Henry and I are back in Ingwavuma after a lovely two week holiday in the UK. It was a very busy time seeing family and friends but great fun. Thank you to all for your kindness and generosity. Of course we are already missing you.
We arrived back to Ingwavuma on a Sunday night and I was straight back onto my ward (Male) on Monday. There had been a big Motor Vehicle Accident (MVA) the previous Friday which resulted in my ward being full. The driver of one of the vehicles arrived with the side of his skull missing. Travelling at over 100 km/h his head had bounced and scraped along the tarmac. Every morning as I approached my ward, I hoped he would still be alive and we could continue chatting about things. By the Thursday, I had eventually convinced our referral hospital (3.5 hrs away) to take over his care. I look forward to having him back after the plastic surgeons somehow reconstruct his skull.
Last Thursday, I went to my clinics – named Nondabuya and Khwambuzi. Every three weeks, I am responsible for driving to them (I feel like Mma Ramotswe in the Number One Ladies Detective Agency books as I battle the potholes in the dodgy 4x4) and then seeing the patients that are waiting for me. The nurses at these clinics are meant to prioritise the complicated cases for me to see. We should only be seeing 20 patients at each clinic but often we see more – especially the children waiting for anti-retrovirals. One interesting case involved a child of three. It is often difficult to know if an infant is a girl or a boy because they all tend to have short hair and aren’t dressed in blue/pink. Anyhow, the nurse presented the case to me and said the child was a homosexual. I looked up baffled. First of all, homosexuality ‘does not exist’ in rural South Africa. Secondly, three year olds don’t tend to have a sexual orientation. It took some time (and confusion on my part) to clarify that in fact the child was a hermaphrodite. I examined the child to confirm and suggested they saw a surgeon. I can only imagine how much trouble the child and mother will receive in their community.
Being responsible for approximately 20 men on my ward, I expect smelliness. In fact, I have found Zulu patients to be much cleaner than UK patients when it comes to daily washing. However, given many have limited access to sanitation facilities and lack shoes, I regularly see very smelly feet. For the sake of the audience, I think it is best if I do not describe the amount of pus that I often extract from these wounds.
Despite my exposure to manky feetitus, I am still occasionally shocked. Over the past two weeks, I have had a patient who was missing a fair amount of skin on his foot because of an infection. Given this, we treated him with antibiotics, debrided the wound and gave him a skin graft. We then left the wound for one week before seeing if the skin graft has been successful. This past Thursday, my patient informed me that the wound was itchy. As I unravelled the bandage and took off the gauze, I saw approximately 40 maggots on the wound. I felt like vomiting but instead took forceps and removed each one. The patient did not seemed fussed at all. In fact, he told me the next day, that he thought they had cleaned up the wound nicely. Male Ward is dominated by male nurses. Yesterday, I was told by one of them in front of the others that they had been very impressed with me the day before. This is a massive compliment from a Zulu man!
I am working this weekend and so far the hospital has been relatively quiet. Long may that continue!
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