On Friday, our car was finally ready for collection from Richards Bay. So, with great excitement, I set about finding transport to get me there (it’s about 220 km from Ingwavuma). None of our friends were heading down. So I ‘opted’ to take a lift with hospital transport.
Hospital transport runs patients from Mosvold to other hospitals in KZN. Transport doesn’t necessarily go every day. But I got ‘lucky’. On Thursday evening I found out that a driver would be going down, departing at 0400. Despite the unpleasantly early wake up time, I immediately signed up. I took little notice of the warnings from other doctors about the quality of the drivers.
Well the journey was memorable. We began uncharacteristically, by leaving on time. But my relief diminished when we headed left, instead of right (direction of the main road), out of the hospital gate onto dirt road. The driver spent the first hour driving round Ingwavuma honking at bushes. I assumed he had instructions to pick up patients. But nobody emerged from the undergrowth. Eventually, having forced our way all the most impassable roads, we then returned to the hospital. There some of the patients who’d got in an hour earlier, got out and left. Seemingly, they had just come for an early morning drive. My amusement at this helped offset the frustration of having wasted an hour of sleep. After ten minutes, we set off again.
And very quickly I remembered the warnings from the doctors.
I’m not sure how many times I have cheated death. I remember a near encounter with a motorist, while cycling on a country road in France. Rounding the bend in the middle of the road, I met on an oncoming voiture. Despite the speed of the approaching vehicle, I somehow managed to manoeuvre into the hedge – accompanied by the beautiful sound of Renault car horn. Mon dieu et sacre bleu! I had survived.
On the hairiness scale – that was high. It was matched by the fear I felt on my journey to Richards Bay. Several factors contributed to my sense impending death. The first was our vehicle. It was a bright yellow mini van dating to somewhere before the South African declaration of independence. It looked ancient, even by African automobile standards. Indeed, I have seen several vans abandoned around the local area that look more roadworthy.
Yet, despite the appearance of the vehicle it could still reach top speed. Just over 140 Km/h. I know this for certain, for I was seated, next to the driver. Except I wasn’t really seated. For there were no seat belts. Instead, I and the rest of the passengers, spent most of the journey airborne. They were completely anaesthetised to the danger – either through habituation or because of the ketamine still in their bloodstream from Mosvold.
Driving 140 km/h in a dilapidated vehicle on excellent and straight roads during the daytime would have been dangerous. But we were driving down mountain roads, often occupied by animals or people, covered in pot holes, in pitch darkness.
Sitting beside the driver, I did attempt to explain to him that we’d all rather arrive alive. However, each time he tried to respond to me, he turned to face me. Keeping his foot flat on the pedal. As his concentration was all that kept us from oblivion, I decided to shut up.
Hoping to be distracted by some escapist literature, I got out my book. But my idea failed spectacularly. Somehow I completely forgot that I had just started reading J. G. Ballad’s ‘Crash’. For those who haven’t read it, it is a dystopian novel centred on characters that seek sexual kicks from partaking in road accidents. The obvious thought crossed my mind. I looked across at the driver trying to decipher any eroticism on his face.
In the darkness I could not tell. Perhaps. Perhaps not. Was there a smile of excitement as we narrowly avoided going over the mountain edge? Was there a hint of a thrill as we drove through a herd of cattle with the horn on full blast? Was there a whimper as we overtook two cars, going downhill on a steep mountain pass? Perhaps. Perhaps not.
At least it gave me a possible explanation for the way he was driving. For the speed we were travelling bore no relation to the urgency of our business. This soon became abundantly clear as, half way into our journey, we ran close to empty in petrol. I pointed to the gauge and suggested we needed to stop. Pulling in, we filled up with petrol. And then our driver paid. Except he couldn’t pay. He had left the petrol card in the hospital. So somebody from Mosvold would have to bring it to us.
Two and a half hours later, somebody from Mosvold arrived. And off we went again. On better roads and in daylight, the journey became less dangerous. Could I sense boredom from the driver? Perhaps. But his boredom was my life. Leaving the minivan in Richards Bay, I vowed to walk back to Ingwavuma if our car was not fixed. Thankfully, it was.
Sunday, 15 May 2011
Thursday, 5 May 2011
Kate who?
As the BBC’s Ingwavuma correspondent, I can report (belatedly) that there were no excited street scenes in response to recent world events. On the day itself, I heard mention of the royal wedding on a Zulu radio station on the way to school. In addition, patients and doctors (mainly Mary) at the hospital were able to watch coverage on the televisions in their wards. But there were no other signs of the madness taking place in Britain. (This should be comforting to the royal couple as they fret about the likelihood of finding a honeymoon destination away from the media glare. They could walk completely unnoticed down Ingwavuma high street.)
News of the death of Osama Bin Laden was equally low key. (How he must now wish he had sought out the anonymity offered by Ingwavuma.)
The news of interest to Ingwavuma is all provided by the upcoming local elections. These are a very dirty affair. One of the hospital staff was instructed to attend a ceremony to open a local school. She was expected to provide specialist auditory assistance. On arrival she found that there was no school opening. Instead it was a front for an ANC rally.
We happened to come upon (it was staged outside the hospital gates) a t-shirt rally for the IFP. Their candidate is the current incumbent and was present at the clothing give-away. I was successful in securing a promise from him that he would organise for water to be delivered to Ntabayengwe. I am hoping that the proximity of the elections and his desperation for votes will result in some action.
Our car situation remains unresolved. It is eight weeks since the computer in the car failed. I have been on the telephone to one or other garage almost every day trying to fix it. Below is an outline of events:
1. Car breaks down
2. Car is towed to Jozini (R3000)
3. Car computer is sent to Jo’burg to be fixed
4. Car computer cannot be fixed and is sent back from Jo’burg
5. Second hand computer is ordered from Durban (R2500)
6. Computer is towed to Richards Bay to have computer fitted (R1000)
7. Car is delivered back to us
8. Car is clearly wrong and I drive it back to Jozin
9. Mechanic in Jozini cannot find the cause of the problem
10. Car is driven to Richards Bay Ford specialist
11. Richards Bay Ford specialist say wrong computer has been fitted to the car
12. Second hand computer is taken out of the car and sent back to Durban
13. Durban man tells me that he only has one second hand computer for our model of car but it may not work as it is very dented
(Rand to pounds = 11:1)
We are currently giving Durban man some more time in the hope that he can identify a second hand computer that isn’t dented. If he can’t locate one, then we will either need to gamble on the dented computer (R600 at stake) or buy a new computer (R7000).
We have loved our time in South Africa but we will not miss the politics or dealing with car mechanics.
News of the death of Osama Bin Laden was equally low key. (How he must now wish he had sought out the anonymity offered by Ingwavuma.)
The news of interest to Ingwavuma is all provided by the upcoming local elections. These are a very dirty affair. One of the hospital staff was instructed to attend a ceremony to open a local school. She was expected to provide specialist auditory assistance. On arrival she found that there was no school opening. Instead it was a front for an ANC rally.
We happened to come upon (it was staged outside the hospital gates) a t-shirt rally for the IFP. Their candidate is the current incumbent and was present at the clothing give-away. I was successful in securing a promise from him that he would organise for water to be delivered to Ntabayengwe. I am hoping that the proximity of the elections and his desperation for votes will result in some action.
Our car situation remains unresolved. It is eight weeks since the computer in the car failed. I have been on the telephone to one or other garage almost every day trying to fix it. Below is an outline of events:
1. Car breaks down
2. Car is towed to Jozini (R3000)
3. Car computer is sent to Jo’burg to be fixed
4. Car computer cannot be fixed and is sent back from Jo’burg
5. Second hand computer is ordered from Durban (R2500)
6. Computer is towed to Richards Bay to have computer fitted (R1000)
7. Car is delivered back to us
8. Car is clearly wrong and I drive it back to Jozin
9. Mechanic in Jozini cannot find the cause of the problem
10. Car is driven to Richards Bay Ford specialist
11. Richards Bay Ford specialist say wrong computer has been fitted to the car
12. Second hand computer is taken out of the car and sent back to Durban
13. Durban man tells me that he only has one second hand computer for our model of car but it may not work as it is very dented
(Rand to pounds = 11:1)
We are currently giving Durban man some more time in the hope that he can identify a second hand computer that isn’t dented. If he can’t locate one, then we will either need to gamble on the dented computer (R600 at stake) or buy a new computer (R7000).
We have loved our time in South Africa but we will not miss the politics or dealing with car mechanics.
Tuesday, 26 April 2011
Excuse me officer
We decided to spend the Easter weekend in Swaziland at a game park. Choosing a destination outside of SA at Easter seemed wise. It meant avoiding the carnage on the SA roads (even more accidents happen at Easter than Christmas) and the SA holiday hoards (strangely unattracted to Swaziland). So, on Friday evening, we set off for Mkhaya Game Reserve, chosen especially in the hope that we would see two rare antelope (not that we have become spoilt).
Unfortunately, we failed to factor in ‘likely chaos at the border post’ in our decision to head to a neighbouring country. There were two main contributing factors. Firstly, the Swaziland border post had made no extra provisions for Easter. In fact, they had generously (or cruelly) given holiday to all but one man. They had left him with the world’s slowest computer to input all passport details. Secondly, unbeknown to us, Easter is a time for all South African Zionist to visit their Swazi brethren. Both entering and exiting Swaziland, we were behind at least three hundred of them – dressed from head to foot in green outfits. Thus we queued twice for at least a couple of hours under the very hot sun.
Our visit to Mkhaya was very special and well worth our problems at the border. We managed to see Roan (but not Sable) antelope. We also had intimate moments with Rhino, buffalo and elephants. But enough of that.
Our journey home was made memorable for our Swazi police encounter. Swaziland has very low speed limits that change almost every 200 metres without reason. And they have very active traffic police. The combination of these, together with the immaculate condition of Swazi main roads, means that there are far fewer accidents than in SA. For this they deserve much praise. However, the abundance of traffic police meant that we (or our friend driving) was caught driving slightly over the speed limit. And so we enjoyed another quintessentially African experience.
The first part of the scenario was as you might expect in the UK. A cop stepped out into the road and waved us down. Giving us Easter greetings he pointed towards his speed camera and informed us that we had been travelling 10 km/h over the speed limit. We owed 60 Rand (£6). Recognising our culpability, our friend immediately began paying one of the policeman. The other resumed his camera work.
So far so good, for African policing and law enforcement. But, midway through payment, another car zipped past the police, far faster than we had been travelling. Out stepped the policeman, only to receive a smile and wave without deceleration from the motorist. Into the distance went the car, without any response by the police. Suddenly, Mary was outraged.
M - ‘Why didn’t you stop that man?’
SP – ‘I tried to but he didn’t cooperate.’
M – ‘But why don’t you chase him?’
SP – ‘We have no car to catch him.’
M – ‘But we are now being punished for stopping.’
SP – ‘Don’t worry. I am sure we will get him when he comes back from the shops.’
M – ‘But, if he does return, he will just wave at you again.’
SP – ‘No, I am sure he will stop.’
The conversation was only halted by the approach of another motorist, clearly speeding. Having lost all faith in the traffic cop, Mary jumped into the road to wave him down. The bemused man was then told by a gleeful Mary that he had been speeding and must pay a fine. She showed him his speed on the speed gun. Attempts by the man to cut half-price deal were thwarted by Mary’s insistence that such negotiations were outrageous.
Eventually the man paid up, clearly worn down by the plain clothed and strange accented new Swazi police recruit. The joyous expression on my wife’s face told me of a career option overlooked. It took some persuasion to get her to curtail her work and return to the car. Eventually she agreed, satisfied that some justice had been done. And Swaziland’s motorists took a collective sigh of relief.
Unfortunately, we failed to factor in ‘likely chaos at the border post’ in our decision to head to a neighbouring country. There were two main contributing factors. Firstly, the Swaziland border post had made no extra provisions for Easter. In fact, they had generously (or cruelly) given holiday to all but one man. They had left him with the world’s slowest computer to input all passport details. Secondly, unbeknown to us, Easter is a time for all South African Zionist to visit their Swazi brethren. Both entering and exiting Swaziland, we were behind at least three hundred of them – dressed from head to foot in green outfits. Thus we queued twice for at least a couple of hours under the very hot sun.
Our visit to Mkhaya was very special and well worth our problems at the border. We managed to see Roan (but not Sable) antelope. We also had intimate moments with Rhino, buffalo and elephants. But enough of that.
Our journey home was made memorable for our Swazi police encounter. Swaziland has very low speed limits that change almost every 200 metres without reason. And they have very active traffic police. The combination of these, together with the immaculate condition of Swazi main roads, means that there are far fewer accidents than in SA. For this they deserve much praise. However, the abundance of traffic police meant that we (or our friend driving) was caught driving slightly over the speed limit. And so we enjoyed another quintessentially African experience.
The first part of the scenario was as you might expect in the UK. A cop stepped out into the road and waved us down. Giving us Easter greetings he pointed towards his speed camera and informed us that we had been travelling 10 km/h over the speed limit. We owed 60 Rand (£6). Recognising our culpability, our friend immediately began paying one of the policeman. The other resumed his camera work.
So far so good, for African policing and law enforcement. But, midway through payment, another car zipped past the police, far faster than we had been travelling. Out stepped the policeman, only to receive a smile and wave without deceleration from the motorist. Into the distance went the car, without any response by the police. Suddenly, Mary was outraged.
M - ‘Why didn’t you stop that man?’
SP – ‘I tried to but he didn’t cooperate.’
M – ‘But why don’t you chase him?’
SP – ‘We have no car to catch him.’
M – ‘But we are now being punished for stopping.’
SP – ‘Don’t worry. I am sure we will get him when he comes back from the shops.’
M – ‘But, if he does return, he will just wave at you again.’
SP – ‘No, I am sure he will stop.’
The conversation was only halted by the approach of another motorist, clearly speeding. Having lost all faith in the traffic cop, Mary jumped into the road to wave him down. The bemused man was then told by a gleeful Mary that he had been speeding and must pay a fine. She showed him his speed on the speed gun. Attempts by the man to cut half-price deal were thwarted by Mary’s insistence that such negotiations were outrageous.
Eventually the man paid up, clearly worn down by the plain clothed and strange accented new Swazi police recruit. The joyous expression on my wife’s face told me of a career option overlooked. It took some persuasion to get her to curtail her work and return to the car. Eventually she agreed, satisfied that some justice had been done. And Swaziland’s motorists took a collective sigh of relief.
Monday, 25 April 2011
Female Ward and Erysipelas.
Over the past two weeks, I have taken over the running of female ward. I was sad to leave Male Ward but also excited to take on a new challenge. Female ward is the biggest ward and divided in three sections – A, B and C. Sister Qwabe is the operational manager of the ward and I enjoy working with her very much. She proudly rejoices daily about her short height and rotund tummy, and isn’t afraid to call a mango, a mango.
Female patients are very different than my Male ward patients. Most obviously, I am dealing with lots of miscarriages. My challenge is to recognise which cases to medically treat and which to take to theatre for an evacuation. I had a woman on my ward in my first week that I discovered had a 25 week extra-uterine pregnancy (i.e. ectopic pregnancy)!
When I started two weeks ago, I had 8 cases of cryptococcal meningitis (all in section A) – a meningitis that only HIV patients get and that I had never seen in the UK before. It took me some time to remember who was who given they were in beds next to each other and many have the same surname. The treatment of choice is an IV antibiotic named Amphotericin B. But my use of this depends on stock levels. When out of this, I need to make a plan (as they say in SA). So far I have been relatively lucky despite not having the full course of this drug. One of my eight died (she also had TB meningitis and Bacterial meningitis) but the other 7 have gone home. Most of the women acquire this serious infection because they stop taking their anti-retrovirals.
Careful thought goes into deciding the location of each of the sections within our ward. Sister Qwabe explained that section B was behind the wall because they often have their breasts out and this would not be good to shock our visitors. It seems to me as if all the patients have their breasts out all of the time, but Sister Qwabe feels gogos are particular culprits.
I have 6 patients presently in my gogo section. One with a pelvic fracture (who will need to be an inpatient for 6 weeks for bed rest), an uncontrolled hypertensive (who did not know she needed to repeat her anti-hypertensives), a gogo (mother of 13) who surprisingly is HIV free, but has end stage cervical cancer, a paranoid schizophrenic who tries to escape every morning, a stroke patient and a t-cell lymphoma patient.
Section C is quite far away from the rest of the ward (where the nurses are) but has the new admissions, orthopaedic cases and the theatre cases. I feel these patients should be in Section A (given this is where we start the ward round each morning after we see the two ‘high care’ patients) but achieving change of this sort is a delicate process.
Another aspect of Female ward that I enjoy very much is the amount of singing and dancing. The sister and nurses love when I sing and especially when I dance with my bum out (Zulu way) – as you know I am completely tone deaf but they do not seem to mind. I reserve this for a daily special occasion – on Friday I had a young girl with a snake bite so we all started singing. The gogos love it and I think it makes patients feel more comfortable. Otherwise, I keep it as a treat at the end of the ward round.
Recent ward rounds have been more difficult because I have a swollen ankle. It is caused by a rare condition called Erysipelas. I knew I hadn’t injured it so the initial pain was very mysterious. I took a course of antibiotics and it has now almost completely disappeared. Hopefully my Zulu dancing will benefit from my added mobility.
Female patients are very different than my Male ward patients. Most obviously, I am dealing with lots of miscarriages. My challenge is to recognise which cases to medically treat and which to take to theatre for an evacuation. I had a woman on my ward in my first week that I discovered had a 25 week extra-uterine pregnancy (i.e. ectopic pregnancy)!
When I started two weeks ago, I had 8 cases of cryptococcal meningitis (all in section A) – a meningitis that only HIV patients get and that I had never seen in the UK before. It took me some time to remember who was who given they were in beds next to each other and many have the same surname. The treatment of choice is an IV antibiotic named Amphotericin B. But my use of this depends on stock levels. When out of this, I need to make a plan (as they say in SA). So far I have been relatively lucky despite not having the full course of this drug. One of my eight died (she also had TB meningitis and Bacterial meningitis) but the other 7 have gone home. Most of the women acquire this serious infection because they stop taking their anti-retrovirals.
Careful thought goes into deciding the location of each of the sections within our ward. Sister Qwabe explained that section B was behind the wall because they often have their breasts out and this would not be good to shock our visitors. It seems to me as if all the patients have their breasts out all of the time, but Sister Qwabe feels gogos are particular culprits.
I have 6 patients presently in my gogo section. One with a pelvic fracture (who will need to be an inpatient for 6 weeks for bed rest), an uncontrolled hypertensive (who did not know she needed to repeat her anti-hypertensives), a gogo (mother of 13) who surprisingly is HIV free, but has end stage cervical cancer, a paranoid schizophrenic who tries to escape every morning, a stroke patient and a t-cell lymphoma patient.
Section C is quite far away from the rest of the ward (where the nurses are) but has the new admissions, orthopaedic cases and the theatre cases. I feel these patients should be in Section A (given this is where we start the ward round each morning after we see the two ‘high care’ patients) but achieving change of this sort is a delicate process.
Another aspect of Female ward that I enjoy very much is the amount of singing and dancing. The sister and nurses love when I sing and especially when I dance with my bum out (Zulu way) – as you know I am completely tone deaf but they do not seem to mind. I reserve this for a daily special occasion – on Friday I had a young girl with a snake bite so we all started singing. The gogos love it and I think it makes patients feel more comfortable. Otherwise, I keep it as a treat at the end of the ward round.
Recent ward rounds have been more difficult because I have a swollen ankle. It is caused by a rare condition called Erysipelas. I knew I hadn’t injured it so the initial pain was very mysterious. I took a course of antibiotics and it has now almost completely disappeared. Hopefully my Zulu dancing will benefit from my added mobility.
Friday, 22 April 2011
Megaphones and t-shirts
It turned out my Easter holiday was a week long. And wasn’t an Easter break. I was back at school last week but now have a long weekend.
During my week of holiday, I visited some of my Grade 7 pupils at home. A while ago, I committed to providing the school I taught at in the UK with stories of the home lives of some of the children at Ntabayengwe. So I set off with camera, mouth and ears, to snap some pictures and chat with them about their home lives. Predictably, it made me all the more amazed by their resilience and spirit. A few of the kids live in houses. Some of these have electricity. The fortunate have a jojo to catch rain water. However, most live in mud huts, walk a distance to fetch water and cook on an open fire each day. Days during the holiday are obviously very long, hard and boring. Not much sign of the new South Africa making a difference here.
Next month we have local elections. And suddenly the ANC is in town every night. With very loud megaphones to shout slogans. And some free t-shirts. Sadly this mega sophisticated style of campaigning seems to be more than sufficient to pick up votes. I am tempted to ask them whether they have any plans for fixing the main road (causing deaths each week), fixing the water supply so that local schools have taps with running water or improving the local hospital. But I think I already know the answer. We happen to know the ANC candidate. He ‘works’ in the hospital
I have just finished reading a book looking at the failure of African capitalism by an economist called Moletsi Mbeki (brother of the ex-President and one of his fiercest critics – especially for his treatment of Mugabe). It examines South Africa as a case study. It didn’t leave me feeling very optimistic. In summary, South Africa is still being run like a colony. By far the largest part of the economy is mining. From the huge profits made, relatively little is reinvested in infrastructure for the long term benefit of the country. For example, the public transport system has deteriorated in the last 25 years. Money that remains in South Africa (40% of all SA capital is kept outside the country) is instead pumped into the benefits system. There are now over 12 million on benefits (versus approximately 3 million in 1990). Many people in Ingwavuma receive these tiny benefits. And they have become completely dependent. Disincentivised from finding work many find a way of surviving on tiny amounts of rand a month.
Meanwhile, the soaring price of commodities has allowed the country to neglect the country’s manufacturing sector. South Africa once had a very promising textile industry. This has dwindled. Many skilled jobs have been lost. Thus, again, mining is undermining the long-term prospects of the country.
Sadly, corruption is also on the rise. South Africa has dropped about 20 places in the league table on honesty. Success in business and friendships at high or low level in government are very connected. Seemingly, bribery of the politicians was engaged in on a massive scale on the transfer of power in the 1990s as the wealthy white business elite sought to insulate themselves from the political earthquake. The culture of backhanders, cuts and deals with friends has grown fast.
Even at a low level, contracts from the different departments seemed to be tendered on friendships. A couple of weeks ago, I got a lift from a white guy from Jozini. He told me he had started up a business delivering food to local schools. He delivers food one day a week to three schools that are close together. Per school, per drop he makes 4400 rand (over £400). It means he and his business partner are making over 500,000 Rand a year profit from one day of work. He got the work because his business partner has friends in the department of education. Obviously these deals harm both private enterprise and the state services.
In theory, the impressive higher education facilities in South Africa should be making a big contribution to transforming the country. The country’s universities churn out 40,000 graduates each year. Positive discrimination means the black population makes up a large percentage of these. However, many graduates leave very quickly. And there is increasing evidence of the lowering of standards. Durban’s university has a particular reputation for not failing doctors with the right skin colour.
There are solutions offered in the book. But all are dependent upon South Africa developing a political system which requires their politicians to listen and act in the long-term interests of the people. The megaphone and t-shirt approach seems unlikely to achieve this.
During my week of holiday, I visited some of my Grade 7 pupils at home. A while ago, I committed to providing the school I taught at in the UK with stories of the home lives of some of the children at Ntabayengwe. So I set off with camera, mouth and ears, to snap some pictures and chat with them about their home lives. Predictably, it made me all the more amazed by their resilience and spirit. A few of the kids live in houses. Some of these have electricity. The fortunate have a jojo to catch rain water. However, most live in mud huts, walk a distance to fetch water and cook on an open fire each day. Days during the holiday are obviously very long, hard and boring. Not much sign of the new South Africa making a difference here.
Next month we have local elections. And suddenly the ANC is in town every night. With very loud megaphones to shout slogans. And some free t-shirts. Sadly this mega sophisticated style of campaigning seems to be more than sufficient to pick up votes. I am tempted to ask them whether they have any plans for fixing the main road (causing deaths each week), fixing the water supply so that local schools have taps with running water or improving the local hospital. But I think I already know the answer. We happen to know the ANC candidate. He ‘works’ in the hospital
I have just finished reading a book looking at the failure of African capitalism by an economist called Moletsi Mbeki (brother of the ex-President and one of his fiercest critics – especially for his treatment of Mugabe). It examines South Africa as a case study. It didn’t leave me feeling very optimistic. In summary, South Africa is still being run like a colony. By far the largest part of the economy is mining. From the huge profits made, relatively little is reinvested in infrastructure for the long term benefit of the country. For example, the public transport system has deteriorated in the last 25 years. Money that remains in South Africa (40% of all SA capital is kept outside the country) is instead pumped into the benefits system. There are now over 12 million on benefits (versus approximately 3 million in 1990). Many people in Ingwavuma receive these tiny benefits. And they have become completely dependent. Disincentivised from finding work many find a way of surviving on tiny amounts of rand a month.
Meanwhile, the soaring price of commodities has allowed the country to neglect the country’s manufacturing sector. South Africa once had a very promising textile industry. This has dwindled. Many skilled jobs have been lost. Thus, again, mining is undermining the long-term prospects of the country.
Sadly, corruption is also on the rise. South Africa has dropped about 20 places in the league table on honesty. Success in business and friendships at high or low level in government are very connected. Seemingly, bribery of the politicians was engaged in on a massive scale on the transfer of power in the 1990s as the wealthy white business elite sought to insulate themselves from the political earthquake. The culture of backhanders, cuts and deals with friends has grown fast.
Even at a low level, contracts from the different departments seemed to be tendered on friendships. A couple of weeks ago, I got a lift from a white guy from Jozini. He told me he had started up a business delivering food to local schools. He delivers food one day a week to three schools that are close together. Per school, per drop he makes 4400 rand (over £400). It means he and his business partner are making over 500,000 Rand a year profit from one day of work. He got the work because his business partner has friends in the department of education. Obviously these deals harm both private enterprise and the state services.
In theory, the impressive higher education facilities in South Africa should be making a big contribution to transforming the country. The country’s universities churn out 40,000 graduates each year. Positive discrimination means the black population makes up a large percentage of these. However, many graduates leave very quickly. And there is increasing evidence of the lowering of standards. Durban’s university has a particular reputation for not failing doctors with the right skin colour.
There are solutions offered in the book. But all are dependent upon South Africa developing a political system which requires their politicians to listen and act in the long-term interests of the people. The megaphone and t-shirt approach seems unlikely to achieve this.
Sunday, 10 April 2011
A Hard Week at Work
This past week has definitely been my hardest here at Mosvold Hospital. It started on Monday afternoon when I (unadvisedly) swallowed some blood from an HIV positive patient. How? I was trying to get a cannula in the worst Stevens-Johnson Syndrome patient I have ever seen. From head to toe he was covered in lesions and there was only a bit of free space on the dorsum of his right hand. It is important that SJS patients get lots of IV fluids as they can (and often do) die from renal failure (not actually from their severe skin rash). I had got a drip in during the morning so thought I would be able to emulate it again. I was wrong. I have been taking ARVs (anti-retrovirals) since Monday evening when it happened on a precautionary basis.
I knew Tuesday would be hard as I was on-call. We were short of five doctors and so the workload increased dramatically. I was scheduled for theatre and was the anaesthetist. Unfortunately, the baby from our c-section came out without a heart beat (fresh still birth). I ran the neonatal arrest for over 30 minutes (managed to secure the intra-uterine line, intubate, and give the adrenaline) but we never managed to get the little heart going again. It is the first time that this has happened to me in theatre and was obviously very sad. My colleague continued with the c-section and no one told the woman until she got back to the ward. Theatre is usually full of life here at Mosvold with singing and laughing. It was a very sombre few hours.
The rest of Tuesday dragged. The RU was heaving and I was the only doctor in outpatients department (OPD) for the afternoon. I worked all afternoon and night but eventually managed to get into my bed in the early hours of Wednesday.
For the first time since being here, I spent some of Wednesday with a Psychiatrist (consultant equivalent). As Male Ward doctor, I feel some despair for my acute cases. I have found that there is a lack of options for medical therapy and there is not the support system than exists in the UK (Community Psychiatric Nurses). It was wonderful to spend hours with the psychiatrist learning new things.
Thursday was supposed to be spent at two of our clinics. I had to drive a ‘vintage’ 4x4 again. The bumber was falling off, the bonnet didn’t close, my ring mirror was smashed, the passenger’s one was falling off, the horn didn’t work (necessary with the cows in the road) and the brakes worked intermittently. It took 2 hrs to find a very small piece of plastic which I was promised would hold the bumper together. The rest didn’t seem to concern our transport office. Given the lost time meant I was only able to visit one clinic.
Ndumo clinic is right near a game reserve with the same name. It is very close to Mozambique – close enough to confuse my primitive mobile phone. (I like to be able to use my phone when at clinic to ring specialists accessible on hotline numbers.) I saw just over 20 cases and admitted one - a little child who was 7 but looked 3 and had not been in school for one year due to his severe rash on head and neck. His skin was falling off and Gogo didn’t think it was a problem. It will most likely be HIV related but I thought he needed a bit of a sort out and convinced Gogo and child to come back with me to Mosvold. He is doing better on Paeds ward but it will take a long time.
Friday was alright. Male Ward is full at the moment so ward rounds are taking a long time. I managed to get to OPD for the afternoon where I saw a variety of cases. Unfortunately, we are having some difficulties with the nurses there at the moment. Circumcision camps are happening almost daily and we are all short staffed. The nurses are not helping the doctors and often the patients. I feel patients are suffering and would really like to stop the circumcision camps. I continue to do my best in an increasingly difficult set-up.
I was on-call all day Saturday - from 8.00 am until 5.00 am this morning. Lots of OPD cases, maternity challenges and sick patients on the wards. The low point was spending two hours from 1.00 until 3.00 trying to get a 25 year old’s foreskin around a very swollen penis gland. I tried everything brute force, ice, sugary solution and a penile anaesthetic block but could not manage it and had to call in the acting medical manager. Luckily, he was understanding and found a solution in 15 minutes. Not sure how he did it but it involved lots of blood. Still, the episode provided lots of laughter for myself and Rosie. The nurse and patient found it less amusing.
Despite this difficult and trying week, I still love it here. Today has been really nice. I managed to get some sleep and enjoy a lovely swim at the dam with Henry and Rosie. Lots of my colleagues were about giving us a chance to socialise and forget work for the day.
* Rosie is a Warwick Medical School elective student who has been with me all week. I feel sorry she has had such a tough first week on her elective. She has been great company, really helpful and I have been lucky to have her around.
I knew Tuesday would be hard as I was on-call. We were short of five doctors and so the workload increased dramatically. I was scheduled for theatre and was the anaesthetist. Unfortunately, the baby from our c-section came out without a heart beat (fresh still birth). I ran the neonatal arrest for over 30 minutes (managed to secure the intra-uterine line, intubate, and give the adrenaline) but we never managed to get the little heart going again. It is the first time that this has happened to me in theatre and was obviously very sad. My colleague continued with the c-section and no one told the woman until she got back to the ward. Theatre is usually full of life here at Mosvold with singing and laughing. It was a very sombre few hours.
The rest of Tuesday dragged. The RU was heaving and I was the only doctor in outpatients department (OPD) for the afternoon. I worked all afternoon and night but eventually managed to get into my bed in the early hours of Wednesday.
For the first time since being here, I spent some of Wednesday with a Psychiatrist (consultant equivalent). As Male Ward doctor, I feel some despair for my acute cases. I have found that there is a lack of options for medical therapy and there is not the support system than exists in the UK (Community Psychiatric Nurses). It was wonderful to spend hours with the psychiatrist learning new things.
Thursday was supposed to be spent at two of our clinics. I had to drive a ‘vintage’ 4x4 again. The bumber was falling off, the bonnet didn’t close, my ring mirror was smashed, the passenger’s one was falling off, the horn didn’t work (necessary with the cows in the road) and the brakes worked intermittently. It took 2 hrs to find a very small piece of plastic which I was promised would hold the bumper together. The rest didn’t seem to concern our transport office. Given the lost time meant I was only able to visit one clinic.
Ndumo clinic is right near a game reserve with the same name. It is very close to Mozambique – close enough to confuse my primitive mobile phone. (I like to be able to use my phone when at clinic to ring specialists accessible on hotline numbers.) I saw just over 20 cases and admitted one - a little child who was 7 but looked 3 and had not been in school for one year due to his severe rash on head and neck. His skin was falling off and Gogo didn’t think it was a problem. It will most likely be HIV related but I thought he needed a bit of a sort out and convinced Gogo and child to come back with me to Mosvold. He is doing better on Paeds ward but it will take a long time.
Friday was alright. Male Ward is full at the moment so ward rounds are taking a long time. I managed to get to OPD for the afternoon where I saw a variety of cases. Unfortunately, we are having some difficulties with the nurses there at the moment. Circumcision camps are happening almost daily and we are all short staffed. The nurses are not helping the doctors and often the patients. I feel patients are suffering and would really like to stop the circumcision camps. I continue to do my best in an increasingly difficult set-up.
I was on-call all day Saturday - from 8.00 am until 5.00 am this morning. Lots of OPD cases, maternity challenges and sick patients on the wards. The low point was spending two hours from 1.00 until 3.00 trying to get a 25 year old’s foreskin around a very swollen penis gland. I tried everything brute force, ice, sugary solution and a penile anaesthetic block but could not manage it and had to call in the acting medical manager. Luckily, he was understanding and found a solution in 15 minutes. Not sure how he did it but it involved lots of blood. Still, the episode provided lots of laughter for myself and Rosie. The nurse and patient found it less amusing.
Despite this difficult and trying week, I still love it here. Today has been really nice. I managed to get some sleep and enjoy a lovely swim at the dam with Henry and Rosie. Lots of my colleagues were about giving us a chance to socialise and forget work for the day.
* Rosie is a Warwick Medical School elective student who has been with me all week. I feel sorry she has had such a tough first week on her elective. She has been great company, really helpful and I have been lucky to have her around.
Tuesday, 5 April 2011
Train him up
Easter approaches and so we are into school holidays. This means I’m at home doing jobs and reading about near nuclear catastrophe (excellent book called ‘The Dead Hand’ about cold war relations - thanks M&D).
One of my highly important holiday jobs has been making fruit juice. We have lots of fruit trees in the holiday grounds. Getting avocados can be tough as the trees are close to the sleeping quarters of the heavily pregnant lady unit. And they are extremely good at hoisting themselves up the trunks at the first sign of pickings. Fortunately, they are less keen on limes.
Last week, Mary and I picked a bag full of limes. And I went to work in the kitchen. After an hour of de-juicing, the mixing began. Into a big pot went 1 1/2 litres of water, 2 kgs of sugar, citric acid, something else acid and some baking soda. And then onto the big hob. An hour later I had four wine bottles full of lime juice. Initially I was under whelmed by my work. Surely four wine bottles worth would be drunk in a couple of days? But then the delight. I had apparently been making concentrate. So a week on and we have drunk less than half a bottle. Furthermore, the flavour of the drink is highly commendable. Definitely worth a prize in the Woodstreet Village Show. With some potential for development as an alcopop.
I sense that I may soon be called upon for even more serious work. For this week we are very short of doctors. There were due to be three doctors on holiday. However, another has fallen ill and her partner (another doctor) is with her. Meaning we are down to five and a half. Resources are being stretched further by pressure on the hospital to meet its circumcision quota. At the moment, this seems to be the only health target of interest to the politicians (they see it as a way of reducing HIV; in fact the benefits of reduced infection risk are highly likely to be offset by misconceptions in the community that it results in immunity from STDs). As a result, one of the two most experienced doctors remaining is being forced to go to circumcision camps all this week. Thereby highly jeopardising lives of patients in the hospital. I think the solution is to send me to do the circumcisions. I'm sure I'd manage. And I've got a favourite joke I could tell to help settle nerves (‘What do you call a cheap circumcision? A rip off'.)
One of my highly important holiday jobs has been making fruit juice. We have lots of fruit trees in the holiday grounds. Getting avocados can be tough as the trees are close to the sleeping quarters of the heavily pregnant lady unit. And they are extremely good at hoisting themselves up the trunks at the first sign of pickings. Fortunately, they are less keen on limes.
Last week, Mary and I picked a bag full of limes. And I went to work in the kitchen. After an hour of de-juicing, the mixing began. Into a big pot went 1 1/2 litres of water, 2 kgs of sugar, citric acid, something else acid and some baking soda. And then onto the big hob. An hour later I had four wine bottles full of lime juice. Initially I was under whelmed by my work. Surely four wine bottles worth would be drunk in a couple of days? But then the delight. I had apparently been making concentrate. So a week on and we have drunk less than half a bottle. Furthermore, the flavour of the drink is highly commendable. Definitely worth a prize in the Woodstreet Village Show. With some potential for development as an alcopop.
I sense that I may soon be called upon for even more serious work. For this week we are very short of doctors. There were due to be three doctors on holiday. However, another has fallen ill and her partner (another doctor) is with her. Meaning we are down to five and a half. Resources are being stretched further by pressure on the hospital to meet its circumcision quota. At the moment, this seems to be the only health target of interest to the politicians (they see it as a way of reducing HIV; in fact the benefits of reduced infection risk are highly likely to be offset by misconceptions in the community that it results in immunity from STDs). As a result, one of the two most experienced doctors remaining is being forced to go to circumcision camps all this week. Thereby highly jeopardising lives of patients in the hospital. I think the solution is to send me to do the circumcisions. I'm sure I'd manage. And I've got a favourite joke I could tell to help settle nerves (‘What do you call a cheap circumcision? A rip off'.)
Subscribe to:
Posts (Atom)