Day134, Not Christmas

Day 134, I’m sitting at Durban airport waiting to go India, where I will see my family and attend my friends’ wedding. The PA system is playing seasonal music but nothing here has felt like Christmas over the last few weeks.

The heat has probably been my greatest challenge, especially recently where it has reached close to 40^oC by mid morning. By the time I make it from my room to the hospital I can already feel beads of sweat trickle from my forehead down my nose. Having to exam patients, write in notes and do sterile procedures with dripping sweat is less than pleasant. But I suppose as my South African colleague says, it isn’t Christmas unless there is a fat man in a Santa suit drenched in sweat.

Another on call where I failed to resuscitate a baby from the effects of traditional medicines being administered and a 19 year old with a blocked spinal fluid shunt returning from the neurosurgeons completely blind was again not in keeping with my idea of the festive season. To top it off, as harbinger of doom I had to tell another patient he had an aggressive lymphoma that we wouldn’t be able to cure, no Christmas miracles here.

Everyone still tries to make an effort, there was a hospital carolling service in Zulu. I couldn’t follow the passages being read but the spontaneous and unchoreographed choral singing and dancing was amazing. A little bit of Ladysmith Black Mambazo in Mseleni. People are wishing each other merry Christmas and talking about the braais they are going to prepare. Even little bits of shredded tinsel can be seen sporadically.

My friend’s homemade mince pies were a nostalgic pleasure but was tempered by the fact that two of them are leaving when I return, much in the pattern of things here it is a recurrent cycle of gaining and losing those that you become close to.

As I think about all my exploits in the previous four months I know I wouldn’t trade it for a better Christmas. And at least with such a non-Christmas I don’t mind spending most of the 25^th in the air. Bah Humbug!

http://www.youtube.com/watch?v=estgBGmkF58

Day 125, The Clinics

Day 125, It is probably no secret that the highlight of my working week is usually my Friday clinic trips. The flights there play a big part of the attraction but increasingly I am finding the nature of what is done at the clinics to be fascinating.

It is the coalface of healthcare, except it isn’t merely an alternative to the gp surgery. These clinics maybe the only medical health that many of the people here will receive. They deal with acute emergencies, manage anti retroviral therapy provision and even help disseminate social support. Of course the degree to which they succeed is variable and extremely dependent upon the nursing staff and to a lesser extent the doctor that attends.

Last week my clinic, Ezimpondweni, held a special function for Christmas and invited many of its regular patients to attend for a lunch. Before the food were speeches by notable people in the community and some public gift exchanges and a DJ spinning African beats. I was of course not informed of the day’s events in advance and when I arrived there I was told that I would be called out to make a speech about the service and HIV.

Half way through my clinic I was summoned to the podium and with the help of my translator I had to address the hundred or so hungry attendees. I was a little bit embarrassed but managed to blurt something about making sure people take treatment, thanking the staff and saying how HIV is a perfectly manageable condition. They seemed to enjoy it and I was presented with a gift, it didn’t make it any less meaningful that they had spelled my name as Data

I was then invited to eat at the head table with my fellow speakers. Lunch inevitably included chicken, rice and the now familiar staples of chakalaka and butternut. As I ate I noticed that most of the patients in attendance were women and children. I asked one of the clinic staff whether this was because the men were at work during the day but it turns out that it is because mostly it is the women that regularly engage with the clinic services.

If South Africa’s health service is to thrive I feel that it will be through the strength of the clinics that it will do so. It is a shame that often a top down approach means that hospitals tend to get a larger share of the resources to provide for a smaller portion of the population.

http://www.youtube.com/watch?v=wa2nLEhUcZ0

Day 118, Cheetahs and Turtles

Day 118, Infinitely cool. I can’t really explain it any other way. In London there is never a dearth of activities however as with so many things, the scale here is massively different. Over the past couple of days I have had the privilege to be enamoured with the beauty of what is on offer in this country. Yesterday, after work I was licked by a cheetah, today I watched as a turtle laid her eggs.

Just an hours’ drive from Mseleni there is a sanctuary and rehabilitation centre for some of the bigger cats in the region. They have a selection of servals and caracals, not to mention cheetahs. With two of my friends due to leave soon, they have been making a concerted effort to sample all the region has to offer before their departure, luckily I get to tag along.

So it turned out that a short while after leaving work I was sitting in and amongst three cheetahs who munched on a healthy portion of chicken and then proceeded to lick my arm with their coarse sand paper tongues. These beautiful beasts were amenable to being petted, touched and the male even lay down on my lap purring as I worried about my right arm and his head on my crotch.

In the spirit of making every day count, today we shot off after work towards the beach. The weather wasn’t brilliant but then we weren’t there for a swim. It’s the turtle laying season and they have been spotted up and down the coast. I saw one on my Friday clinic flight, but it was only a brief glimpse. I needed to see one up close, and my friend’s Landrover can drive on the beach

As we got stuck in the sand and the light started fading I had given up hope of seeing a turtle. However waiting for the tow truck we spied some rocks in the distance. We chanced a walk further along the bay and alas the rock moved! It was a loggerhead turtle slowly making her way up the beach to lay her eggs.

The animals were amazing to see and a brilliant experience but the fact that I can do this after a days work is what I still can’t get over. It is simply too cool.

http://www.youtube.com/watch?v=R8mMBT62rgQ

Day 116, Exhausted

Day 116, I’ve worked some long shifts in my time and it’s left me feeling absolutely shattered. When I first started working I recall working seven nights in a row and by the end of it my body clock was out of kilter and I would need a week to get myself feeling normal again. Working 13 hour days is fairly common place in the NHS and it does leave one feeling drained. But the senior doctors are always quick to remind of days gone by where working through a whole weekend was the norm

Out here this is essentially what we do, work from a Friday morning right through to end of play on a Monday afternoon. It is a genuine slog that varies on the luck of the draw. On my previous weekends I have been lucky enough to have some time to recoup during the call. I was due a bad one.

Having been in the OPD until late on Friday I found myself being called at 6 am on Saturday. It was a patient that had come in with horrible chest infection that looked like he was in for a quick exit. The day carried on unrelentingly from there with babies struggling to be born while others struggled to live; old women fitting in a cot and old men gasping for breath. I managed to sneak away for 10 minutes only to be summoned by labour ward again.

The day turned to night and I was still sifting through notes trying to see whether I could add anything to the treatments. When I finally made it home they left me just enough time to crawl into bed and drift into sleep before hauling me back into the conscious world; the walk up the hill getting ever more difficult with each trip up in the dark. It was 2am before I managed to collapse into a heap on my bed, fully clothed, with my stethoscope still round my neck.

The sheer exhaustion I felt is incomparable to anything I have ever experienced, I have never been required to be that alert for that period of time. In the past I have always enjoyed having busy on calls, because when you finish it there is a genuine sense of accomplishment that goes with the relief. This weekend all I felt at the end was separation from reality, a profound slowness of mind, body and soul.

http://www.youtube.com/watch?v=UCDcmpp3nPU