Day 319, There but for the grace of god....

Day 319, Not that long ago I was unfortunate enough to be very sick. I was an inpatient in hospital for a prolonged period of time and it has had a lasting effect on me. Working at Mseleni has made me realise just how much of an effect it has had.

I have a 7 year old boy on my ward who was admitted on my birthday. He is an orphan who was living with his alcoholic grandmother and psychotic uncle and had been neglected for a while. He was quite malnourished and came in unable to walk or communicate. We were convinced he was HIV positive but tests proved otherwise.

A lumbar puncture revealed that he was suffering from meningitis cause by tuberculosis. Not that unusual in the grand scheme of things in this setting but his general demeanour was even more debilitated than I had seen. I have had adult patients who have succumbed to this but they have often been unwell for a long time and usually suffering from multiple ailments. When he wasn’t improving we organised for a CT scan several weeks into his treatment. It revealed that he had essentially had a stroke as a result of the infection.

The therapists have worked with him and he has managed to sit up with assistance and he manages to swallow his food now. Yet he is not going to walk again and his communication is limited to gestures and groans at present. We have contacted other members of his family and are slowly making them realise that he will go home not the boy they remember but one that will require constant care.

When I had the same condition I was horribly ill and bed ridden for 7 weeks. I cannot really remember the pain but the overwhelming memory is feeling feeble, like the strength had been sucked from my soul. Eventually, through what felt like a herculean effort, I managed to stand up, only to find that I could not see straight. The muscles in my eyes did not want to coordinate and I constantly saw double.

Getting meningitis has had a significant effect on my life since. Aside from leaving me with occasional double vision, it is not a stretch to think that had it not happened I may have never ended up in Mseleni. For my patient, his life has been permanently altered by it. I have been lucky enough to recover and continue on with my life and career, but I fear despite my best efforts he will never be able to do the same.

I don’t do what I do out of some sense of needing to make up for being fortunate enough to be in a position to make a difference. But every morning on the ward round he manages to high five me and for a brief moment I consider how it could easily have been so different.

http://www.youtube.com/watch?v=rmC3kpM3C_k

Day 317, Mseleni Essentials

Day 317, This is the time of year when new people from overseas come to work and as such I’ve had a few enquiries about what they need to bring. I thought it would be useful to go through a few of things that I’ve found most useful.

A flashlight is essential. I was fortunate enough to be gifted a wind up one as a parting gift and I’m sure it has saved me from harm on more than one occasion. Though the sound if it being wound has become a running joke, it has helped me stay snake free to date. Most snake bites in this region are from the lazy puffadder, they seldom move out of the way and tend to bite when stepped on. A light is a must to make sure they don’t dig their fangs into you.

In my career prior to coming to South Africa, despite the reams of notes I would write every day, I have never had to purchase a pen. For the non-medics this is because of the sheer volume of pharmaceutical reps and their very generous donations of pens. Drug reps are few and far between in rural Kwazulu Natal and a steady supply of pens is a necessity, not just because everything is written manually but also because they have an uncanny ability to vanish.

Driving licence, those without are severely disadvantaged. Whether one buys a car or not, the ability to drive a car and carry proof to that effect is a big bonus. The hospital’s eight satellite clinics are all significant distances away and lie on a mix of sandy tracks, gravel roads and proper tar ones. On a weekly basis if not more frequently, it is required to take one of the hospital vehicles, offroading or otherwise out to one of the clinics. Add to that sharing in driving duties for one of our weekend forays into various parts of the country and it becomes a handy skill to bring to the community.

Always useful to have is a sleeping bag. Whether its bedding down in the middle of a big five game park, setting up a tent with an ocean view, or even just in a field next to a major music festival I’ve gained much more mileage from my sleeping bag than I could have anticipated. Of course, even in the confines of the minimally insulated parkhome residences it doubles up well as a duvet in the winter months.

Plenty of entertainment. We do make a lot of our fun in this place but it helps when you’re backed up by games, movies and music. Movie nights are always fun, if more for the arguments over what to watch rather than the films themselves! A constant supply of music can turn long car journeys from tedious to raucous with the choice of the right choon. And nothing works as well as a bottle of pinotage and a game of 30 Seconds to find the last person in the world never to have heard of Nelson Mandela.

The list is clearly not exhaustive and a million things could be essential here but we often get by without much. Above all the most important thing to bring here is one that cannot be bought at any store, and that’s an open mind and a positive attitude, probably the one thing that will ensure you survive here (and don’t forget chocolate, easiest way to make friends!).

http://www.youtube.com/watch?v=seU5S5DLDpU

Day 307, Technical Issues

Day 307, Technological failure is frustrating to me. In the religion of science technological failure is akin to the test of faith. It has happened to me in the past but in Mseleni this spiritual trial feels harsher than ever before.

My cell phone has been my conduit to the outside world, not only does it allow me to speak to friends and family but it is also my modem and thus allows me to stay in touch with news from abroad, arrange my affairs back home and by way of my writings it even helps broadcast my thoughts. So when a piece of the phone broke and then it refused to let me speak through it I felt abandoned by the heavens.

My laptop and external hard drive are the other components to keeping me on the grid. Also, all my entertainment; music, TV, movies, they are all contained in this paraphernalia. Being representative of Mseleni these became infected by contamination from their local counterparts. They still function but are left crippled and weak by the virus. It does make me wonder how cruel the fates can be to give an innocent computer a virus, but science works in often mysterious ways for those who do not understand its’ intricacies.

But technology doesn’t stand still and even in rural Kwazulu Natal those of us that believe in it are trying bring others round to our way of thinking. My friend and I have even been trialling a digital pen to record our clinical notes and decipher our questionable scrawls. It is our hope that maybe through the use of modern ideas and equipment we may be able to improve upon the practices of old to the benefit of the masses.

In the hospital technology is not alien. We have portable ultrasound machines, bedside haemoglobin meters, and even a pocket saturation monitor, albeit these examples are but a small portion of all the things that we are lacking. Perhaps the most useful pieces of tech are other people’s phones (as we’ve already established mine has limited functionality now). Particularly those with Apples or Berries are able to consult my favourite colleague, Dr. Google, on any number of medical conundrums.

It may sometimes test us when the system crashes, a bug appears or we drop that piece of kit into water but ultimately the answer is usually hidden in the readme file or the user manual. It is true that science cannot explain everything though it tries very hard, but through technology shows us a light even in the darkest of places.

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

Day 304, Bush Fire 2011

Day 304, Much to my dismay I have never camped at a music festival. Considering the UK is home to some of the most famous festivals with the biggest bands playing every summer, it is quite a thing that my first festival experience came in the tiny mountain kingdom of Swaziland.

The Bush Fire Festival is described as Swaziland’s premiere arts and music festival, though in all honesty I haven’t really heard of any other such events in the country. Six of us set off sharp after work on Friday, camping gear in hand, dancing shoes on our feet. My knowledge of southern African musicians being limited I was only really aware of one of the bands on the bill but I was enthusiastic nonetheless.

In the UK these events are held in the summer in the hope that the weather is conducive to the festivities. The great consternation is about whether it will rain or not and will the wellies be needed. Being the middle of winter here, we too were concerned about the weather, not a drop of rain poured but the 15 degree dip in temperature at night was very noticeable. Setting up the tents in the dark we wrapped up warm and toasted the night before wandering over to the main stage.

The band I’d known, Goldfish, were headlining the first night and we made it in time to catch their set. The Cape Town duo played their upbeat electronica which proved the perfect kick start to the festival. My friends and I danced nonstop through their performance and awed at their digital gadgetry. Even the open air setting and the chilling conditions were not enough to dampen our mood as we revelled until the wee hours of the morning. The midnight pancakes before retiring to our tents helped to warm not only our spirits but our bellies too.

The following two days were a blur filled with hidden treasures of music I never would have known about. The highlights were the celebrated Oliver Mtukudzi of Zimbabwe and Habib Koite of Mali and South African bands Hot Water and Tonik. The latter played an intricate set of keyboard and tablas as a silent gig, with the audience listening through headphones. A slightly odd idea, it did serve to question the listening experience.

The crowd was a slice of all demographics; older hippies, families with children, black people, white people, Swazis, Saffas and foreigners. There was of course enough interest in football to have it distract for a while on Saturday evening. Of course, aside from the Barcelona and Manchester United shirts the festival was awash with colourful costumes, crazy hairdos and glow sticks. The giant puppets and insane Tshe-Tsha Boys with their boiler suits and clown masks only added to cacophony of bizarre and bright sights and sounds of the festival.

Like so much during my time here, this was yet another thing that I’ve been introduced to that I never got around to doing back home. With a nudge in the right direction from friends I have again managed to widen my horizons. Who knows, I may even have to invest in a pair of wellies.

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

Day 296, The Prawn Shack

Day 296, Under normal circumstances I wouldn’t be partaking in a 500km round trip for a restaurant, but normal has been few and far between lately. This weekend I had the opportunity to participate in a rather indulgent dining experience.

About a 100km outside of Durban, along the coast, is the Amatikulu nature reserve. Not particularly stunning in of its self, it is an extension of the Dolphin Coast with a characteristic network of lagoons. Just set off from the beach is the Prawn Shack. A restaurant open at the weekends catering for an 8 course lunch meal dominated by the eponymous prawns.

Set in what resembles a wooden shanty, the blare of Bob Marley welcomes customers along with the complimentary caipirinhas. The drinks are essential to the meal and it is customary to try a shot of tequila complete with a live prawn in the glass. The oddity of the dining experience is confirmed by the proprietor greeting and instructing guests at the beginning on how the whole thing is meant to work.

The food included some local influences with curry filled buns known as bunny chow as well plates of Zulu sushi. Prawns were represented well in the curry, as well as in pasta form, in a bisque and simply grilled. The feeding started at midday and was scheduled to finish four to five hours later. Recognising the restraining capacity of the human stomach, a walk to the beach is pencilled in after course 5. It is a welcome break from the eating but upon returning we were treated to dessert, camembert with a crystallised caramel layer torched in front of us.

The restaurant is situated next to a campsite, and being quite a journey back after the afternoon’s feasting we bedded down for the night. Despite living near the sea, our local coastline being protected waters means we get very little fresh seafood locally. I suppose it is a true testament to the Bengali love for prawns that I journeyed for 3 hours and slept over by a restaurant just to indulge myself on the delectable crustaceans.

http://www.youtube.com/watch?v=leohcvmf8kM