Uthi lizokhithika?

School holidays have meant another week of inactivity for me. My time has been filled mainly reading.

After work Mary and I have been training for the half-marathon. I am trying to convince my wife that it is unnecessary to greet every single person that we happen to pass (there are many). I am having little impact and feel mean spirited to boot. Those that greet us, do so in a mixture of Zulu and English. Sometimes this can be very funny. Yesterday a teenager bowed slightly and said, ‘Good evening, my lady’ as Mary ran past. Henry Higgins would have placed him in the Home Counties. Even I find it impossible not to wave and talk with the children we pass.

We are in the process of moving house. We are having to vacate our current property (Mandela’s mansion – no 110) for an English family that are coming over. We always expected to move. We were meant to live in no 130 from the start. Convincing promises were made that it would be ready a week after our arrival. Suffice to say we are about to move in and little has been done to it. Today an army of pink ladies were sent in to clean it. I arrived just as they were leaving. Then began a very sensitive negotiation process. On the one hand I needed them to feel the warmth of my thanks for the job they had done. I managed to convey this very well – smiles and laughter all round. On the other, I wanted them back inside to do all the things that had been missed; the bath still looked like it had just been used by a particularly dirty rugby team. Not as successful on the second part. Eventually one pink lady agreed to perform a ‘polishing’ job. Another exercise in the art of the possible. Hopefully Mary won’t be too aghast when she sees it later.

Our vocabulary in Zulu isn’t improving much. It is a very difficult language to learn. Take, for example, the sentence for ‘I am speak very little Zulu’ – ‘Ngisazi kancane kakhulu isiZulu’. Not exactly a longhop. Then I have difficulty learning the phrases that I most need. Annoyingly, much less useful ones tend to stick. I can now say ‘uKhisimusi omuhle!’ meaning ‘Happy Christmas!’. Pronunciation is an absolute nightmare. I have no handle on the clicks at all. Furthermore I get a bit angry when I’m corrected by somebody repeating the noise I have just made but suggesting a difference. Our language issues aren’t helped by our tiny Zulu phrasebook. This was clearly written by an owakwelinye izwe (foreigner). Among the essential phrases section is, ‘Uthi lizokhithika?’ meaning, ‘Do you think it will snow?’ Not bloody likely.

Anyway, on a more cheery topic, we are likely to go to Cape Vidal this weekend. This is meant to be a stunning part of the coast, good for e.g. whale watching. I’ll let you know what my inkosikazi (wife) and I get up to.

Hlane

As foretold, we visited Hlane over the weekend. It is Swaziland’s biggest game park with more life than ‘a tramp’s vest’ (thank you Stereophonics).

We had a terrific time. Although we are on the border of Swaziland, we have to take a circuitous route to get onto the nearest major road into the country. It took us 5 hours to get from Ingwavuma to the Hlane.

We were immediately charmed by the Swazis and their beautiful country. And we were also wowed by their superb roads system. Barely a pot hole to be seen. I got terribly excited about the smoothness. I found myself uttering phrases like ‘a positive pleasure to drive’. Self-revulsion soon kicked in, as I realised I was becoming hideously ‘Top Gearish’.

Given that we are likely to be visiting a number of game parks over the coming months, Mary and I have begun a ratings system. As it is in its infancy, we haven’t yet agreed on all the criteria or even a name. But we think it needs to be harsh for it to gain credibility.

Hlane: the positves

There were some excellent things about Hlane e.g. a restaurant right by a big lake that attracted hippos, rhinos and more. Our ensuite hut was also very tasteful. But...

Hlane: the negatives

On the downside, some idiots decided not long ago, that a major road should be built straight through the middle of the park. The result is that you can hear a faint motorway noise from most sections (think Wisley and the A3). This somewhat kills the sense of being in the bush. Secondly, the animals in the park have had to be divided into sections. The rhinos have been separated from the big cats. This is because of poachers (the park can now send round foot patrols). As a result it creates a bit of a zoo feel. Thirdly, the food did not hit the heights of Tembe. With great seriousness, I was able to lean over to Mary during dinner and pronounce that my impala steak was disappointing.

All told, we still had a great time. But still no leopard. Does anyone really sympathise with somebody that complains about his impala steak? I hope not.

Our return journey was memorable if only for the fact that I think I have worked out how to get our air conditioning system working. My breakthrough came at the end of our sweaty drive. I felt like the men at Bletchley Park after cracking the enigma code. (Their task was of course easy by comparison.) The irritation caused by the heat was only trumped by our lack of in car entertainment. We agreed that we need to buy some more CDs for the car. We have one album by a famous Zulu artist. Good as it is, we need a break from her. And we cannot tolerate any more of Durban’s East Coast Fm (station policy – ‘if it ain’t by Christina Aguillera, Atomic Kitten or Lady Gaga we don’t play it’).

PS – sadly rhino poaching in South Africa is still very prevalent and provides a real threat to the extinction of the species. SA has 80% of the world’s rhino population. They have approximately 40,000 rhino. The animals are being poached at a rate of more than 20 a month and the poachers are running ever more sophisticated operations. The rewards are massive. One large rhino horn is estimated to be worth 3 million rand (300,000 pounds). 3 million rand buys a nice house with pool and swimming court in Jo’burg.

Sometimes they don’t want our help …

Today is a public holiday in South Africa. I do not get the public holidays off as a holiday but the workload is much less because patients tend not to come in. In addition, most of the buildings are closed and there are no x-rays and even fewer blood tests available.

While working in OPD this afternoon, a very thin forty year old man was wheeled in by his wife. Immediately, I knew he had HIV, TB or both. Such is the prevalence of these disease that I can now be confident before testing simply by the way they look. Sadly, he had both illnesses.

I began to take a history. My interpreter who is a nurse informed me that the reason he came in was because he felt dizzy and his legs had lost strength. Patients here bring a card with them. His was empty except to tell me that he had started TB treatment yesterday. On questioning, he told me he started anti-retrovirals a week and a half ago. No wonder he was weak!

I examined the patient and found some of the biggest lymph nodes I have ever seen in his neck (which will be filled with TB) and a tongue covered in candida (there was no red tongue to be seen). His blood pressure was low and pulse rate was high. I explained that it would be best for him if he was to be admitted onto our TB ward in order to ensure the pills go down and also for the dietician to help him. He weighed 35 kgs.

Medicine is very paternalistic here and patients tend to agree with what you suggest. However this patient was not happy. He explained to me (which the interpreter kindly translated for me) that he was not going to stay in hospital. I was surprised and tried to establish the reason for his resistance.

Our discussion went back and forth with long pauses when suddenly the interpreter asked if it would be OK for the wife to enter the consultation room. In she came and the discussion went on.

Then the brother of the patient arrived and there was further discussion. All in Zulu. Again, long pauses. Suddenly, the brother stated in English that the patient would consent to being admitted. I looked at the patient whose face showed defeat.

I am not confident that he will stay. His prospects are very bleak. We will do what we can.

Tubal Ligation Please.

I was working last weekend on-call. I had been told by the medical manager that the priority for weekend on-call should be to the ward patients. Conversely, the patients waiting in outpatients were (and always are) lowest priority. Last Saturday was very busy on the wards – sick child fitting on paeds ward, acute psychotic patient hitting staff members on male ward and maternity ward heaving with complicated labours – this resulted in me ending up in OPD at 15:00. By 15:30 I was ravenously hungry so decided to take a 30 minute break for lunch. I went back to OPD and continued seeing patients.

At 17:45, a woman stepped in holding a blanket and asked for a tubal ligation. Although this is a procedure we perform often in theatre, it is not an emergency. Whilst explaining this, a cry came from the blanket. Mum had brought her small baby to her breast. I asked Mum the age of her child. Her response, ‘One day’. She had travelled 3.5 hours to get to the hospital. She had left her house at 5 am to travel to Mosvold to wait over 8 hrs. I had to tell her that we would not do the procedure on a weekend. Mum showed no sign of frustration. In consolation, I ‘offered her’ the floor on paeds ward to sleep. She had her tubal ligation yesterday. I think she will be happier knowing she cannot have a seventh child. To quote one of my favourite people - the mind boggles.

NB. Zulu men would never agree to a vasectomy so it is the women who ask for a tubal ligation (or we offer after child number 5 or so). It is done in a secret way from the father of the children – usually prior to a c-section or the day after normal vaginal delivery. I always feel a bit sorry for the woman.

Close to greatness

This weekend we are heading to Swaziland to Hlane National Park. Mary is being very tolerant of my ever increasing leopard obsession (Toulson family – think Michael Jordan Chicago Bulls shirt). The tree bound big cat has thus far hidden from me and I am growing tired of its games. Keep your fingers crossed for us.

I should also mention an incredible discovery. Last night was the first meeting of the Ingwavuma Half Marathon Committee. After the meeting one of the group casually mentioned that Nelson Mandela had used the toilet in our house. ‘Pardon? The world’s greatest living human used the toilet of number 110.’ I had not misheard. Not only did he sit on our toilet but he also sat on our couch! It turns out he came to Ingwavuma for an ANC rally in 1993. He came to our house to meet the Chief Doctor.

In my excitement I immediately sought our copy of his autobiography. Surely he will include mention of his visit to 110. Alas not. No mention of any rally either. Nevermind. There are plenty of people still here who were present that day who have confirmed the veracity of the story. Surely that puts our property on a par with Robben Island. Best not tell the tourists.

A Well Deserved Holiday?

I have just completed three days at Ntabayengwe Primary School.

About the school, its name means mountain of the leopard. It is called this either because: a) there used to be a leopard that hunted in the area killing lots of sheep b) the mountains behind the school make the outline of a leopard. (Mme Ntembo - Deputy Principal - took time out to show me the leopard-like shape of the surrounding hills. I wasn’t entirely convinced. I tried to argue that it looked like any sedentary animal. She was adamant that it resembled a leopard. I didn’t push my point.) The school is about 15km from home. Being at the base of the mountains it is 5-6 degrees hotter that the temperature at the hospital.

Though Mpontshini (school I was at last weekend) was hardly Charterhouse, Ntabayengwe is much more desperate. Most of the buildings have temporary roofs. There are very few staff. One of the two male members of staff is very sick and so is rarely able to attend. There are almost no classroom resources. Despite all this, I had a much more enjoyable time with the children. The main reason for this was that the school has much fewer pupils. As a result I was able to teach classes of 25 instead of 70.

I taught most of my lessons to a group of grade 6s. What they lack in English they make up for in huge enthusiasm. Being only 25 in number, I have learnt most of their names (or shortened versions) which they are very pleased about. This has helped us to bond. They clearly like me, even if they are puzzled by my lessons. My biggest appeal is that I do not hit them if they are not paying attention. This is the practice of the fearsome lady who usually teaches them. (She now sits in the corner of my lessons and acts as translator when they look entirely lost.)

The quality of my lessons is very suspect. The trouble is that what I am meant to teach them is far above their ability levels and often extremely dry. My challenge is trying to inject some interest but without any resources. I have had some successes but more failures.

Failures:

In social science lessons we have been looking at causes of ‘change’. We looked firstly at technology and the impact of the computer on the world. We went through examples of technology. The children were familiar with cars and phones. None have electricity. Most had seen computers. None knew about the internet. My lesson on the profound impact of technology and computers on the world ‘we’ live in began to unravel.

Yesterday, in a follow up lesson, I brought in my computer. I hoped to be able to show them the internet. Unfortunately, I could get no connection. To try to make up for their disappointment, we played a game of computer chess. They were thrilled. After this we looked at how individuals have changed the world. We discussed Nelson Mandela. Then muggins here, decided to teach them about another great individual – Albert Einstein. Why did I pick him? Because he was the example in the text book. Crap reasoning. My monologue on Einstein quickly descended into farcical levels of detail. So atoms…and splitting….and huge release of energy…and nuclear reactions…and atomic bomb…and Hiroshima…and the Cold War…and prospect of nuclear holocaust. Lindon’s increasingly animated nose picking in the back row was the only productive part of the lesson.

Then, I give you the example of my social science lessons. Prior to my arrival, the children had been learning about human rights. I was given the task of explaining gender stereotyping and sexism. Before tackling this, I thought a recap on rights would be worthwhile. What were their rights? I focused in particularly on their right not to be subjected to physical abuse. I’m not sure what my friend in the corner thought about my emphasis.

Looking at gender stereotyping, the boys and girls congregated in different corners of the room. Right, says I, ‘What do most boys like doing?’ Answer from bright girl called Slo, ‘Playing football’. ‘Guhle’ I say (meaning good in Zulu; must be pronounced as if thoroughly inebriated). ‘But, obviously, not all boys like playing football’. Except, all the grade 6 boys at Ntabayengwe do. Nevermind. Then we reversed it (with equal success) to look at how not all girls like netball.

‘Now, what if I said that all the boys in this corner are very clever. They all have big brains. All the girls in this corner are not clever. They are all stupid. Would anybody disagree? What is wrong with what I just said? Please somebody put up their hand. Girls, please defend yourselves.’ Silence. Rest of the lesson was spent trying to show that boys are not more clever than girls. I’m not sure I changed many opinions on either side.

Last but not least, my English lessons were truly horrid. Yesterday was spent teaching about prefixes and suffixes. Never have I been so boring. Regardless, at the end of each lesson the children my departure would be accompanied with a chorus of ‘Thank you, Sir.’

Football

The end of the day I was able to organise games of football and netball. The football match took place on a pitch outside the school. When we arrived, one end was occupied by cows. They willingly vacated the area when we made clear our intentions. The pitch has no grass and has many rocks. I split the sides into two. And they kicked off. The game was utterly brutal. There was little passing as nobody was clear on their team mates. (I need to try and make them some bibs). The boy in possession of the ball was routinely hacked down. The referee made an early decision to let the game flow. As a result not a single foul was called. Though most of the players were bloodied and bruised by the end nobody complained once.

Sadly, today marks the start of a school holiday. The holiday runs until the end of next week. To fill my time I have taken on responsibility for organising the Ingwavuma half-marathon. I will let you know more about this.

After half-term I will probably return to Ingwavuma High School to get a better idea of what it would be like to teach there. Unless I really enjoy it, I am likely to return for good to Ntabayengwe.

Reed Dance Festival

Daily Mirror says ‘Get your breasts out for the King’
Sun says ‘Best of the Fest of the breast’
Daily Sport ‘Breastacular’

This weekend Mary has been on call. Being a doting husband I decided to stay and keep her company.

That at least was the official line. More accurately, staying put allowed me to go to the ‘Reed dance festival’ that takes place each year in Ingwavuma. This long running event provides the Zulu King with an annual opportunity to add to his collection of wives. Here is how it works:

1) Thousands of women from across Zululand converge on Ingwavuma hoping to catch the eye of the King.
2) Each must carry a reed to the festival. The reed is a symbol of virginity. The reed acts as a ‘lie detector test’. If any girl’s reed wilts or breaks, then this means the girl is not a virgin. (I was unable to establish the consequences for a girl if this happened.)
3) The girls parade before the king wearing a traditional skirt and with their breasts on display.
4) Then they dance and sing and have a good time.

Hearing this description of the event, I felt a strong moral obligation to demonstrate my respect for local culture and traditions.

After a 10 minute drive, we (I accompanied some other medics) arrived at the site for the ceremony. As the Lonely Planet guide promised us, so we were immediately surrounded by half-naked ladies with reeds aloft. They were walking together in regional groupings rather like at a girl guides’ parade.

We made our way to the centre of events – a marquee to house the royal entourage. We were accompanied by a couple of Ingwavuma locals. They headed for seats not far from the King. We followed. I was stopped and asked, ‘Are you part of the Zulu Royal family?’ I was very impressed by the politeness of the question. I pointed and said I was just following my group of friends. This seemed a satisfactory answer.

We took up seats and awaited the entry of the King. We were not disappointed. After not many minutes, a number of chiefs began arriving. They were dressed in leopard outfits. All looked very traditional except for the football shirts many were wearing underneath and wrap around shades.

Then the Zulu King arrived. All rose. He was identifiable by a feather in his hair.

And so the festival began.

From an outsider point of view there were two main detractions from the enjoyment of events. Firstly, each dance was interspersed with very long speeches in Zulu. This obviously made no sense to us. Furthermore, they clearly bored the locals. By the end of the ceremony, a number of the chiefs were fast asleep. The King gave a particularly long and dry (judging from the amount of laughter) speech.

The second drawback was that the King did not pick a wife. Seemingly, he never picks a wife on the day. Instead, he picks later from photos and from research done by his advisers. This created a great sense of anti-climax. Should they choose to commercialise the event I think they will need to change this.

In the end, I was very glad I brought a book with me for proceedings. The only slight peril of reading through the ceremony, was making sure I stood up, with all the other males present, each time the King rose. This happened quite a lot. Suddenly I would have to raise my right arm three times and mumble a Zulu word. Despite the danger, all passed off smoothly.

Unfortunately, after the event, I returned home to find Mary with a gastro bug. She valiantly completed her 24 hour shift at 8 this morning and is now in bed.

How's That ?

I have just finished my week at Mpontshini Primary School.

1) The highlights of my week were:

The school run – Each day I ran a taxi service to and from school. I would stop my car at the beginning of the dirt road and shout ‘lift’. Tens of children would surround the car all trying to fit in. Somehow I would manage to fit 8 or 9 in the back of my tiny 3 door car. I hope to take a picture to prove it.

Umpiring cricket matches - After school sports are on Tuesday and Thursdays. Some of the kids but none of the teachers showed great enthusiasm for the leather and willow (or our substitutes). So I decided it was where I could best help. As well as umpiring I provided a running commentary during both matches. Many of the players were younger children they could not understand me. Nonetheless they seemed to enjoy it and trying to imitate me. At the end of the games all gathered round to hear me read out the scores. Making no sense at all, everyone would then celebrate – hands aloft waving pieces of kit in the air.

2) The lowlights for my week were:

Social Science classes - Being invited to teach the slave trade seemed something of a hospital pass. Thankfully, none of the children seemed to hold me personally responsible.

The school toilets - Unfortunately, a great planning booboo was made in siting the school downwind of the ablutions. The odour that drifts across with the Ingwavuma Mistral is horribly pungent.

Next week I head for another primary school. I shall report back.

(I should perhaps explain that the grades roughly correspond with the UK comprehensive system. However, in SA, each year group contains some much older pupils. In my year 7 class I was teaching some 17 year olds.)

An unusual afternoon.

This morning I was in theatre. Our first case was a c-section. The indication was a twin pregnancy with the first twin in a breech position (feet first instead of head). Two beautiful healthy girls came out. I was excited (as have seen many not survive) but mum was less than amused. Mum’s name in Zulu was ‘happy’ but the surprise of twins made her cross. She is 22 years old and already has two children at home and cannot afford another two. After a tea break, we were supposed to do another c-section. Prior to inserting her spinal, I was examining her and realised she was not 38 weeks but in fact 26 weeks! This is a common occurrence here – I would say half the women I see do not know their last menstrual period! Our third case was (very sadly) a rape case. I will not go into the details as it is very depressing but needless to say it involves one of my lovely paediatric children who has now developed an ano-vaginal fistula.

After lunch I was in OPD. My first patient complained of hot and painful feet. This symptom – peripheral neuronitis – I have learned is common in both TB and HIV patients. Typically, the patient has both conditions. Whilst prescribing TB treatment, in steps the medical manager of the hospital. He asks me if I would be willing to remove a dead baby from a dead mother. I look up entirely perplexed. Two minutes later, I was in mortuary about to carry out the procedure. The reasoning behind the request relates to Zulu culture. This dictates that as mum and baby are brought into the world separately they should leave the world separately (even though they are going be buried in the same coffin). The case was of a 19 year old pregnant woman who complained of abdominal pain and then died suddenly in one of our community clinics. I am very aware of needle stick injuries so completely gown up with ski goggles, two gowns, two pairs of gloves and of course mask and boots. (I look quite funny in full kit but don’t care). As I conducted the post-mortem and c-section (thankfully with the help of the mortuary technician), I uncovered lots of congealed blood directly under the abdomen (she was cold) and after some searching, realised she has a ruptured right ovarian cyst. I removed all the blood and then conducted my c-section. The baby boy was approximately 5 months old and looked healthy. I then needed to remove the placenta (which was intact) as this too needs to be with the baby. We then sewed up the body.

Yet again my day had taken a very unexpected course.

Mpontshini

I have spent this week in Mpontshini Primary School teaching the year 7 children (aged 13).

I arrived yesterday to be given a set of lessons that I would be teaching – English, Social Sciences (mainly geography and history) and Life Orientation (everything from personal health to study skills). The head of year 7 was, thankfully, understanding when I suggested it would be helpful to observe the lessons for a day. This gave me a chance to see what and how they were being taught.

Most of my expectations have been fulfilled. Here are some examples:

1) The children sing beautifully.
2) Religion plays an important part in the day. All the children squeeze their eyes shut and bow their heads for prayers in the morning.
3) The classrooms are jam packed. I have 70 in my class. I can barely pronounce a single name as most are Zulu and are not pronounced phonetically. If I stay at the school I will have to come up with nicknames.
4) The classroom atmosphere remains very old-fashioned. The children greet a teacher that enters a room by standing up and chanting, ‘Good Morning Sir. How are you today?’ They stay standing until asked to sit down.
5) Teaching style is ‘chalk and talk’. It is difficult to do otherwise as there are almost no resources.

One misconception is that all the children are desperately enthusiastic and keen to learn. They are children. While their behaviour is much better than in the UK, and much greater respect is retained for the teacher, there are plenty who would prefer not to be there. For them, friendships, parental wrath and the promise of a lunchtime meal act as the determining factors.

The staff have been very friendly towards me. My lack of Zulu will be a barrier to getting to know them well. Nonetheless, they involve me quite naturally. Today I was given the ladling chicken broth (served at 11.00; the children arrive at school at 7.00 so the timing feels right). The pot was quite enormous. I stood serving for approximately 20 minutes as hundreds of bowls passed. I felt very mean with my portions but nobody asked ‘Please Sir, Can I have some more?’

Heroes in a half shell

As forecast, we did indeed go diving. We returned to Sodwana Bay. We are likely to be doing almost all our diving there as it is known to the be the best dive site in South Africa and it is only 90 minutes drive from Ingwavuma.

We spent Saturday on a refresher course so that we were familiar again with the basic techniques and rules for diving. We realised that we had forgotten almost everything since we were PADI certified. Our pool session took an age as we had to revisit all the skills with Johannes. It was made slower by our instructor’s inexperience and grasp of English. His thick Africaans accent meant it was easier to understand him under the water.

We rose obscenely early on Sunday morning for the dive proper. Nerves, tent discomforts and my snoring meant Mary wasn’t feeling well. I had slept like Rip Van Winkle.

We had beautiful weather for our dive. Having driven out to a top section of coral our diving group were invited to backwards roll into the sea simultaneously. In (what I took to be) revenge for my snoring, Mary dived backwards into ‘my’ water. Result = I smacked my head on her tank. As we both emerged from the water, Mary was frantically shrieking, ‘Something hit me’. Unamused, I enlightened her.

I enjoyed the dive tremendously. We were only at a depth of 9-10 metres and we had great visibility. The coral was stunning and tropical fish life surrounded us. The highlight was swimming with some giant turtles. There are five species of turtle off the SA coast. I am not sure which type we saw - probably leatherbacks - but they were very handsome. Leatherback turtles are drawn to the sandy beaches. We hope to time a visit for their nesting - done during the summer months.

For Mary, the dive was less enjoyable. She offered her critical assessment moments after surfacing vomiting several times. Sadly she had felt sick throughout. As a result we decided against doing a second morning dive. We will, though, return soon.

Coming to terms with paediatrics here.

Since last Monday (August 30th), I have been in charge of the paediatric ward. The ward only covers children up to 12 years old but most patients are under 18 months. It has four sections – high care (there are four beds which are usually all used up by very sick children), surgical care (this is mainly burns patients as well as minor surgical procedures), gastro bay (unfortunately, this is very common here for obvious reasons such as infants drinking water from the tap but also because many mums give their children enemas as suggested by the sangoma – the zulu traditional healer) and a large bay with all other patients.

I was thrilled (and scared) to be in charge of paeds as this is an area of medicine that I love. My days now involve starting the paeds ward round at 7.30am – completing it whenever I can – and then joining my colleagues in OPD for the rest of the day. This is usually after tea. Once a week, I spend the day in theatre so on that day I only see the new and sick patients between theatre cases.

The paeds ward is run very differently than I am used to. I work hand in hand with the top ward sister (her status is clear from the deference shown by other nurses). I took a few days to adjust to the set-up which involves each mum bringing their sick child, their medical notes, nursing notes to the sister and me. (I feel we should go to each cot where each infant lies (*) But at the moment I am scared to rock the boat. I do worry about confidentiality – as it is carried out in the middle of the high care bay – but sister usually asks the mums to leave. The other aspect that I am not used to is the constant cleaning by the pink ladies. I seem to spend half my time lifting up my legs or moving to one corner of the bay to avoid having a bucket thrown on me. I used to find it frustrating but now it is the norm. I also have stopped pointing out all the cockroaches that I spot. When I did, it caused huge hysterics. One aspect that I do enjoy on ward round is the constant giggling – most of the time I have no idea why all the staff are laughing but usually I join in.

My first week on the ward was good. There were less patients due to the strike and no one died. This week has been much harder, I have four times more patients and have had three deaths in the past two days. Yesterday was quite horrific – a 9 month old child - who I only met yesterday morning - had gastroenteritis (probably secondary to an enema but denied by mum and gogo) which lead to an aspiration pneumonia. When I arrived at the peri-arrest, things looked bad - the infant was gasping and the heart was beating slowly. I phoned my colleague Natalie to assist me and so pleased I did. Soon after Nat arrived, we started cardiac arrest. The arrest was similar to that in the UK except that you don’t have the same high tech equipment. There are of course no paddles/ electric shocks and we used a lumbar puncture needle to create an intra-osseous line (as we had lost the intravenous line). We tried for a good 20 minutes – and managed to get the heart back once – but with no ventilator there is not much we can do. I felt awful when I broke the news to mum (she was 20 years old and had also lost her first born – child mortality is far too common here). I held a debrief session in the afternoon which all the paeds staff attended – I explained why the child died and also did my best to ensure they did not blame themselves.

Today, my colleague Holger (who is in charge of maternity) asked for my help with two very sick twins who had been delivered by c-section just a short time before. I arrived and once again started CPR on one of the 32 week premature babies. We have no surfactant (which helps the lungs mature and work) and no ventilator so I ended up spending a few hours giving oxygen to the baby after we had secured a definitive airway (intubated). We were waiting for the helicopter to arrive. Unfortunately, the little boy died before the transport arrived despite all our efforts. The little girl was still alive when air transport arrived but then exhausted herself and died before they could fly her down to Durban. Luckily, the helicopter was used for a pregnant woman who lost her baby in utero and was bleeding extensively internally. I do not yet know the outcome for her.

Although at times the job is incredibly difficult emotionally, it is balanced out by the occasional good outcome and the hardworking staff who seem to always be giggling.

* At night the mothers sleep underneath the cots.

Back to School

The good news from SA is that the national strike has now been suspended for three weeks. Indications are that the strike is over but that the unions did not wanted to face the wrath of their members by declaring so outright.

And so yesterday I visited three schools – Ingwavuma High (secondary school), Mpontshini Primary School and Ntabayengwe Primary. My plan is to spend two days with the A-level students at IHS before they have their mock exams. Their exams will then last two weeks and students will only come into school to sit papers. During the two weeks when they are away, I will visit the two primary schools. I am then likely to settle at IHS.

My introductory meetings with the headmasters of each of the schools were entertaining.

1) Mr Njoko (HIS). He was very welcoming and introduced me to some of his staff. Each time he wanted a colleague, he would get out his mobile phone and have a long conversation. Then the person would emerge from the Deputy Principal’s room next door.
2) Mrs Mngomezulu (Principal of Mpontshimi). She was equally affable but slightly distracted. She could not get phone reception from her office. Instead her mobile was placed on a wall ten metres from her office. Each time it rang, she excused herself.
3) Mr Mkhumbuzi (Principal of Ntabayengwe). A very kindly man. On my arrival he halted classes by summoning all the staff. In trooped a group of formidably built ladies. They took chairs to form a semi-circle. Immediately they each struck upon their best ‘bored’ facial expressions. Mr Mkhumbuzi took me through each of their names. He prefixed each introduction by saying – ‘this one is very difficult to pronounce – but you will learn it quickly’. Then it was time for words from the Deputy Principal. First she was handed a piece of paper with my name written on it. She immediately fell about laughing. Hysterics ensued. The spelling of the name was passed round the semi-circle for each to laugh.

I spent today at IHS. I am likely to be helping with year 12 English classes and life orientation (things like sex ed; so plenty of scope for future blog entries). I looked over the text books for most the morning. The one English class I attended had about 70 pupils. The classroom was no bigger than many at Ashlawn School. Facilities were very ‘Victorian’. Despite the challenges, the teacher was excellent and clearly well liked. The bird on top of the blackboard particularly enjoyed the lesson. It chirped throughout.

This weekend we are likely to go diving. Watch this space.

Richards Belly

A mixed weekend in Richards Bay.

On the plus side we managed to get a new battery for the car meaning that the mule will now start. Unfortunately we will have to put up with its numerous other annoying quirks. These include 1) a malfunctioning air conditioning system. Obviously a car with AC is highly desirable in Africa. Worse than not working, our ACS blows extremely hot air straight into the face of the driver and passenger for at least the first hour of a journey. 2) A previous owner of the car thought it a great idea to fit it with fancy alloy wheels and fat tyres. These are far too big. As a consequence, whenever we go over bumps (i.e. all the time) they rub against the car body above. 3) The petrol cap is nigh on impossible to remove. Petrol stations in SA all have service. Teams of young guys immediately rush round incoming cars to do different jobs – a la Formula 1. Our pc problems have led to ‘Sword of Excalibur’ scenes as the pump guys vie to be the one strong enough to remove the cap.

Also on the plus side we managed to buy some things for the house. Duplicitously, I managed to convince Mary of the importance of being frugal as we went through the home ware shop. We made lots of excellent savings. This created some budget space. I then assured my beloved wife that buying a speaker to allow us to play music at an audible level from our laptop was high priority. I’m extremely happy with ‘our’ purchase.

On the down side, I ate a dodgy burger the evening. My system responded with ‘great anger and furious vengeance’ (Bible/Pulp Fiction). I didn’t sleep much and felt very sorry for myself. (No photo to be included here.) Fortunately the misery was short lived.

My back is also playing up a lot. I have been seeking out help from our resident physio and popping Marilyn Monroe like quantities of pain killers. Hopefully it will come to realise the futility of resistance.

Tomorrow we host supper club. This is a monthly event. Huge pressure to deliver a culinary experience. I am still trying to win Mary round to starting with beans on toast on small triangles of toast. What’s not to like about that?

Random pictures of our life in Ingwavuma

Just a few pictures of our new life here ...

1. Mary standing outside our house in a lunch break (this is our temporary house as our other one gets fixed). We enjoy waking up to more chaos outside.

2. Some Africans washing their hair ...

3. Mobile clinic van which has been parked directly outside our house for quite some time. I have a feeling it is not going anywhere soon ...

We have to spend some time in Richards Bay

Ingwavuma is situated at the top of a mountain. In one direction are views over Swaziland. In another are views into Mozambique. The borders of both countries are only a few miles away.

On Wednesday night, after Mary had finished work, we took a drive a couple of miles up the road. We had been invited for ‘sundowners’ (drinks while watching the sun go down). The vantage point chosen looked over miles and miles of Swaziland.

Theoretically, we didn’t pick the best evening to watch the sun’s disappearance. A slight haze covered the land making it harder to pick out details. However, we still got to appreciate the amazing changes of colour as the sun slowly vanished. Sitting on rocks on the hill edge we sipped our drinks and toasted the beauty. At some point we will put up a picture or two to make you jealous (still having problems doing this). It was one of my favourite experiences here so far.

We had planned to visit both Swaziland and Mozambique. I have been particularly excited about visiting the latter. Most of all I looked forward to walking around singing, ‘I like to spend some time in Mozambique, the sunny sky is aqua blue, and all the couples dancing cheek to cheek it’s very nice to stay a week or two, and maybe fall in love just me and you’. The words come from a lesser known but highly commendable Bob Dylan song about the country (helpfully titled ‘Mozambique’ for those wishing to look it up).

Sadly all is not well in the country and we will have to wait and hope things calm down. The country is in the top 5 poorest in the world. After winning independence in 1975 it spent the next 18ish years in civil war. Since 1992 the country has become more peaceful. Nonetheless most of the people remain horrendously poor. Escalating food prices in recent weeks have driven people into protest on the streets of Maputo. Police clashes have led to deaths. The BBC carries more about the situation at http://www.bbc.co.uk/news/world-africa-11173112. Fingers crossed, Dylan’s words will ring true again soon.

In the meantime, this weekend we visit Richards Bay. It gets a kicking from our guide book ‘there are better places to spend your time’ and has no Dylan song to defend it. However, it is the nearest city and we need to visit a garage to fix our car. We’ll let you know what they think of our mule.

Choral masterpiece

On Tuesday mornings, we have a teaching session which starts at 7:00 am. This can be on any topic. Last week it was on the current HIV management guidelines (I prescribe ARV (anti-retrovirals) many times a day in OPD and it seems half of our patients are HIV positive- so this session was very useful) and this week it was on using our ultrasound machine.

Anyroad, yesterday, Shabana (the other UK doctor) and I were waiting outside the ultrasound room for our tutorial. By 7:10 am it was becoming clear that Bird (one of the doctors providing the tutorial) had forgotten. So, we decided to wait in the middle of OPD. This was because there was the most incredible choral masterpiece going on. All of the OPD staff (as well as patients – a good 30 people) were singing Zulu in the most amazingly harmonious fashion. Shabana and I sat with them and enjoyed the incredible singing. Then, they stopped and asked us to sing a prayer song. Momentarily I considered taking up the challenge. Their songs had inspired me to believe in my own ability to produce beautiful sounds. I felt like Frauline Maria. I saw the Swiss Alps all around. Then reality bit. A) I do not know any prayer songs. B) I am tone deaf. I tried in vain to volunteer Shabana. She looked suitably horrified. Fortunately we were rescued by two of our colleagues who arrived to take us elsewhere. How I wish I could have joined in!

Fancy Stitch

Summer seems to be upon us. That is to say that it is very hot today. I have been told that it will not get much hotter. I am relieved. It is a Wednesday so Sophie is here cleaning the house. I feel very guilty that we have a maid to clean while I am sitting on my backside waiting for the strike to end. Sophie is superb. She works incredibly hard and leaves the place spotless. Her visits remind me that I need to keep working on my Zulu. She is no longer impressed by the few words I can speak. She knows I can do better. I confessed that I have been lazy of late learning my 10 words a day.

We went on Monday for lunch at a place called ‘Fancy stitch’. It is a restaurant and a crafts business. It was started up by the wife of the senior doctor at the hospital – Daniel Heese. The restaurant is lovely but survives off regular visits by the doctors. Mary has already developed an addiction to their milkshakes. Ordering food can be a little like pressing the Ipod Shuffle button (i.e. random outcome). This time, they got everything right. Then, as we were leaving, we were chased down by a waitress carrying a chocolate brownie and ice cream. Apparently we had also ordered it. In ‘pooh bear mode’ we gladly sat down for a second dessert.

Next door to the restaurant is the main business. It is a craft workshop. It sells embroidered art. All the art is produced in Ingwavuma. Approximately 500 women provide work ‘free lance’. They are given the materials and are paid for what they produce. Many of the women have HIV. The work they produce is terrific. You will get a chance to sample it in your upcoming birthdays and Christmases. The business has become very successful. They have shown their work across the country and have even exhibited abroad e.g. in the UK. You can find out more about them at http://www.fancy.org.za/.