Day 230, The Heat

Day 230, I didn’t think it was possible for it to be so hot that my earlobes would sweat, but the past week has convinced me it’s true.

I have never been built for heat and humidity and after months of fantastic weather I am beginning to see what an African Summer truly feels like. The heat has been unrelenting with temperatures soaring. Driving to my clinic today through the sand track “roads” of the thickest bush, the temperature gauge on the car reached a melting 40 degrees.

As bad as the heat is, the humidity really makes it a struggle to achieve anything. Of course the locals seem far more used to it than me and I have even seen them wearing jeans in the daytime; the mere sight of this provokes beads of sweat to run across my brow. By the time I have had my morning shower and taken the short walk up the hill to the hospital, I am already dreaming about the next opportunity to shower.

There has been some validation from my patients, or rather the mothers, on my paediatric ward. Usually I’m scorned on when I insist the fans be turned on as the mothers all feel their babies will catch colds being exposed to them. But in recent days I’ve been pre-empted with the fans feigning a cool breeze even before I start my rounds.

Though discomfort is good enough reason to moan, there are noticeable practical issues with the heat. For instance it is a lot harder to write on paper when it is soaked by sweat dripping from the tip of my nose. Likewise already stressful procedures, such as spinal taps on children, run the risk of perspiration contaminating sterile samples. The most striking difficulty with the heat is trying to prevent the elderly and the babies who are already dehydrated from drying out further.

Ironically this has been a very good summer in that it has had more than a usual share of rain. The first couple of months of 2011 even saw widespread flooding around the provinces. Though this had inspired a lush green countryside it is rapidly becoming dried veld land and bush fire smoke has already started to make the sky hazy.

As I write this, the clouds seem to be gathering and everything has become very muggy, a few flashes of lightning and cracks of thunder are heard welcomingly. It is ominous as the last showers we had a few weeks ago were short lived. Though when it rains here it sometimes means it is even more uncomfortably sticky.

If my earlobes don’t eventually melt I will consider it fortunate. Either way, I’m not going to be taking cold spring mornings and dark, biting December days for granted ever again.

http://www.youtube.com/watch?v=PqZ9WVBXBvw

Day 228, Drakensberg

Day 228, Perhaps it isn’t really surprising but increasingly I have noticed that this is a country of contrasts. Even in the slight microcosm of the province of Kwazulu Natal I have become more aware of how varied it is, not just in terms of the people and the poverty but also in the very geography of the region itself.

The weekend just gone is typical of how different worlds exist in this little corner of the planet. Being a public holiday on Monday, my friends and I took the opportunity to visit the world heritage site of the Drakensberg Mountains. The range is located in the middle of the province on the borders with the land locked nation of Lesotho. Its peaks are sought after by climbers and the rivers running through are bountiful with fish.

Driving through the approach to the mountains one notices the cooling down of the air and the sun loses its harshness, becoming almost sweet. The defiant thorny shrubbery with yellow and green fruit in our region is noticeably supplanted by more flowery, gentle foliage with dashes of bright red and blue. The undulating landscape is more reminiscent of the Cotswolds than it is of the Ubombo mountains.

The houses we pass on the motorway also bear a more than passing resemblance to British country life. Much of this part of Kwazulu Natal had English forefathers and there are plenty of tributes to the “old country”, from the village bakeries, to the mock Tudor bungalows, to even grandiose estates. We visited a restaurant in such an estate known as Hartford House, a indulgence of gastronomic pleasure, it compares to the Michelin starred haunts found peppered along the English countryside.

But as with everything here, it is within the populations that we see the starkest differences. We struggle with the burden of HIV and TB and the locals will beg, steal and borrow to try and put food on the table (usually metaphorical as they are often unable to afford them). Whilst in the pleasant hills of the Drakensberg Arabian thoroughbreds are reared and ridden, tea is sipped and scones are had in view of the marvellous Cathedral Peak, and people while away the time trout fishing or golfing.

Though the Zulus in the mountain region have found innovative ways to try and earn some money. Boys with bags of golf balls fished out of the rivers from wayward linksmen will stand by the roadside in hope of selling a few to the next hopefuls. Children also gather to sing and dance for loose change as shoppers stock up at the supermarket and visit the oddities at the curio store.

Driving seven hours back to our region, with the heat becoming oppressive it is no wonder that life can be difficult here. It is in a forgotten corner of the country where people try to eke out an existence in any manner they can. One wonders whether most here would know about how many in their country live without the same trials and tribulations. The hope is that though the climate may not change, at least people having to live in poverty and disease may do so.

http://www.youtube.com/watch?v=rThblvAJ_Z4

Day 222, Traffic

Day 222, “Traffic”, that’s how it is known here. It is a quality that certain individuals possess in medicine, but it is not one to be desired. Basically there are certain doctors who attract work, not usually through their own devices but through chance. They will have the busiest calls, the most complicated patients and least sleep. My last call was with a doctor who is traffic, it was true to form.

I was relatively optimistic at the start of my call, by 6pm the OPD was quiet, I had dealt with all the patients there and I was looking forward to heading down for some downtime. My colleague rings me as I’m finishing up to let me know that we have to take a twin pregnancy for a Caesarean and I duly to head to the operating theatre. She tells me we can only get a good heart trace from one baby and having previously had a Caesarean, this lady would be tricky.

The concept of traffic is a stigma, if the nurses start labelling you as well then the subsequent air of expectant chaos can almost be a self fulfilling prophecy. We struggled to get through to the babies through the old scarring but the first glimpse of baby was not promising, I saw a limp scrawny leg flap about. Delivering the rest of the baby was similar, a torted foetus, dusky and lifeless, there was no attempt to resuscitate her.

We proceeded to the second baby, we delivered him and he spluttered and yelped a cry. We were grateful that this one was more successful than his sibling when we realised there was another bulging sac. The words “friggin’ kidding me”, may have escaped my lips as we realised there was yet another baby to deliver. As this one came out screaming I thought that was our lot of traffic for the evening. That’s when the nurse shouted across the room to let me know there was an emergency in the OPD, a gun shot wound.

I may have shot my colleague a very dirty look as I rushed out of theatre and headed to OPD where I found, amongst the commotion, a young man thrashing around on the trolley. He had an entry wound in the right armpit and I could feel the bullet near his left kidney. With the bullet having pierced through his lungs into his abdomen, I was grateful when the cavalry arrived to assist me. The guy was well known locally and within minutes there were dozens of people crowding the cramped cubicle as we inserted a drain into his chest and stabilised his condition. We managed to maintain him until the infamous Emergency Medical Rescue Service (EMRS) made time to come and pick him up.

When I eventually made it down I managed to wolf down some food and fell quickly asleep. With two hours rest I was awakened by the dulcet tones of my colleague informing me of yet another caesarean. We didn’t manage to get any further significant rest and soon I found myself trying muddle though my ward round in the daylight.

I try not to be superstitious for fear it might provoke misfortune, but the concept of traffic genuinely is undeniable in its existence. My colleague is diligent and conscientious but clearly somewhere along the lines she has majorly ticked off the gods of fate or perhaps it is merely a witch doctor’s curse. There is an old wives’ tale that the moniker of traffic can be got rid of by the arrival of another who is equally afflicted. For the sake of a good night‘s sleep, I can only hope that we recruit a karmically challenged patsy before our next call together.

http://www.youtube.com/watch?v=w4oB00TCb7Y

Day 221, Crazy and the Peacocks

Day 221, The people on the television were telling me what to do with my psychiatric patients. They listened to what I said and told me which ones I should report to the police and which ones I should just give drugs to. Of course I wasn’t alone, the patients were there too, but they had their own problems.

As I approached the makeshift clinic this morning I walked past three peacocks strutting around the hospital grounds, that was probably my first clue that today was going to be a bit loopy. I am sure they were there, I took a picture of them, but no one else seems to believe me. Perhaps I empathised a bit too much with the psychiatric patients, after all I inadvertently ended up spending a whole morning with them and their special television.

Just before one wonders whether the pressures of working in the bush have completely broken my sanity I was indeed talking to the television through the wonders of telemedicine. This is a system that was set up several years ago to try and connect rural hospitals to specialists who wouldn’t physically be able to visit often. It is essentially a package consisting of a webcam, a mic and an ISDN line that helped me connect to the psychiatrists at our referral centre.

The initial plan was to have the psychiatrist fly out to us but a technical servicing issue had grounded the flight. Rather than completely lose the time with her we fired up the telemedicine system in the hope that everything still worked. Like Dr Jones finding the Ark of the Covenant I felt I had unearthed something mystical from an ancient time, circa 2005. After a few quick calls to tech support I found myself staring at three psychiatrists on the TV screen ironically asking the patients questions about hallucinations and hearing voices. It does bring a whole new dimension to the term thought broadcast.

The session wasn’t without its teething problems but it is genuine achievement that in a place like Mseleni we are able to have viable consultation with a remote doctor through technology. This is especially wondrous as most of my blogs have been eeked out on a GPRS connection that struggles with even letting me check emails.

Now, if I could only convince everyone that the peacocks actually existed, I might be able to confirm my sanity.

http://www.youtube.com/watch?v=KTWMtsFkn-Y