Day 11

Day 11, every morning is turning into a bit of a farcical head count. We play the “let’s see what staff we have today game”, unfortunately it’s the patients that are the losers. One of my patients died last night. His wife could be heard wailing on the ward today. We blank it out and carry on. I don’t know whether with better management from a full staff of nurses he would survive, it’s tragic that its even a possibility.

The trench camaraderie is exhilarating though, everyone getting involved, coming back after hours to make sure the patients are getting basic comforts such as dinner, blankets, medications and turned to avoid pressure sores. We’ve had to cancel our weekend plans of all going up to cabins in the game park. We may need to help out if as expected nurses and domestic staff stay away over the weekend. We mostly don’t mind because there is a sense of ownership, this is our hospital, we will keep it open and ensure those who need it most can be helped with whatever we can muster.

The medical manager has known some of the strikers all their lives and helped get them jobs. The seniors have worked with them day in and day out for years and now the friction is palpable with threats of disciplinary action when the strikes end. It makes me wonder what can lead people to such action? Being privileged enough that I’ve never had to worry about money, it is hard to fathom how dire people must feel to turn on those they have trusted for so long.

As a doctor, especially in the NHS, I think there has been many a time when I’ve felt strike action should be taken, yet as a concept this would never be considered. I do not necessarily think it is because we are humanitarians with hearts of gold, but as people who provide care to the sickest it feels wrong that we hold to ransom the neediest. Perhaps that’s why as a group we in the NHS are often manipulated by those who know that our sense of duty would prevent us from carrying out such actions.

The sick trickle through and today we had a boy who had been fitting for three days. The family took him to a traditional healer as it seemed easier than coming to the hospital with the picket lines. He has HIV and neurological signs of a lesion inside his brain. Along with the temperature and poor nutrition the prognosis is not good. Close monitoring will not be possible with the skeleton staff but even without the strikes his multiple problems would complicate a possibility of a transfer for further management. As the hospital normally has patients this sick, one has to wonder what the rest of them are doing during the strikes, are they staying away and getting sicker for fear of the picket lines?

http://www.youtube.com/watch?v=dO4BrGInoRo

Day 10

Day 10, The strike continues and we were even more stripped of staff today as even the domestics weren’t allowed in. We’ve heard stories about the strikes escalating in more urban parts of the country and in one nearby hospital they have had to transfer out most of their patients to ensure they are given care.

The outpatient department is unusually empty most of the day. We haven’t figured out whether people are scared of coming near the hospital, whether patients are being turned away by the strikers or whether they just reckon there won’t be anyone to look after them.

We have all mucked in with jobs such as getting the patients their food, mopping the floors, and restocking the ward. In some ways this has given us an opportunity to organize the wards from the chaos that is usually manifested. We were helped by the medical students who have beavered away trying to do as much as they can as well as the longer resident doctors rounding up folk to volunteer and help out. They were doing things like cooking the patients’ meals, doing the dishes and working the laundry.

I asked the sister who had made it in to work whether there will be any repercussions for her. She said that as she came into work people were calling her a “rat”. These are of course the very same staff that have worked with her for years on end. She was usually a theatre nurse and had not been on a ward for a long time and though she was doing her best she was finding it very difficult to look after patients there.

Those patients that we do have are suffering. An elderly man, a baba, has been in for the past few days with kidney failure. We were trying our best but this morning his condition deteriorated, presumeably not helped by the lack of nursing monitoring at present. He needs dialysis and more intensive care and as such I spoke to a renal unit in Durban, their doctors hadn’t been let into the hospital and were having to send their patients to private hospitals. I tried sending him to the local dialysis unit in Empangeni, they were full up and were being affected by the strikes as well. He is still hanging in there but I genuinely don’t know how much longer he’ll be able to.

One of my flatmates, the hospital dietician, says the last time these strikes happened it took 4 weeks to resolve them. Apparently the situation is worse this time round.

http://www.youtube.com/watch?v=6yXRGdZdonM

Day 9, the strike begins

Day 9, I had never intended to blog everyday, mainly because I thought there wouldn’t be enough to say, I’m sure things will change but right now I feel there is so much I want to write down.

Today was completely Hinsane! Let me give a little background, the World Cup in South Africa generated a lot of money and was a great success, but the people at the coal face, the public servants, have not benefitted from all this investment. As such pay rises have not been to their liking and there is industrial action all over the province. Hospitals, schools and other public offices are facing strikes up and down the country.

We had heard murmurs of strikes and stories of it elsewhere but today it arrived at Mseleni. The news filtered through and I could hearing singing and vuvuzelas at the hospital gates as I walked to the main hospital. At the doctors morning meeting we found that most of our nursing staff were picketing the gates. People were being organized at the gates and patients and staff alike were not being allowed to come into the compound.

I ventured down to the gates with a colleague and a visiting med student to see for myself, I was keen to take pictures. As we walked down and I was videoing I was told in no uncertain terms to stop so as not to identify those taking part. The scene was part festival part rally. Individuals with microphones were blurting out slogans, while the people sang choral songs and furiously blew at the vuvuzelas.
There was a man standing at the gate who seemed to be marshalling things, he was draped in a banner that said “I support Robert Mugabe”. There was supposedly a man with a club stopping people from coming though I never witnessed this myself. The armed police were however much more visible. As I tried to surreptitiously take a couple more snaps I began to sense it would be safer if I weren’t here, and we retreated back to the barren hospital.

The wards were eerie, one or two nurses at most. We did our best to try and discharge all non critical patients to lighten the load. This included sending home a patient who had a litre of fluid drained from a cavitating chest lesion without a post procedure x-ray. We tried to be as safe as possible but resources being slim meant we triaged much more harshly.

Whatever skeleton staff we had mustered was working all out, doctors helping out making beds, the physios and OTs helping dispense meds and the med students running around as orderlies. A gallows humour was noticeable.
Unfortunately emergencies don’t respect workers rights and there were two on maternity. I got involved in theatre with a post partum haemorrhage. The baby had already been born dead and mum was now bleeding out, her haemoglobin had plummeted as had her platelets. The senior doctor tried to stop the bleeding whilst myself and a colleague tried to gain access to give her plasma. This meant the theatre now housed 5 staff, about a quarter of the whole hospital whilst the strike was still on. We managed to stabilise her and eventually called in the emergency helicopter transport.

We are not sure how long the strikes will continue but what we do know is that there is no money to be given. Things might just start to get interesting!



http://www.youtube.com/watch?v=lU4ke34dKWo

Day 8

Day 8, The working day here starts with a prayer. The medical manager here came in a missionary capacity in the 1980s and set up a church in the locality. Some of the senior doctors have a literal pastoral role at Mseleni. A passage was read from The Bible, and then a prayer was said for the working day. In some ways it makes perfect sense that only people of faith would be able to work here day in day out with everything they have to witness, but perhaps that would also be reason to question faith.

Today I did my first cannula and lumbar puncture here. Not a big deal in most settings but I was slightly anxious about the LP as I had only done one in the last 2yrs, and even then I had help for that. No such luxury here. Of course the real worry about needle procedures were that both patients were inevitably HIV positive. In the UK I would almost certainly take extra precautions; double glove, have a sharps bin within reach, mark the bottles high risk. Yet again, no such luxury, you just to have to crack on. There is one sharps bin on the ward, nowhere near the patient bay. To those who were wondering, the indication was possible cryptococcal meningitis in a guy with widespread and likely visceral Kaposi’s, it was a champagne tap.

http://www.youtube.com/watch?v=HKnxmkOAj88

Day 7, First day of work

Day 7, Today was my first official day of work, it didn’t get off to the best of starts when the water stopped working at 7am. I was assured this wasn’t a common occurrence but it was inauspicious at the least. Thirsty, grumpy and unshowered I trudged up the hill to work. The morning began with a grand round in paediatrics before one of the every so monthly mortality meetings. The descriptions of some of the deaths and the travails the entailed were not encouraging.

I was then shown to the ward but my colleagues were based elsewhere for the morning. I was back doing ward rounds, no house officers and no clue how to get things done, on my lonesome. I persisted with what I knew (or at least thought I knew) and started seeing the patients, unsurprisingly all but one had HIV and TB. The degree to which they have to be ill before being admitted is remarkable considering the nonsense we end up admitting to be defensible. But by that same token how many patients here are being sent to home with a degree of doubt in their prognosis? Any hospital in the NHS and the patients I were seeing would be under a specialist Infectious Disease team, here that was me that had to figure out what to do with the cryptococcal meningitis.

In the afternoon I was covering the outpatients. Essentially this encompasses the A+E department, the GP surgery for the local area and routine appointments for all specialities. Despite the sheer workload the most frustrating aspect of the OPD is not having enough translators. There is only so much Sawbonna (Hello) can tell you about a patient’s 3 weeks of coughing and I ended up spending about half of the time trying to convince the nurses to help me.

The day was not as dramatic as it could have been and it was a fairly gentle introduction, but that maybe because I have yet to interview for this job. That will be sometime this week, would be a short blog if was unable to continue! The days will get harder especially as I become on call; let’s just hope the shower is working tomorrow.

http://www.youtube.com/watch?v=zwFS69nA-1w

Day 5, Hluhluwe game drive

Day 5, Today was my first taste of the wildlife. The destination was the nearby Hluhluwe-Imfolozi game park about 90km south of Mseleni. Being a safari virgin I got a briefing on etiquette by my colleagues; don’t get out of the car except where marked, don’t blare the music and of course to participate in the ‘safari game’ (this involves betting on how many different species could be seen on the trip).

Within five minutes of driving into the park in my colleague’s Toyota Yaris, we saw two young giraffe pop their head up. We caught them posing for a few pictures before moving on. Soon we were encountering impala, zebras and rhinos. They wander around the park completely unperturbed by the passing vehicles. As we drove up to the top of hill we came across a group of zebras grazing the new shoots of grass. They stood serenely on the backdrop of the hills and valleys, majestic and proud with their bold stripes, to think this is essentially my backyard now.

After a stop at the Hilltop lodge, where you can see the landscape for miles around, we continued along the tracks. But after our initial flurry of gamespotting activity things had dried up like the winter landscape. We tried to identify fresh dung of varying shapes and quantities to help us track the animals but that just turned out to be a load of poo. Still we were hopeful and persisted; my colleague was convinced that we had to turn to her secret weapon of drawing the animals out, so we turned on to the animal attractiveness of Tracey Chapman. Lo and behold we chanced upon an elephant in the bushes and a buffalo as the power of Tracey was clear to see. As dusk settled the animals seemed to become more visible and got a few more glimpses before heading back.

On the way back I offered to drive and got my first taste of night driving in the bush. The complete darkness is disconcerting enough but this is compounded people wandering onto the main road, speed bumps appearing out of nowhere, and of course the nomadic cows that chance a brush with death by walking in the middle of the road.

Having yet to have unpacked, not yet shopped, and not yet done a day of work it was fantastic to manage 3 of the so called Big five in the matter of hours. Just need to see lions and leopards and then I’d be done with Africa.

http://youtu.be/watch?v=SKYWOwWAguk