Day 164, Camping and Leatherbacks

Day 164, Camping is not something I’ve ever been a fan of. Sleeping in a tent is uncomfortable, it’s hot, sticky, and you’re constantly aware of all the bugs creeping in. Of course all these things are heightened in the heat of an African summer. So why is that I’ve come back from a weekend camping trip, bruised, battered but with a massive grin on my face?

The Mabibi setting certainly helped, the campsite is set along a bay in a virtually untouched part of the coast. The warm waters are hospitable at any time of the day and perfect for “parking off” when the sun is beating down. The rock pools at the point allow for a break from the waves and is a goldmine for snorkelling. Unfortunately for me the rock surface can be quite slippery and in my pursuit of wonderfully patterned fish that I know none of the names for, I managed to maim myself repeatedly

As glorious as the daytime was it was at night the real treats awaited us. With bright moonlight we set off along the beach more in hope than in expectation of the catching the tail end of turtle laying season. It was bright enough that we did not need to use our lights to spy a rock slowly edging up the beach. Of course it was a massive leatherback turtle on its way up to lay her hundred or so eggs.

As we approached the turtle, keeping a healthy distance a truck pulled up with a film crew and a conservation team. They proceeded to follow her very closely and to our dismay we were told to keep our distance. As she huffed and puffed trying to dig a nest she seemed to get perturbed either by the presence of the crew or the hardness of the sand. With conditions not right she did not lay and proceeded back into the sea. The conservationsists managed to take a few measurements, with a length of 175cm she probably weighed in excessive of 400kg.

As enthused as we were, the following day we chanced our luck again. Despite the odds we stumbled across another leatherback, this time just having finished laying. Without the pomposity of the conservationists, and happy in the knowledge that the laying had been a success we were uninhibited. I even took the opportunity to brush some sand off the waxy shell of the massive creature. Taking pictures we stood and watched as she slowly waded back into the sea, disappearing into the waves.

As long as there are beautiful rock pools, unspoilt beaches and moonlit nights with giant turtles laying eggs, camping may actually be tolerable.

http://www.youtube.com/watch?v=sNethmQyd4A

Day 160, The Lighter Side of OPD

Day 160, We see a lot of sick people in our OPD department every day. People with genuine illnesses who are struggling to stay alive, men, women, and children alike. It would be quite overwhelming but there are some rather more comedic cases that serve to lighten the mood.

One of the more common ones is when the patient has presented to ask you their age. A bizarre concept, and possibly in need of a psychiatrist in other settings, it is however a semi regular occurrence in Mseleni. Time is not a great concern here and as such seasons and years pass without any account. If you weren’t lucky enough to have an identity card then you may genuinely not know your age. Of course this is a problem if someone wants to collect a state pension, hence the question, “doctor, what is my age?”

Unfortunately I am not aware of many ways of aging a fully grown live adult, especially with the accuracy required for state benefits. The usual procedure is a referral to a social worker who will either look the patient up and down and come up with a magic number or try and correlate it with events at a certain time.

In a similar vein on more than occasion I have been asked the sex of a patient. Were this an unborn child during an ultrasound scan it is perfectly reasonable. However these tend to be adults who have been incorrectly mislabelled as a member of the opposite sex thanks to a clerical error. I then have the task to correct these mistakes. The trouble lies in that with strict professional integrity I ideally need to check for boy or girl parts to confirm the sex, not the stereotypical examination by a long shot. Amusingly, it is inevitably a burly, Zulu man with a beard and alpha male appearances that will have been carrying and ID card with female on it. Luckily I have not had a case which has been to difficult to determine whether they are qualified to use a urinal or not.

Of course we do also get the rather more conventional emergency department quirkiness. Psychiatric patients can often be quite disturbed but at Mseleni we have a regular attender who believes he is a spiritual healer. He will often pass by the department lay his hands on a patient’s forehead, chant loudly in Zulu and then claim the patient is healed, it seldom works. At least it all serves to break up the otherwise taxing working day.

http://www.youtube.com/watch?v=K7l5ZeVVoCA

Day 154, The Blessing in Disguise

Day 154, Sometimes things that afflict us on a grand scale may end up working to benefit all of society. In this respect has HIV actually being a blessing for South Africa?

There is the old adage about distance bringing perspective and I have come to realise how true this is. On my holiday away from Mseleni, I spent time in India. My ancestral home is in the village of Sonamukhi, a four hour drive from the Calcutta, and though the distances may not compare the ‘rurality’ is similar to Mseleni.

I took an afternoon to visit the local hospital. It serves a population close to 200,000 but is half the size of Mseleni. There are separate male and female wards but no designated paediatric section. The OPD in Mseleni always seems brutally busy and harsh on the patients but at least they get cubicles most of the time. In Sonamukhi the OPD queue resembles a food line, and the patients gather round a writing bureau with 3 or 4 doctors scribbling nonchalantly as they present their cards. History and examination are a pragmatic sacrifice.

With a burgeoning economy in the face of real poverty there are many similarities to South Africa, begging the question as to why the health service in India is lagging behind. With TB rife in both settings the main difference is with HIV. Not as open and as widely disseminated HIV often gets swept under the rug in rural India. It is on the rise, and with such poor provision of free healthcare and the prevalence of TB it is surely a time bomb.

So how has HIV benefitted South Africa? Primarily because it has become such a well publicised epidemic it has attracted much foreign aid. The free antiretroviral program has been sponsored by USAID as has much of the provision infrastructure. Particularly with the latter provision of other healthcare has been piggy backed. Now because there is staff to look after the provision of ARVs they also monitor for diabetes and hypertension.

Of course the HIV aid money isn’t exclusively propping up South Africa’s health system, but it certainly helped to kick start it and now ensures it is a more robust rural health provision. The worry is that with HIV rates rising in India without it becoming much more open a similar augmenting of rural health services will not arrive in time to save the a much larger number of people.

http://www.youtube.com/watch?v=Z3qVl8Gb2J4