Day 51, Crazy

Day 51, The absurdity of what we do here really hit home today. Unsurprisingly it takes an on call to bring it to light. I picked up a card in the OPD and saw my handwriting in the notes of the next patient I had to see. I had seen him a week ago and identified that he had a degree of heart failure but felt he would be alright at home. He came to today a puffy and bloated man who was essentially drowning himself. Something about a 40 year old with heart failure didn’t add up so I decided to stick the ultrasound probe on him. As I looked up at the dark area around his heart I realised it was actually fluid.

From radiographer I moved to paediatrician with the next patient. A 9 monther who had being given a Zulu remedy enema to help with her diarrhoea and vomiting. Earlier in the week we had a healthy 5 month child who had come following a Zulu enema. His kidneys eventually stopped working and before we knew it he had died, I did not want my patient to follow suit. It was as usual nigh impossible to get a drip into her arm, pudgy and healthy as she was, it made it much more difficult to do what I wanted.

I then got called to help with a caesarean and played anesthetist doing the spinal again. Of course there’s only two doctors out of hours and that means when the baby comes out and refuses to breath, one of you has to descrub and help the baby. This happened to me and the blue baby did not comply with the nasty oxygen habit we wanted to give it. I had to resuscitate the baby all the while hoping mum’s anaesthesia didn’t start to compromise her.

Of course whilst in theatre I received a call from one of the local clinics reporting a patient came in following a car versus cow accident. He said a few word before collapsing into a heap. The clinic sister had called to see what could be done as the ambulance service was not contactable. We gave some basic resuscitation advice but then remembered some of the doctors had gone out to the beach and were having dinner near by. I gave them a ring, more out of hope than expectation and they said they would swing by on their way home.

I got called again once they had seen the patient and they said it was pretty messy. The guy was responding minimally but things were deteriorating fast. The ambulance had mobilised at this stage and we were getting prepped in the OPD for the arrival. It was a far from pleasant sight. He had a bandaged head injury, he wasn’t making any sound or movement the oxygen masks were covered in rapidly clotting blood.

After I had attempted to enhance my intubation skills, and my colleague actually succeeding we started to manually respire for the man. Of course our ventilator was missing a piece so we were left with very few options for a man who was for all intents a purposes in a vegetative state. For my most recent transformation I turned into judge and jury as the staff present agreed to the most humane course of action was to give him pain relief and let nature take its course.

Its seems crazy what the variety of what my responsibilities are. I’m aware that as I fall asleep I will constantly be thinking about the next obstacle that will inevitably rouse me from my slumber during the course of the night. Of course the pizza my friends brought me back whilst performing the resuscitation does sum up the ludicrous world I live in.

http://www.youtube.com/watch?v=4Fc67yQsPqQ

Day 48, Kruger

Day 48, The perception of distances is very different in South Africa. On our tiny little island back home driving for 6 hours gets us from one end to another, in fact we could probably be halfway through France if the traffic is kind. In my former life, the trip to Kruger National Park this weekend would have seemed epic, here it was just a long weekend.

My trip was technically an international journey as I had to traverse the border for the miniature kingdom of Swaziland, it was actually shorter to go through it than round it. Driving does not feel as much a chore in this part of the world as it does in the UK. I have yet to work out whether it is because having a car is a privilege or whether it is simply due to the vastness of this country.

Nowhere was the vastness more noticeable than at Kruger where the game park stretches for miles on end. Impossible to take in the entire park in any single visit we confined ourselves to the southern section. Yet again our days started hellishly early to reach the gates before the queues built up and sun was too strong.

The graft did not go unrewarded as we saw elephants, buffalos and rhinos. There was a group of chacma baboons with amusingly revolting rear ends doing everything from backflips to 360s and even a few the more senior ones just pausing to scratch themselves like only and old man can. Later on in the day we had good viewings of hyenas tending to their pups, and odd blend of mangy with a dollop of the cute factor. However the highlight of the trip had to be lions. We saw a group of four lions on our first day just sitting on the edge of a verge, looking fairly resplendent in the afternoon sun. We were quite pleased with that until the following day.

As we drove down one of the tracks we saw a little clutch of cars peering down a slope, at the bottom of which were three bushy maned male lions. You could hear a strange rumbling nose reverberating around the valley and it took me a few seconds to realise it was emanating from the lions. They seemed quite curious of the cars and proceeded to take a wonder around the vehicles as people poked out of their cars to see who could get the most outrageous close ups. One of them eventually wandered next our car and for the first time I refrained from leaning out to take another picture.

The excitement of the lions was fairly special but I was left slightly disappointed by yet another game park visited without spotting a leopard. On the upside it gives me an excuse to keep exploring all the wonderful parks in this country.


http://www.youtube.com/watch?v=cgn78fCZkbk

Day 44, The First Departure

Day 44, I got my first taste of one of the sadder experiences at Mseleni, namely the departure of a doctor. The nature of most of the doctors, and some of the therapists, mean that we are all fairly transient. Stays vary between months to a year on the whole and people constantly overlapping. I get the feeling that most here have become quite used to the idea of friends leaving and new faces coming in.

The joy of being such a close community that treat each other as families is that the loss of a member affects you that much more. And though they maybe moving onto their lives in the outside world you can’t help but feel a pang of guilt at the wish for them to stay. It isn’t simply because it means there is one less person to share the workload of the day, or one less person to go to for help, or even one less person to go away with for a weekend trip. It is more the feeling of losing a connection.

My time in Mseleni has been brief but the friends I have made feel much longer standing. Of course, we say goodbye with food and drink and warm embraces, and we speak of remaining in touch with all the ways and means afforded by modern technology, but one wonders how it will be once the “real world” intervenes. That is not say that what I am experiencing here is any less real, but more that it is likely to be the anomaly rather than the norm. And once we are taken out of this world of Mseleni, will I still be able to maintain the bonds I have made? I would certainly hope that I could.

I suppose before the end of this year I will feel this way again on more than one occasion and end up approaching it with the same sort of bonhomie as everyone else, such is the nature of life in our little corner of the world.

http://www.youtube.com/watch?v=Qf2S7kKLtEQ

Day 41, Weekend On Call

Day 41, Mseleni is a pretty isolated place at the best of times but there’s a genuine sense of extended families with the doctors and therapists here which one feels most in their absence. Such is the feeling you get over a weekend when everyone takes off either collectively or individually to enjoy life away from here. Of course part of the deal of being here is I occasionally have to do some work and accordingly this has been my first weekend on call.

The on call essentially means that you start covering from a Friday and finish on Monday working 80 hours in a row, during the course of which you can be called at anytime and are required to look after the whole hospital. But of course having one person covering would be foolish for a hospital of 200 beds, maternity, paeds, medical, surgical and the emergency department; so they have two.

Nowhere have I felt more alone then when faced with a labouring woman. Being called at the wee hours of the morning to be asked by experienced midwives to help deliver a baby is not everyone’s idea of a nightmare, but it is certainly mine. During daylight hours at least there is support to help you through it. At night all I have to go on are the recesses of my knowledge trying to channel med school lectures from 5 years ago or the little books I carry around. I’m sure to an outsider it must look quite odd when I have to step out of the delivery room, have a quick leaf through my book and then return with some pearl of wisdom every few minutes!

Being cornered into making decisions isn’t always a bad thing as it means you are often bolder in your choices. This weekend I’ve so far had to decide to intubate a patient, drain a bartholin’s abscess, and put in an intraosseus line, all with minimal prior experience because push came to shove. The bottom line is that if I fail to even try then the patients really would have no hope so it is the best of a bad situation.

The fractious nights lead to my thinking becoming less analytical and more pragmatic. The nurses are fairly understanding and try not to call you for every little thing but even so you rarely get an undisturbed night. The colleague you are on call with will try not to wake you if they are called and courtesy is repaid as much as possible. However if an emergency happens then you are both there in the dead of night despite neither of you having decent sleep.

But on Sunday, almost at the end of the slog the extended family starts trickling back and the lonely atmosphere is replaced by the friendly faces. The very real sense of community was no more apparent when they brought me back a 6 piece of chicken from KFC from their weekend away. A little bit of junk food heaven, but the sentiment was perhaps more satisfying than even the colonel’s secret blend of herbs and spices. I may yet survive this adventure.

http://www.youtube.com/watch?v=HaVXfHZv50Y

Day 35, A Month Gone

Day 35, One of the things that I’m beginning to realise about Mseleni is that there is rarely anything one could possibly call a normal day. Being on call again last night I was contacted by the nurses to be told that an abdominal injury had come in to the OPD at 2am. They assured me that the wound was dressed and the vitals were stable. I took this courtesy call at face value and eventually fell back to sleep. I went in early this morning to ensure things were under control and see the wound.

The nursing documentation of the wound sounded ominous despite the patient looking fairly comfortable, he had had a chunky dose of pethidine though. As I pulled back the dressings I was somewhat taken aback to find his stomach merrily lying on top of his abdomen. This is not something one expects in the best of times, and least of all when you’ve been reassured that the patient is fine. I duly had a gentle prod of it, trying to discern if any of his bowel was out as well and was unable to visualise the actual wound. He had a laparotomy later in the morning and everything was pushed back into its right place.

Later on in the day I finally had my interview. Now that the strikes have been “suspended”, a panel of two of the senior doctors and two nursing bigwigs grilled me for a job I have been doing (perhaps sometimes questionably!) for the last month. Though they have said they will contact me in a couple of days to let me know the result, it would be hard to see them not employing me as I represent about 10% of the workforce. It is wonderfully liberating to do an interview in this no pressure situation, I was very tempted to be facetious especially as my colleagues on the panel kept giving me wry smiles. In the end professionalism won out.

To wrap up this day of variety I was walking past the OPD on the way home when one of the med students was struggling with a lumbar puncture. Perhaps feeling slightly overwhelmed by her first attempt at the procedure she asked me to take over. I duly did knowing full well that I was still quite new to it all, and even gave tips to the med student. Without realising it a month has passed on this job and suddenly I’ve gone from clueless to teaching others.

http://www.youtube.com/watch?v=VrpGhEVyrk0

Day 30, An Issue of Race

Day 30, You can’t really get away from the issue of race in South Africa. After so many years of people literally being defined by their race it should probably come as no surprise. It seems fascinating that in urban areas it is a melting pot of races with origins from further afield, but all have adapted an identity unique to their community in this country.

I got a breakdown of the four main groups; blacks, whites, coloureds and Indians. Just saying these out loud pangs on my “western” sensibilities. Even after 15 years of post apartheid democracy the divisions are still present. The neighbourhoods, the nightclubs people go to, even the foods they eat. However the Rainbow Nation is moving on; my course was been lectured by a black woman who was head of her research department on TB and HIV whilst outside there was a middle aged white man begging on the Durban beach front. These would be unheard of under apartheid.

Being lulled into a false sense of optimism, I wasn’t really prepared to see my first display of genuine racial derision. I will be vague about the context but I was in conversation with a white gentleman in his sixties. He was originally from Northumberland but had been here since the 1970s, his accent did not give him away at all. I was on the beach front in Durban and as we were discussing a matter a local hawker, a black guy, kept interrupting us to try and sell his wares. Particularly he was trying to peddle black leather belts. After a few cursory “no thanks” from me, the man I was talking to was getting very frustrated. He snatched at a belt from the hawker and glared at him with genuine disgust whilst holding the belt threateningly.

“This’ll be round your neck if you don’t go away”, he snarled in his rolling Afrikaaner accent. The hawker was perhaps as stunned as I was to hear what he said and kept repeating “what did you say?” The man just looked at him and slowly replied, “you heard what I said, now go away”. The hawker gave me a knowing glance, to suggest this was not the first time he was looked at like that, and the reality is it probably won’t be the last. He muttered something about “you can’t be like that”, before taking his belt back and moving off.

The man then turned to me and continued his conversation. He seemed unperturbed by the fact that I was not white. I went straight back into conversation however reflexively I was now speaking with my most enunciated and pristine English. Perhaps this was a subconscious effort on my part to show him that I should not warrant a similarly hateful manner.

For some, hopefully a minority, the old sentiments seem to bubble under. It is genuinely ugly when these spill over to the surface and I truly hope that I never have the capacity to look at another human being in that manner.

http://www.youtube.com/watch?v=QQtLoJlQD6E