Sunday, 30 August 2009

Doesn't matter if you're black or white? Alegedly so.

Another weekend, another trip away. As I am working next weekend, we thought we'd make the most of this one. And we needed to get to a bank as without accounts, we aren't going to get paid. So, a trip to Jozini, the nearest town. An interesting experience for both Deyo and I. Finding myself the only white in the town, and the attention that attracted was a strange experience. It wasn't in any way a threatening one, just a feeling of being different and people noticing that. Deyo's take on it in comparrison to her own experiences as a black person in Edinburgh made for interesting discussion.
We then headed a couple of hours on to Sodwana Bay which is a holiday resort in the area, popular with Jo'burgers and their 4x4s. It's just down the coast from the beach we went to last weekend, but nowhere near as beautiful, with the beach torn up by vehicles. And funnily enough, there too we had an interesting experience. All the guests were white. And all the staff black. And I felt more uncomfortable with that than I had at any point in Jozini.
We both agreed that we have much to learn about people's attitudes in South Africa, but the voluntary segregation that we are already seeing is disturbing.
On a less thoughtful note, we joined up with a group from the hospital for body boarding and the obligatory braii. And we're now back at Mosvold preparing for another week and our first on calls.

The best meal we've had so far.

Friday night we recieved a dinner invite from Vuma, one of the nursing students here. She took us to her home, across the road from the hospital. It is a small cement builing consisting of a bedroom, kitchen area and living room, in total smaller than my room at the hospital (about 4x4metres). She and her husband built it 5 years ago when they moved to the area and they now live there with their 5 year old son and two older girls that they have 'adopted'. It's a very interesting dynamic that we're discovering here; people who really have very little themselves will share that with others who are needy, in this case the orphaned daughter of a relative and a neglected neighbour's child. She made us an amazing dinner of local zulu food (curry and a sort of rice/cous cous made of ground meal) which we ate by candle light, there being no electricity. It was an amazing insight in to how people live (particularly bearing in mind that with Vuma working at the hospital, they are considered to be on a good income) and in to why so many children come in with burns.
And also a stark reminder of how lucky we are in the opportunities we have had in life.

Natural selection?

So, as well as being the evening for declaring my love for Thembe, Thursday was also my first, second-on on-call. Let me explain. Every day one person is the 'on call', this means they hold the mobile phone which all the outlying clinics ring for advice and from 4.30pm until 7.30am they are called if anything requiring a doctor occurs. And remember this is a hospital that has 7 wards (Paeds, SCBU, maternity, male, female, TB and isolation) as well as being the local casualty. As one of the things that is often required overnight is a c-section, there is also a second on who gets called for those, and also for any major incidents. Actually, as we pretty much all live in, I think we'd all be called if there was a major incident. The person who is first on then works a half day the following day, finishing at 1.30pm. Oh yes, a 30 hour shift. Eat your little EWTD hearts out!
Anyway, shortly after my love decleration, my phone went off. The 32/40 PET lady with deep variable decels on her 10 minute CTG trace who we'd been planning on transferring to the nearest specialist centre, a mere 3 hours down the pot holed road, was now flatlining (for non-medics, a lady who was pretty sick with a premature baby had just got a whole lot worse). So we'd decided to section her.
I was to be the anaesthetist. And the paediatrician. Caring for two quite unwell patients at once. Scary biscuits. Not as scary however as when the baby came out looking pretty ropey, breathing a lot faster than is normal and grunting away (not good). I'm going through my usual resuscitation procedure. And then some. And I suggest to the surgeon that I attempt to intubate to give the baby some medicine directly to the lungs to help it's breathing (not something I've ever actually done before but I've seen it done and I'm learning that that's what counts). And he looks blankly at me. "Surfactant?". When I explain, he replies that we don't have that. So I suggest CPAP (breathing apparatus). We don't have that. I decide to just ask what we do have. Just oxygen. By nasal prongs. And a warm room. So that's what we do. Miraculously the next day, the baby is still alive and looking perky. The midwives assure me that "black babies are a lot tougher". And apparently it's true. They kind of have to be.
Interestingly enough, there is a plane that we can call for to take babies to the bigger centre. But it only flies between 8am and 3pm. On sunny days.
Fortunately that was it for my on call and I slept until morning. And then did a full day in clinic. Not looking forward to my first first-on on call on Tuesday.

Thursday, 27 August 2009

A reason to never leave Ingwavuma.

Her name is Thembe. And she's our cleaner. She comes once a week, cleans our house from top to bottom, polishes our floors, changes our sheets, hand (yes, hand) washes all our clothes, and irons them too. And for this we pay her the princely sum of 100R (about a tenner).
I think I'm in love. (although having your underwear handwashed and ironed by someone else does feel a tad strange)

Tuesday, 25 August 2009

A wealth of experience.

So, I'm delighted at how many geeks there are out there bothering to read this (I can see how many times my site has been viewed, now who's the geek?!) and really touched by the comments you're leaving.
It's weird though because in some ways I don't feel like I'm touching on what's really happening or what I'm thinking or feeling about things. But that's because I'm not really sure yet what I think or feel about things. So it's hard to write it down.
Last week we went for a quick drive outside of the hospital. One of the girls was explaining that 50 metres down the road from the hospital, running water stops and at 100 metres electricity stops. So for many of my patients, the house I described as basic, is in fact luxurious.
And today I had a trip to Welfare, which is the local social services. Once a week, one of the doctors goes there to decide which patients get disability grants. There are really no hard and fast rules about who should get them and it seems very much up to the individual to decide what makes a patient deserving of the money. I found it hard watching patients ill with HIV and TB being turned away as they had already had 6 months DG. Especially in the knowledge that for many families, one person's DG is the only income they have. I fear that I am going to be the weakest link in Welfare.
I joked a lot before coming out about this year making me a 'better person', but I think it would be very difficult to come back unchanged from this experience. And I certainly don't think that's a bad thing.

Sunday, 23 August 2009

Not exactly Mozambique, but pretty damn good.

A weekend off. Something that I am soon to appreciate as pretty precious I think. So we made the most of it. Saturday we unfortunately went to an amazing, beautiful, empty beach, lolled around in the sun (25 degrees, and it's winter!), braii'd and body boarded to our hearts content.

I say unfortunately as it was also the Zulu King's daughter's wedding in Ingwavuma this weekend (there's long been dispute over the border with Swazi so the king built a palace up here and installed his 6th wife). And there were rumours that Jacob Zuma would be attending. And maybe visiting the hospital. I was desperate to attend the royal wedding (it is a free invite system) but the more experienced hands out here advised that they can be rather painfully long experiences where you want to sit at the back but that if invited to sit at the front by the king, it would be rude to refuse. So the beach won. And it was a great day.

Today (Sunday) we checked out the alleged border with Swaziland. According to Google Earth, it's at the top of the dirt road leading to the mountain edge but locally it's thought to be the bottom of the mountain. So sandwiches in backpacks, we hiked all the way down, taking the 'coffin route' (lots of our patients come from Swazi but, if they die, it's very expensive to repatriate the bodies so they carry the coffins down the very steep path). There we picniced and then hiked back up again. So I've officially and illegally been to Swazi.

Thursday, 20 August 2009

Whatever happened to see one?

Wow, the first week is almost over. Not soon enough. We are exhausted in the way that new jobs always are, but a million times more once you throw in the moving country, foreign language and lack of your normal back up support network.
Yesterday was my second day in theatre. Quite an experience. There are always 2 doctors on for theatre (one to do the anaesthetic and one to do the surgery!) and I was in with the boss which I thought would be good for experience but turned out not to be as he really is a believer in sink or swim. And despite my total inexperience, he was keen for me to 'give it a go' on the caesarian front ("just do whatever you think"). But now I've done two c-sections almost unaided. Could have been a third today but I drew the line at my first breech c-section also being my first twin section and my first vertical scar. So I assisted one of the other juniors. And now I've seen one...
It's just so different to home. I think I'm almost going to have to stop comparing. With the twins today, we had only two junior doctors and a med student in theatre for what at home would have required at least 5 doctors (2 O&G, 2 Paeds and an anaesthetist), 3 of whom would have been more senior than anyone we had today. And normally we'd only be two doctors; one to operate and one to do the anaesthetic and resuscitate the babies. Luckily everyone was ok (patients and doctors!!).
I then spent today in OPD which would be the equivalent of A&E/ the local GP, and is our main work. Saw a total range of things from someone needing physio after a hip fracture to a abdominal gunshot wound. Finding it so hard to figure out not only what to do with things I'm inexperienced in but also what to do here with things I would know what to do with at home.

Anyway, one more day and then it's the weekend and there's talk of a trip to Mozambique. I think both Deyo and I are feeling the need to get out of the hospital and remind ourselves of the positive things about coming to SA. Mozambique is definitly one of those!

Monday, 17 August 2009

The end of day one.

Ok, rather hastily posted last blog (due to rush to get to afore mentioned Survivor evening of fun). Two things: 1. I can spell anaesthetics. And soon will be able to do them too... 2. Apologies to anyone who may have recognised any part of an e-mail there. Cut and paste-tastic.

Survivor itself is missable (think an American version of Shipwrecked) but the evening was fun with plentiful tea and cake (it was one of the med students b'days) and chat. And an early finish so that everyone can be in bed by 10pm. Really. They argue that it's necessary for the 7.30am start, but with no commute, I'm not sure I need that much sleep. Nor should I get used to it if I'm ever to survive London again.

Day one at Mosvold Hospital

Mammoth journey later and we arrived. The chat in the pick up tailed off as we drove closer and closer and Deyo and I were fairly silent by the time we arrived. And deadly silent when we saw our new home for the next year. Basic is one word that springs to mind. Clayton Road are two others for those who ever saw the place.
Our hospital boss Daniel came to meet us. And scared the pants off us by asking about our surgical and anaestheitc experience. Erm, none.

First day today was all a bit daunting. So many people with really unfamiliar names, a huge hospital ground in which to get lost (twice) and scary new medicine.
I've been placed in Paeds which was reassuringly familiar in many ways (bronchiolitis, gastroenteritis) and not in others (an 8 year old with kaposi's). Also had my first theatre session; a D&C and a skin biopsy both of which were fine. Unnerving to discover that the anaestheitc options are a spinal or sedation with a diazepam/ketamine combo. But apparently if I want to play around with the propofol and iso I can... The anaesthetists do make it look very easy at home.

The people seem very nice which certainly helps. There's 10.30am tea in someone's house evry day. And we're going round to someone's house to watch "Survivor" tonight; apparently it's the Monday night social. Quite taken with the idea of everyone socialising, but then I found out that Wednesday's social is bible study group. It's certainly not Desperate's.

Friday, 14 August 2009

The penultimate day.

So it's the day before I fly.

My whole life for the next year is next door, packed into two bags (plus some maxing of hand luggage).
In just 48 hours I'll be landing in Durban, picking up my "bag of books and doctor's coat" and driving 4 hours to my new home. And I'll be starting work just 12 hours later.

Still doesn't really feel real. Not sure quite when it will.

Have been giving it the "I'm going to keep a blog" chat for some time now but finally pulling it together for the purposes of giving me something to do with myself, giving me something to look back on and letting my mum know that I am alive. It's also the alternative to those awful send-all e-mails.

So here it is, read as you wish.

Some links for you:

You really can find out about anything on wikipedia.,_KwaZulu-Natal

Possibly a little stalker-ish but this is the link to some med student's elective photos of Mosvold Hospital. I'm thinking my through-my-phone e-mail connection may not allow fantastic photo uploadage so these are an alternative. And she has put them on the web...