Day 21

Day 21, I knew he looked awful, he was sweating so much earlier and he could barely speak. I can hear his chest from the end of the room, looks like there’s a bit of blood in the face mask. The xray looks horrible, it’s probably TB but I ought to treat him for everything, I almost can’t believe his status is negative. I’ve already got him on broad spectrum antibiotics and as hi flow oxygen as we have, it’s ridiculous that we don’t have 100% O2 masks. Is there anything else I can do? He doesn’t look too wasted and he isn’t really very old. I can just pummel him with fluids, antibiotics and see how he does...

...Ok, I better go and check him out again, the nurses seem to be getting concerned. Balls! He’s about to tank it, better get some help. Ok, so Jo’s on the compressions, need some gloves and the resus trolley. Surely we’ve got to try, he’s not even positive, let’s start bagging him and call the others. How about one of you nurses start timing and give us an airway while you’re at it? Yeah I think adrenaline would probably be a good idea, I hope someone else can take over soon, I’m getting knackered...

...So what do u guys think, try intubating him? I forgot about the guy in OPD who was being ventilated, and I guess what is the point if there are no ICU beds in the whole province because of the strikes. We managed to get the pulse back, let’s try and do something for him. I’m happy to keep bagging and his pupils still seem OK. Fair enough intubation isn’t an option and he is making some respiratory effort. We haven’t got CPAP, do you think chest physio could help get some of the secretions off?

Well we’re agreed, if he arrests again we shouldn’t resuscitate him. Is the physio helping? We should find out about the bloods from the morning. Damn, his kidneys are in failure as well. He’s going to need a catheter and lets up the antibiotics. Well if he makes it through the night we can try and refer him again tomorrow...

...He’s gasping. That’s probably going to be as much as we can do. His wife thought he was gone the first time, if you’re OK talking to her then I’ll document. “Not for further intervention at this time, plan – keep comfortable”.

http://www.youtube.com/watch?v=r87YEtf9jpo

Day 19, Lie Ins

Day 19, I’m beginning to think the concept of a late start doesn’t exist in South Africa, at least not anywhere near Mseleni. Our workday starts early, every morning at 730am. And it seems that is not enough as at the weekends you seem to get up even earlier. I suppose it is maybe to try and make the most of the time spent not working.

After having done my on call on Thursday night (even though I wasn’t woken up during the night as my woman managed to deliver naturally and did not ultimately require a Caesarean) I was in at work in the morning and continued during the day. At the weekend I was being woken up at 545am, admittedly under my own volition. The reason this weekend was Thembe Elephant Park.

Game drives are great fun but in order to get the most out of it one has to balance the availability of light with the activity of the animals. Unfortunately for me this meant hauling myself out of bed at the unearthly hour to set off on the drives. Admittedly I was well rewarded for my efforts, I saw a bull elephant charge around, a pair of elephants scaring a rhino and a lioness munching at a lowly nyala for breakfast, as well as a couple of dozen other creatures.

The effort needed to wake up was made even harder by the luxury of my accommodation; I was in a permanent tent with a bathroom and a seated veranda. The morning chill was countered by the electric blankets and one could simply lie in bed and listen to the distant rumbles from the elephants and the patter of bush baby feet on the tarpaulin roofs.

One can try and compensate for the early starts by going to bed at a sensible time, what is known as Mseleni Midnight i.e. 10pm. Through no one else’s fault but my own, over the weekend I did not manage to turn in sensibly, instead I spent the evenings speaking to other visitors to Thembe. I blame the campfire and the South African reds I was drinking.

At any rate, after the exertions of the week and the excesses of the weekend, I could really go for a good old fashioned lie in. Seeing as I’m on call again tomorrow, might have to wait until next weekend.

http://www.youtube.com/watch?v=Bv4sfT0tnVA

Day 17

Day 17, I’ts just gone 11 at night and I’ve just come back from the OPD. I’m on call today and there has been a steady stream of patients, most of them minor injuries and I have spent the last 4 hours suturing patient after patient. I’m feeling a little sleepy but I have the South African Family Practice Manual open and am desperately trying to read up on general anaesthesia.

This is because I don’t expect to be sleeping through the rest of the night, there’s a primip on labour ward and she’s failing to progress, the baby is starting to get distressed and we’re probably going to have to do a caesarean section tonight. I’ve been prepared for this, I was aware that it might come to this and I even went to a couple of sections to see the spinals being given during the day time. It’s not a whole lot different to doing lumbar punctures and I think I’m fairly happy to have a go.

Slight hitch however. She’s spiked a fever and dropped her platelets, to the non medics out there this basically means that we can’t use a partial (regional) anaesthetic and if as expected we take her to the operating theatre, then I am going to have to administer a general anaesthetic and put her to sleep. This is the point where anyone in my position, never having ever even been close to administering a general, would start spewing a barrage of expletives.

Seeing as I’ve never used the anaesthetic machine before I’m hoping if it comes to it, then the surgeon on call is going to be able to whip this baby out before the ketamine wears off. The thought of how things could go wrong and I could end up having to intubate her and use a ventilator to support her breathing is pretty scary but at the same time exhilarating, like the climb up to the top of a rollercoaster, right before you get hurled in all directions.

Don’t know how this is going to play out, better carry on with the reading.

http://www.youtube.com/watch?v=ghPcYqn0p4Y

Day 14, Another Monday

Day 14, Two weeks in now and the start of another week things should start to fall into some sort of routine, that was the plan at any rate. Two things have gotten in the way of this grand design. The first is that the strike restarted in full force after the weekend, staffing is a little better but the limitations of what we are working with are all too evident. The second is that this is Africa, and in rural Africa life goes on, or not.

The morning ward round took us to paediatrics and my fitting child from the other day was first up. He looked worse than he did on admission and despite our best efforts over the weekend he had deteriorated. We collectively knew what we were witnessing as we saw that his oxygen levels were dropping despite being on masks. His sister was in the vicinity but she did not quite understand what was happening as his breathing became more angular and gasping. His face was expressionless behind the plastic mask and seemed worn down, as if he was tiring in a race he had no hope of completing. We moved on to give him some dignity in his last few moments.

One of the other doctors stayed behind to talk to the sister, by now she was aware that something was wrong. As we started to look through the notes and x-rays of a boy down the corridor we heard a cry go out. We pressed on with those that we could actually help and I watched from afar as the nurses pulled a room divider across, it couldn’t stop the sobs carrying through to the rest of the ward.

That was Monday morning.

http://www.youtube.com/watch?v=raVfK6__rJ0

Day 13, Stalking Prey

Day 13, I’m driving down the road as light is fading in Hluhlwe I come over a hill and I see a shape in the distance walking in the middle of the road. It’s trotting along quite slowly and though the thought crosses my mind, but I tell myself it must just be an impala, it cannot be this easy. I slowed right down to see if the shape is perturbed by the presence of four people in a Toyota yaris. As I edge closer it keeps on walking but I am catching up to it. Now I’m too close to disbelieve, but she is actually right in front of me marching along the road, without a care in the world. She waddles slightly with a very full middle, either having just fed or pregnant.

I try to keep pace with her, edging ever closer, juggling my camera with the steering wheel as my friends lean out the windows. I am wary even as she is, care free, she could easily turn around attack if she felt threatened. I see a car in the side mirror coming along at some speed about to overtake me, and I drift to the middle of the road to block them for fear that they will scare her off. They slow down near me and slowly realize the extraordinary situation we have. The Clio pulls up beside me and we continue to stalk her side by side across the breadth of the road. She turns around every now and then in disdain but carries on walking.

We carry on fixed on her for what seems an eternity in the fading light but is actually only matter of ten minutes. Eventually one of the official game drive canopied cars creeps over the hill ahead. She continues as it drifts closer, and walks past its side as the passengers snap pictures in a blaze of flashes. I start swearing at them under my breath thinking they will definitely make her turn into the bush. She doesn’t. It is only when a further car comes that she has enough and turns off into the camouflaging brush land.

I turn around to my friends, my heart still pumping that I’ve not only seen my first lion in Africa, but that I’ve had the sheer audacity to stalk her. I am exceedingly glad that the strike back Mseleni has had a weekend respite and that we’ve been able to come out here after all.

http://www.youtube.com/watch?v=aCca5mPMp9A