Day 208, Tempting Fate

Day 208, There are many ways of describing it, some call it Sod’s Law, others call it Murphy’s law while still others will refer to it as simply speaking too soon, but however you describe it I have fallen afoul of it in spectacular fashion. The last two months on paediatrics has been tough but rewarding having had no losses in that time. I quipped recently that I was going for a spotless record, a day later fate wanted to punish my vanity.

It was a 29 day old baby who had come in with fits and a fever that challenged my resolve. Initially he was deceptive, made me think that as I’d made the diagnosis of bacterial meningitis I would give the treatment and it would be plain sailing. Two days on the ward and he started to wobble, his temperatures wouldn’t settle, his blood sugars were all over the place and his kidneys were packing up. I managed it during the day and the on call was fire fighting all night long.

The following morning we noticed it had started to bleed. It was succumbing to the overwhelming infection and soon it would be over. Feeling guilty for tempting fate I decided that if the child was going to die, it wouldn’t be through a lack of effort, not on my watch. Giving it almost intensive care I kept ringing round the various referral hospitals to see if I could get anyone to take the child. After several hours of negotiating it was agreed that I could transfer him.

At every turn the baby was fighting me. If I managed to stop the bleeding, his IV line would blow and prevent me correcting the shock. If I managed to find a vein and push fluids, he would start fitting. I tried not to take this as a sign, and arranged for an airlift, though the helicopter was unavailable meaning he had to travel 50 minutes down the road to catch a plane. I left for the evening knowing I’d arranged the transfer and at least I’ve given him a shot. I knew he wouldn’t be on the ward this morning, one way or another this child wouldn’t be around.

As I went to work this morning the paramedics came up and explained what had transpired. En route to the plane the ambulance had gotten stuck in the sand. The plane had subsequently departed sans baby. A second ambulance sent to retrieve the vehicle had also gotten stuck. The baby was somehow taken to a local hospital to be monitored and eventually a functional ambulance transported the baby in the wee hours of the morning. As is usual in such circumstances, the baby finally gave up en route. And despite resuscitation he died in the back of an ambulance.

Recently one of my colleagues remarked how we see miracles happening at the hospital every day. Though I admire the positivity, today it feels as if the only miracle is that more don’t share the same fate.

http://www.youtube.com/watch?v=f_wHJo2oZAg

Day 200, Religion

Day 200, Religion, it’s a funny thing, it has the power to bring communities together and tear them apart. As I have alluded to previously it plays a big role here and guides people’s lives in a manner in which I have not experienced in my professional life.

Though it is almost completely Christian this does not mean that they are homogenous in their beliefs. Many of the local population are Zionists, one can see them on Sundays in their brilliant white garb on the roads en route to the outdoor churches. Others in our community belong to various denominations including Anglicans, Catholics and those that follow the Afrikaans Church.

As in many countries, particularly those with an impoverished population religion and religious practices are central to society. Much social interaction will revolve around the church and here most occasions begin with a prayer. Faith seeps into the very fibre of everyday life here.

I wake up to the sound of African gospel music from my flatmate’s television through the walls. At the hospital the nursing staff will gather to sing a choral prayer in the morning whilst the doctors will also start the workday with a reading from the Bible and a prayer. Hospital committee meetings and theatre procedures will similarly be preceded by a prayer, usually in Zulu. Recently in theatre, whilst assisting with a caesarean, I got my first taste of listening to the mother sing whilst baby is being delivered, true to form this had a biblical theme as well.

At times it can feel somewhat overawing. On my Sunday morning call I was on the paediatric ward trying to review the severely malnourished HIV kids and an evangelist on the ward television was preaching about the ills of society and Judgement Day, perhaps not the most inspiring of topics given the setting. The thought of a benevolent force is often difficult to imagine in the presence of the many horrors we see every day, but on the contrary people here draw strength from it, a reassurance that in the end things will be alright.

It seems to me that all religions are a way of explaining the world around us and believing in a higher purpose is a way of making sense of the chaos that is living. When things seem out of control, which it often does in our setting people find religion a way of taking back that control. As a concept it works in many ways but fails when people start to argue about the differences and interpretations. And all too often that’s when we fail to realise that just as one man’s terrorist is another’s freedom fighter, so is one man’s devotee another’s non believer.

http://www.youtube.com/watch?v=883t2Pac8pk

Day 194, Legacy

Day 194, Legacy is something that preoccupies a lot of thought. In politics it is important to conceptualise as a plan of action for a government. For individuals it is often more personal, having a family, a home to pass on or a business to build. Now in the latter half of my time at Mseleni, I have begun to realise that though I am one of many transients here, there may be an opportunity to leave a legacy behind.

Last week I had my first sitting of the Psychiatric Committee, one of more than a dozen committees beavering away in the hospital environs. As doctors we are allocated either through choice or randomly to these to try and work towards bettering the service we provide to staff and patients. I am also a member of the Suggestion Box Committee and the Nutrition Committee. Though not individually, this is an institutional encouragement to work on lasting changes. Working with nurses, social workers pharmacists amongst other long staying staff means that any plans I may be bringing to the table should be maintained in my absence. Though often it feels like a forum to say a lot of things that will never be auctioned.

My own pet project is one that was conceived in conjunction with one of my friends who have now departed. In an attempt to catch Mseleni up with the rest of the world, we felt a computerised record of chronic diseases, and their management should be kept as a way of monitoring individual treatment but also the population as a whole. In theory it should be fairly uncomplicated but when you take into account a minimally computer literate workforce, lack of modern equipment and already busy clinics it becomes rather more challenging.

I would hope my legacy would include the effects on individuals I have met, personally, professionally and on the doctor/patient basis. Of course I would like to think they are on the whole positive but I am realistic enough to know that some will not be.

Legacy essentially seems to be the innate instinct to leave a lasting impression. Why we seemed to be programmed to want to better those who we leave behind is up for debate, whether this is altruism or indeed borne of selfishness. Only time will tell what I can achieve to leave behind here at Mseleni.

http://www.youtube.com/watch?v=Hw2vBYBE24Y

Day 191, Jo'Burg

Day 191, After a number of recent trips in and around northern Kwazulu-Natal I ventured further afield for my first experience of Johannesburg this weekend. Jozi is not somewhere that I had any particular desire to visit, especially after all the foreign media warnings of murders, gun crime and general ‘badness’ for good, law abiding folk. As it turned out, it was another classic trip with thrills and indulgence, mixed in with a little bit of conscience of course.

I stayed with friends of my friends in a luxurious house complete with perhaps the most extensive collection of vinyl records and rock memorabilia I have ever had the pleasure to peruse. The house was in one of the nicer suburbs in the city, predominantly white, and bore the trademark large fences and patrolling security personnel and of course came complete with a bouncy golden retriever.

I had the opportunity to attend a charity dinner which was being held at the Rand Club, a colonial gentleman’s club established during the diamond and gold rush from which the city was formed. From the exterior it is not more remarkable than any of the other buildings in the Jozi CBD. On the interior however it is old world opulence that was guarded even from women until 10 years ago. The grand staircase is surveyed by busts of prominent members, and the walls are adorned with paintings, newspaper clippings and memorabilia of its colonial and diamond rush heritage.

One of the few attractions in the city I was keen not to miss was the Apartheid Museum, not only a catalogue of the racist regime that dictated but it bore witness to the role of the economic forces, colonialism and the tribal history that have shaped South Africa. Allocating people randomly to different colour groups to enter the museum only served to reinforce the arbitrariness of the apartheid regime.

The main reason for this trip was to however to attend a rock concert, not just a concert but rather what has been dubbed the “greatest show on Earth”, the U2 360^o tour. A genuinely impressive marriage of some of the finest popular music of the last three decades with the cutting edge of innovation, design and technological vision, it stunned the 90,000 strong crowd at the Soccer City stadium. With the band’s history of protest music and activism, there was time for tributes to South African leaders such Nelson Mandela and Archbishop Tutu while hailing the recent release of Aung San Suu Kyi. The support of Mali’s Amadou et Mariam and the trumpet stylings of the iconic Hugh Masakela only served to reinforce this was well worth the trip.

Buzzing with the excitement of being a mere 10 meters away from one of my favourite bands and being a part of 90,000 people all bathing in the same awe inspired feeling was almost a spiritual experience. It is somewhat indescribable how being part of a collective voice singing out of pure unadulterated happiness can make one feel completely insignificant yet at the same time at the centre of the universe.

The only trouble with such indulgent weekends is now I face another week with the realities of work, but as far as escapism goes, I can’t think of any better way of doing it.


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