared most – obstetrics – was my next job. I rushed to the labour ward to see more meconium than I thought was possible. I examined the mama (zulu for woman) and noted she was only 5-6 cm dilated. I asked the sister (who had way more experience than me) to also examine and she agreed the vagina was only 6cm dilated! Ummm – what to do. I knew the baby had to get out but was not sure the next move. I decided to wake up the second on-call doctor (I told him I would for anything obstetric as my experience was so limited given I have not worked in obs+gynae since medical school. One minute into our phone call, the sister came to see me to tell me that the baby had delivered and was doing well. I was amazed! I got off the phone and saw a baby crying. I was relieved. I then looked at the mother and noted she was bleeding. The sister was slowly pulling out the placenta (which was intact) but the mama kept on bleeding. I thought to myself – this is what they call a post partum haemorrhage. I quickly asked the nurses to get another big cannula in (IV line) and gave her lots of fluids to bring up her blood pressure. I also gave her a few drugs to stop the bleeding but nothing was working and the blood kept on pouring. There was only one option – to bring the mama to theatre! I phoned the second on-call and he came in. He assessed her and agreed that we needed to go to theatre and stop the bleeding. At 2.30am, I acted up as anaesthetist (third time as had previously done so twice earlier in theatre) and administered ketamine, fentanyl and midazelam as the second on-call tried to stop the bleeding. He found many tears in the vaginal wall (this is what happens if you go from 6 cm to delivery in a couple of minutes) and sewed them up. It took quite some time and I felt tired. Eventually, the patient stopped bleeding and I was hoping to go back to bed. The second on-call doctor certainly was. However, I received a phone call as I was leaving theatre to say that there was a complicated case in OPD.
Sadly, it was an 11 year old girl who had been raped. She was with her mother and had been to the police station. (I had received a phone call earlier in the evening from a nurse in a clinic who asked me what happens in these cases – I explained the girl had to go to the police station and then come to the hospital). I started my consultation with the girl but she was very upset and it didn’t feel appropriate. I thought it was best to let the girl sleep and see her in a few hours time after we both had some sleep. I went to bed and managed to sleep on and off for three hours (I received a few phone calls but was able to manage the cases over the phone). I then headed back to OPD and continued where I left off with the rape case. Rape cases are taken very seriously in SA (as they should be) and take approximately two hours to sort out. We need to gather all the evidence and conduct a complete physical exam which I find hard. I also started the girl on ARVs, three different types of antibiotics as well as some analgesia. I finished the case and headed for tea at 10am.
I then continued until 1:15 pm in OPD and was relieved to finish my shift! Without doubt, it was the hardest thing I have done professionally but I am sure there will be many more challenging shifts to come. I was happy I survived my first on-call and decided I deserved a lunch at a place I had heard about called Fancy Stitch (I think this is the only place to eat out in Ingwavuma – more about this relaxing incredible place in another blog). I phoned one of our new friends up called Kelly (South African who teaches at a nearby school but schools are not open at the moment as they are on strike) and we enjoyed lunch together. They have the most wonderful milkshakes. I am already looking forward to many more! I then came back to our house and we packed for our first weekend away to Tembe Elephant Park! We had the most lovely time which Henry or I will write about tomorrow. But for now, I am tired and about to go to bed. Goodnight and hope you had a nice weekend.
Love M
Thursday, 19 August 2010
Nasty insecty things
Another fine winter’s day. The weather hasn’t altered much since we arrived. Rarely a cloud in the sky and temperatures somewhere in the 70s. Locals in town often wear winter hats and leather jackets to keep themselves warm. I pass them sweating profusely in t-shirt and shorts. At night the temperature drops to sweater/ trouser wear. Not looking forward to the middle of summer.
Mary has put the house (meaning ‘me’) on snake red alert. She has briefed me on how snakes get into houses (they climb trees and slip through windows apparently). She has also told me about the difficult clinical decisions for doctors treating those bitten by snakes. I promised to be more cautious (I didn’t mention that I already check under everything when I enter a room and that they feature in many of my dreams).
We had some positive developments today. Firstly, I met with Andrew Swift. He is in charge of an educational NGO in the area. He is setting up meetings for me with some local schools. He and I will visit them next week. Current thinking is that I will teach in one of these schools 5 mornings a week. In the afternoons I will help him to run a sports program for schools in the area. This program involves coaching school children in different sports and helping to organise tournaments. All sounds very promising and I shall keep you posted.
The second big development is that we now have a cleaner. She is called Sophie and she is excellent. I always think cleaners are very good at their job because I don’t much notice untidiness or dirt. However, Mary, who most certainly does notice these things, is very happy. Sophie has also spotted a nasty flying biting insect nest just outside our door. I hadn’t noticed it because the bugs don’t move much unless disturbed. Indeed, I was convinced they were all dead, I tried to persuade Sophie that this was the case. Sophie won the argument most heroically, by running up to disturb the insects. Cue much screaming and shrieking as she and I then ran for cover.
Third piece of exciting news, is that we plan to go to Tembe elephant park on the weekend. It apparently contains South Africa’s last ‘free ranging elephants’. (Hopefully more free range than the hens at Billhurst). There are also lions, buffalo, leopard, rhino et al hidden among the forests. God willing, they will all come out to say hello.
So plenty to rejoice about. One exception is our car which is scooping awards left, right and centre for crapness. I am going to try and sort out a new battery tomorrow.
Lastly, please spare a thought for my wife tonight as she tackles her first night shift. I shall let you know how she gets on.
Mary has put the house (meaning ‘me’) on snake red alert. She has briefed me on how snakes get into houses (they climb trees and slip through windows apparently). She has also told me about the difficult clinical decisions for doctors treating those bitten by snakes. I promised to be more cautious (I didn’t mention that I already check under everything when I enter a room and that they feature in many of my dreams).
We had some positive developments today. Firstly, I met with Andrew Swift. He is in charge of an educational NGO in the area. He is setting up meetings for me with some local schools. He and I will visit them next week. Current thinking is that I will teach in one of these schools 5 mornings a week. In the afternoons I will help him to run a sports program for schools in the area. This program involves coaching school children in different sports and helping to organise tournaments. All sounds very promising and I shall keep you posted.
The second big development is that we now have a cleaner. She is called Sophie and she is excellent. I always think cleaners are very good at their job because I don’t much notice untidiness or dirt. However, Mary, who most certainly does notice these things, is very happy. Sophie has also spotted a nasty flying biting insect nest just outside our door. I hadn’t noticed it because the bugs don’t move much unless disturbed. Indeed, I was convinced they were all dead, I tried to persuade Sophie that this was the case. Sophie won the argument most heroically, by running up to disturb the insects. Cue much screaming and shrieking as she and I then ran for cover.
Third piece of exciting news, is that we plan to go to Tembe elephant park on the weekend. It apparently contains South Africa’s last ‘free ranging elephants’. (Hopefully more free range than the hens at Billhurst). There are also lions, buffalo, leopard, rhino et al hidden among the forests. God willing, they will all come out to say hello.
So plenty to rejoice about. One exception is our car which is scooping awards left, right and centre for crapness. I am going to try and sort out a new battery tomorrow.
Lastly, please spare a thought for my wife tonight as she tackles her first night shift. I shall let you know how she gets on.
Wednesday, 18 August 2010
Inkomo
After a better night’s sleep I felt ready to get out of bed. I spent the morning doing jobs in the house and in town. We have been promised that we will be moving into a newly renovated house. We were told that this would take a week to get ready. Having now inspected the house we think Christmas is a more realistic completion date. For the moment we are staying in ‘the mansion’. As its nickname suggests it is one of the biggest properties.
To get jobs done on the house, we speak to Mama Butalezi (not sure about spelling). She is the house mother and a woman of immense power as she is responsible for all accommodation. So far, so good. Mama B has instructed her workers to sort out the problems in the palace. Most have now been fixed.
My progress in finding work in a school has been hampered. Teachers and many other public servants are on strike at the moment. The precise reasons are unknown. The doctors are not sure whether they are meant to be taking part. Even if they are, they won’t.
I am doing my best to learn Zulu words. It is helping to get laughs from the locals. We only have a medical phrase book. So my vocabulary is very medically orientated. I learnt the word for cow yesterday – inkomo. This featured in Mary’s phrase book because it is also the polite term for vagina.
To get jobs done on the house, we speak to Mama Butalezi (not sure about spelling). She is the house mother and a woman of immense power as she is responsible for all accommodation. So far, so good. Mama B has instructed her workers to sort out the problems in the palace. Most have now been fixed.
My progress in finding work in a school has been hampered. Teachers and many other public servants are on strike at the moment. The precise reasons are unknown. The doctors are not sure whether they are meant to be taking part. Even if they are, they won’t.
I am doing my best to learn Zulu words. It is helping to get laughs from the locals. We only have a medical phrase book. So my vocabulary is very medically orientated. I learnt the word for cow yesterday – inkomo. This featured in Mary’s phrase book because it is also the polite term for vagina.
The pink ladies
Monday evening I developed a headache. It meant a very bad night. I couldn’t sleep at all. My mood was mad worse by a dog nearby that barked incessantly. Just as he finally gave up, the roosters started crowing. I felt rotten all Tuesday and stayed in bed. As a consequence, I missed the weekly football game (always on a Tuesday evening) and supper club (held once a month; turns are taken to cook parts of the meal). Felt very sorry for myself.
Mary at least managed to make me laugh. At the hospital, there are lots of ladies dressed in pink. They carry out responsibilities such as cooking and cleaning. She said that at 10 in the morning, with a packed outpatient department, a pink lady decided to mop the floor. She saw no need to issue a warning. Instead, she began by throwing a large bucket of water across the waiting room. This drenched those without seats. None complained. No sooner had the lady begun her mopping than she slipped headfirst cracking her nose on the floor. Blood poured out over the floor. Bandages were fetched. Pink lady took a seat so she could be treated.
Monday, 16 August 2010
Survived my first day at work!
Wow – so much has happened in the past week that I can hardly keep up. I have been meaning to write on the blog but have been so busy with moving country, getting used to life in South Africa and then getting used to life in Ingwavuma. Henry and I have only been in Ingwavuma for 48 hrs and are slowly getting settled in. I was expecting but still found it a bit scary to see lots of welcoming cockroaches when we arrived to our new home. We also had no running water but after speaking to the house mother of Mosvold today (the hospital where I am working at), we now have running water. As for the cockroaches, I don’t think we will be getting rid of them unless we get a dog. I am very keen but will probably not as it is not really fair given our lifestyle and we get the perks of them (there are many) without the responsibility.
I thought I would write a bit about Mosvold Hospital which is the hospital in the town of Ingwavuma. Mosvold Hospital serves a population of 120 000 and has 8 doctors (since today - this is an improvement of the 6 doctors they have been having for the past two months). It has six wards: male, female, paediatrics, maternity, TB and isolation. It also has a ridiculously busy outpatient department (OPD). It is a district hospital with 246 beds but in clinic today I had three patients who I ‘lodged’ for the night. This means they don’t need to be admitted but either can’t get the investigation they need on the day (CXR stops at 16.00) or live too far away to travel back home after their visit to the hospital. Given this, I can only imagine that the actual number of patients who stay in the hospital is much greater.
I start work at 7.30 am and on routine days should finish at 16.30. There is a mandatory tea break at a colleagues’ house at 10 am for 30 minutes – this morning it was at the home where the dentist is living. I was very impressed we had a dentist but she has only been here for 6 weeks. We currently have no pharmacist, ultrasonographer or radiographer (these are the only ones I am aware about).
Today, I worked in OPD and it was very different than I am used to in the UK. First of all, the waiting room is heaving by 8.30am and no one seems to complain. Maybe this is not true but my Zulu is not yet up to scratch (Henry is trying to teach me 10 words a day as are the nurses but a lot of the time we end up in giggles). Luckily, during my consultations, I always have a nurse (usually a student one) who also doubles up as a translator. My first patient was a rape case which takes approximately two hours so one of my colleagues (who explained to me that we had many rape cases) kindly took on the case – I am not sure I could have handled the whole thing first thing! My second and third cases were people asking me to complete death certificates on their relative which was bizarre given I had never met the patient let alone seen them in the mortuary. My fourth case was a gogo (elderly woman) who had post menopausal bleeding and needed a pipelle and biopsy (couldn’t believe we just carried them out in clinic). The examination and investigation was quite hilarious as she was quite large and didn’t quite fit on the bed. I ensured I did not laugh given it took a good 10 minutes to get the gogo in the right position! I continued to have an array of cases throughout the day. I had a twenty six year old male with significant amount of blood loss - who I brought to the resuscitation room (which has one bed) not because people were worried about his tachycardia (fast heart rate) and low blood pressure - but because he would get blood on the floor. I also prescribed many ARVs (anteretroviral drugs) – I found this aspect easier that I thought as both colleagues and patients seem (so far) to be open about HIV and TB. There were lots of other cases which I will not bore you with except to tell you about a case of a young man who came in with severe burns of his legs and feet – the worst I have ever seen. As popping the massive blisters with a scalpel was so painful, the patient was given both ketamine and pethidine and was quite knocked out. I was quite worried about whether he was going to wake up but my colleague told me not to worry!
I think that is enough cases to tell you about but needless to say – I worked until 17.30 and will be back tomorrow. Thursday I will be in theatre for the day (emergency stuff which frightens me but will have my goggles at the ready) and I am also first on-call which I am more worried about as the idea of me running the entire hospital by myself is quite scary! I will be working from 7.30am on Thursday until Friday at 13.00 so very much looking forward to my weekend off. Henry and I are thinking about going away somewhere!
The people here at Mosvold have been so welcoming and kind to Henry and me. There is a lot of accommodation on site – all quite basic – either homes or parkhomes. Everyone is South African except Henry, Shabana (the other British doctor who also started today) and me. Tomorrow, we have supper club which will be held at the OT and physio therapist park home. This fun event happens every month!
I am off to bed. Love M
Sunday, 15 August 2010
Settling in
We woke late at 10.30. We needed to get to the town’s Spa shop before closing at midday. Having hurried for an hour to get jobs done, we found the store closed all day for a stock take.
We decided to try and sort out our new car. Two problems a) it wouldn’t start and b) the bonnet would not open. Nevermind. A chance to put all my manliness to the test. Fifteen minutes later I went for help.
Eventually we solved both car problems. (A picture of grinning and proud Henry beside old Ford Focus to follow.)
On walking to introduce ourselves to a couple of doctors absent the previous night, Mary’s heart was stolen. Across our tracks walked Kumbu carrying a washing basket containing 11 puppies. Thus far I have managed to forestall Mary’s attempts at purchasing ‘piddle’, ‘puke’ or any of the rest.
Most of the afternoon was taken up by a tour of the hospital. We were shown round by Nat (female doctor married to Tyrone – also a doctor). The full enormity of what Mary and Shabana (also over from the UK) are about to do, hit home. Two years into their medical career they will be on call alone once a week and one every three weekends. The hospital regularly receives locals suffering from:
Machete attacks
Gun shot wounds
Car accidents
Rapes
Complicated pregnancies
Obviously, many of these come in at night.
The hospital currently has 8 doctors. It serves a community of over 120,000. Each doctor is given sole responsibility for a ward. Typically they complete a ward round within the first two hours of the day. They must manage their wards on very limited budgets. More to follow on what ward Mary is allocated.
The doctors share the task of processing admissions. This takes place after they have completed their first ward rounds. The numbers coming into the hospital each day can be huge, meaning great speed is required. Only the very sick are admitted. The death rate is very high. There is a huge cemetery located just down the road. Apparently, despite the frequency of deaths, all funerals are treated as very big occasions.
My awe at the skill and dedication of the doctors here is growing by the hour.
Little to say about our evening.
We decided to try and sort out our new car. Two problems a) it wouldn’t start and b) the bonnet would not open. Nevermind. A chance to put all my manliness to the test. Fifteen minutes later I went for help.
Eventually we solved both car problems. (A picture of grinning and proud Henry beside old Ford Focus to follow.)
On walking to introduce ourselves to a couple of doctors absent the previous night, Mary’s heart was stolen. Across our tracks walked Kumbu carrying a washing basket containing 11 puppies. Thus far I have managed to forestall Mary’s attempts at purchasing ‘piddle’, ‘puke’ or any of the rest.
Most of the afternoon was taken up by a tour of the hospital. We were shown round by Nat (female doctor married to Tyrone – also a doctor). The full enormity of what Mary and Shabana (also over from the UK) are about to do, hit home. Two years into their medical career they will be on call alone once a week and one every three weekends. The hospital regularly receives locals suffering from:
Machete attacks
Gun shot wounds
Car accidents
Rapes
Complicated pregnancies
Obviously, many of these come in at night.
The hospital currently has 8 doctors. It serves a community of over 120,000. Each doctor is given sole responsibility for a ward. Typically they complete a ward round within the first two hours of the day. They must manage their wards on very limited budgets. More to follow on what ward Mary is allocated.
The doctors share the task of processing admissions. This takes place after they have completed their first ward rounds. The numbers coming into the hospital each day can be huge, meaning great speed is required. Only the very sick are admitted. The death rate is very high. There is a huge cemetery located just down the road. Apparently, despite the frequency of deaths, all funerals are treated as very big occasions.
My awe at the skill and dedication of the doctors here is growing by the hour.
Little to say about our evening.
Saturday, 14 August 2010
Arrival in Ingwavuma
Saturday -
And today we arrived at our final destination - Ingwavuma. More about that to come.
We spent the early morning trying to sort out computer things. We were sorry to be leaving Durban without exploring it all. However we (or at least I) still got to appreciate from afar the magnificent new football stadium. Imagine Wembley by sand and sea. It has an arch running over the top. When we return we hope to take a tour over the top. Mary is also keen on investigating bungy jumping from the roof (which is apparently on offer).
We were due to be picked up at 10.30 but our lift arrived at 12.50. Our driver was called Enoch and his lady friend was called Cornelia. They had already picked up the one other English doctor (*) who will be working in Ingwavuma named Shabana. We all crammed into an old Ford truck and headed for the local supermarket to buy food basics (+ marmite and Finn crisp biscuits).
Our journey up was smooth. Enoch proved to be an excellent driver - easily the best we've ever had in Africa. Cornelia acted as translator. Durban's number one radio station provided the in-car entertainment. As promised by Adam Elliott the English/ American pop selected for the listeners was at best erractic. Nonetheless it gave me a chance to sing along to some long forgotten songs (e.g. enigma - return to innocence). Cornelia's accompanied me in much of my singing and her big booming laugh followed all of my jokes. I began to feel immediate and intense affection for all Zulu women (and thereby a sense of understanding for President Zuma).
By the time we arrived at our hosptial accommodation, it was nightfall. We were shown to our accommodation. We have been placed somewhere for the week while our permanent residence is fixed up. Suffice to say that it wouldn't be entirely Susie Toulson's cup of Rooibus (sp?). 'My family and other animals' doesn't begin to capture the biodiversity on offer. But thus far all have kept themselves to themselves. Reassuringly, we have antivenom on site (something I am keep telling myself in preparation for snake encounter number 1).
Before bed, we met up with most of the other doctors and med staff + partners that are living on the compound. All were very friendly. One was a teacher. I will be visiting his school on Tuesday to investigate opportunities.
Mary is now asleep beside me. Her last question, prior to losing consciousness was 'What do cockroaches do?'. I think she meant 'Are they dangerous?'. I reassured her that they have received a grossly unfair reputation. It seemed to do the trick.
(* - Mary - poking her nose in beside me - would like all to be reminded of the fact that she considers herself Candian.)
And today we arrived at our final destination - Ingwavuma. More about that to come.
We spent the early morning trying to sort out computer things. We were sorry to be leaving Durban without exploring it all. However we (or at least I) still got to appreciate from afar the magnificent new football stadium. Imagine Wembley by sand and sea. It has an arch running over the top. When we return we hope to take a tour over the top. Mary is also keen on investigating bungy jumping from the roof (which is apparently on offer).
We were due to be picked up at 10.30 but our lift arrived at 12.50. Our driver was called Enoch and his lady friend was called Cornelia. They had already picked up the one other English doctor (*) who will be working in Ingwavuma named Shabana. We all crammed into an old Ford truck and headed for the local supermarket to buy food basics (+ marmite and Finn crisp biscuits).
Our journey up was smooth. Enoch proved to be an excellent driver - easily the best we've ever had in Africa. Cornelia acted as translator. Durban's number one radio station provided the in-car entertainment. As promised by Adam Elliott the English/ American pop selected for the listeners was at best erractic. Nonetheless it gave me a chance to sing along to some long forgotten songs (e.g. enigma - return to innocence). Cornelia's accompanied me in much of my singing and her big booming laugh followed all of my jokes. I began to feel immediate and intense affection for all Zulu women (and thereby a sense of understanding for President Zuma).
By the time we arrived at our hosptial accommodation, it was nightfall. We were shown to our accommodation. We have been placed somewhere for the week while our permanent residence is fixed up. Suffice to say that it wouldn't be entirely Susie Toulson's cup of Rooibus (sp?). 'My family and other animals' doesn't begin to capture the biodiversity on offer. But thus far all have kept themselves to themselves. Reassuringly, we have antivenom on site (something I am keep telling myself in preparation for snake encounter number 1).
Before bed, we met up with most of the other doctors and med staff + partners that are living on the compound. All were very friendly. One was a teacher. I will be visiting his school on Tuesday to investigate opportunities.
Mary is now asleep beside me. Her last question, prior to losing consciousness was 'What do cockroaches do?'. I think she meant 'Are they dangerous?'. I reassured her that they have received a grossly unfair reputation. It seemed to do the trick.
(* - Mary - poking her nose in beside me - would like all to be reminded of the fact that she considers herself Candian.)
Friday, 13 August 2010
Arrival in Durban
And finally our blog becomes active. More about that later.
So we have now been in Durban for a night and a day. We arrived at lunchtime on Thursday and settled into a lovely b&b. Mary has created a buzz about our arrival by informing everyone we have met (even fleetingly) that 'We've moved to South Africa. Today is our first day' (imagine Mary's impossibly enthusiastic Canadian accent to get full effect).
We were meant to be picked up to go to an AHP (Africa Health Placement - non-profit organisation that have placed Mary) gathering at 1500 on Thursday. 1430 slowly became 1600 as our lift arrived late. This was due to the challenges of finding our address. Road names apparently change all the time in Durban. Sometimes the previous name of the road is left with a red line through it. The changes are to honour newly important people (though it seems rare that any locals have actually heard of either the old or new 'vip').
Once picked up we went to meet the other volunteers. After some mingling we were given a crash course in Zulu for doctors. I found this terrific fun. For those who know nothing about Zulu (not me anymore!) it is a language of clicks. There are three major clicks and many minor ones. We spent the next hour trying to say zulu medical phrases. After much amusement and confusion, all the doctors were pronounced ready to embark on their Zulu medical career. (For any of our readers considering medical treatment in Ingwavuma/Mosvold hospital please rest assured that Mary will have a translator through the year).
After the language course, the doctors were given a 'diy' medical textbook for most of the possible procedures that they are likely to have to perform. Again this was exciting for me. The book isn't too big and condenses most major operations into a step by step two page summary. Having a read of this last night, I am now very confident that I can be qualified by experience as a doctor by the end of our year here.
Our evening culminated in a South African bbq aka a Braai (sp?). These seem to be very regular occurences in South Africa. The responsibility for cooking the meat is huge and usually belongs to the senior South African male. However, there were none present (*). As one of only four males and the one that happened to be standing nearest to the flames, I was nominated as chef. Despite trying to protest (with Mary's support)at the dangers of putting me in charge, my attempts were interpreted as 'false' modesty. With the lives of many doctors in my hands, I decided to play it safe implementing a 'burnt is best' policy. All our new found friends were very complimentary about the results.
(* The braai was hosted by Tracey Hudson. The walls of the home have lots of cricket mementos. It turned out Andrew Hudson opened the batting in South Africa's first test post apartheid. In that test against the West Indies (still with a formidable bowling line up) he scored 150. It was his test debut. He was the first South African to score a century on his debut. He is also one of a select number of players to score a century on debut in first innings and a duck in the second innings. All hugely exciting - Tom Toulson please check wikipedia for more information).
Friday
More boring day. Spent the morning setting up a bank account. Spent the afternoon trying to sort out an internet connection. We will be buying a modem that will allow us a fast connection when in Durban opening up the possibility of e.g. skyping occasionally. For most of the time though we will only be able to email or update our blog. We need to download picasso before we can add any pictures. We will do this asap. In the meantime please continue to follow and add posts with anything interesting. Hope you are all missing us masses.
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