Thursday, 24 September 2009

One in the eye.

Well, I managed 29 safe days in Ingwa but today I had my first blood exposure incident.
Not, as I had expected, a needle stick injury (yesterday I was doing LPs on HIV positive patients with the electricity flickering on and off), but actually blood in my eye. Nice.
Half-way through a c-section (baby was out and I was attempting to rejoin the two halves of the uterus) I managed to flick blood under my eye shield (why out here are the shields attached by elastic around the forehead leaving them loose over the end nearer the patient??) and in to my left eye.
Following the "rinse it" procedure I promptly welled up, with added lip trembling and voice shakiness, and told the anaesthetist. I guess the plus side of being here is that he could then scrub in so that I could go and properly rinse my eye (and the other one for good measure). Unluckily we have a 25-35% HIV rate amongst our pregnant patients (the group we routinely test).
Rapidly checked her notes and then some internal debate went on; she was last tested 6 weeks ago and was negative (phew!), I wear contacts, surely women who are 8 months pregnant don't do a lot of sleeping around (help me out here placenta head girls?), it's actually quite difficult to get HIV in this manner and PEP (post-exposure prophylaxsis) makes you feel incredibly nauseous and generally rubbish. So I'm not taking it. This time.
What a great start to my week of annual leave; heading off on a game park/beach trip to think about what I have done.

Wednesday, 23 September 2009


So bloggees, it has been a week since I last posted, but I have a good excuse; I have been living it up in the big city. Yes, after 5 weeks here, Deyo and I cracked and headed for Durban. We were also booked on to an HIV/TB/STD course, as an aside.
The 5 hour drive down was a testing time (I re-discovered that I have a Y-chromosome when it comes to being directed; "what do you mean, 'I think this street leads in to that one', you have the map" and "why are you turning the map around?") but we finally arrived at our hostel late Thursday evening.
Friday, Saturday and Sunday were spent on the course learning the theories of diagnosis and management (I say theory as the concept of holding off TB treatment until you have a positive culture, when cultures take 6 weeks to come back and the patient in the meantime is infecting the 12 people they live with is just not practical) by day (with a couple of early finishes which allowed us to hit the beach...) and getting to know the other doctors and the bars of Durban by night. Was interesting meeting other doctors, many of whom are also foreigners working in rural hospitals, and comparing notes, but also frustrating at how common some of our experieneces are.
The weekend also provided us with our first true SA experience when our hostel was robbed (despite the electric security gate). Fortunately our room was left untouched but it reminded us that as protected as we are in Ingwa, where we can leave our door open, the rest of SA is still risky. A scary reminder to be fore-front in our minds as we drove back up our little pot-holed road to Ingwavuma in the pitch black. And blew a tyre. Now, I pride myself on knowing the theory of tyre changing, but in the pitch dark I was less sure. And just as we were debating how much damage it could do to the government car if we drove an hour home with a flattie, a car pulled up. An even rapider debate occurred as to whether we ought to flat wheel-spin off (both Deyo and I were thinking of all the assault and rape cases we've seen in the last 5 weeks) but another car also stopped and a total of 5 very friendly Zulu men surrounded our car, sympathised with our situation, were amazed that we actually had a spare tyre and rapidly sorted us out. A very pleasantly surprising outcome, but not one we shall rely on.
As we invest in our own car, I think we'll be investing in a hefty torch and some decent breakdown cover!

Wednesday, 16 September 2009

Shiver me timbers, I'm 28!

You'd have thought that I'd have learnt from Oz that expecting very little from your birthday inevitably leads to an excellent day, but no, I was yet again preparing myself for a miserable day, far from home (small violins at the ready). In reality it was a great day from start (discovering a birthday present in my pigeon hole at quarter to twelve on the 14th- thanks mum and the SA postal service, a mere 11 days!) to finish (10.30pm drunkenly putting myself to bed).
Was a little unsure about the fun of being on call on the night before your birthday but I lucked out with 4 hours straight sleep, and the trade off was having the afternoon off on my birthday. Headed to Fancy Stitch Tea Garden (oh yes, Ingwavuma has an eating out option; although I believe we are pretty much the only people to ever go there) for a long birthday lunch in the sun with various doctors, therapists, teachers and others.

I'm fast learning that no SA celebration is complete without a braii and my birthday was no exception; a "Pirates and Princesses" fancy-dress one. Cue plentiful homemade costumes (I take full responsibility for any world shortage of tin foil), some illegally smuggled in wine (as we live on hospital property we are not supposed to have alcohol and we get searched coming in. However, security happily come to our parties and merrily drink any that we have got in. So South African.) and copious well-done meat. Oh and my present from Deyo; an array of beautiful little cupcakes (one of which I secreted in a cupboard to ensure that I did get one, then forgot and discovered it to my surprise and delight today. Yummy!).

Sadly the other thing that I discovered today is that too much buccaneering the night before is not conducive to a pleasant day in OPD. Unlike myself, hangovers do not improve with age!

Sunday, 13 September 2009

Oh deer.

So, it finally happened. After 4 weeks in South Africa, I have seen an animal bigger than a monkey (that isn't a cow or a donkey). Having worked last weekend (and Deyo having decided to stay behind and be my personal shopper and chef) we felt like we really needed to get off the mountain this weekend. And luckily two of the other girls obliged with a trip to Pongola Game Reserve. A fairly upmarket private game reserve, we enjoyed a sunset cruise on the Pongola river (complete with sundowners), drifting amongst crocodiles, hippos, and a variety of exotic birds, whilst various not-deer and warthogs watched us from the bank (the SAs were amused at my insistence that I had spotted a deer and pointed out that there are no deer here. So not-deers it is). We also spied elephants from afar and girrafes from not so afar, having to stop the car to let them cross the road in front of us. An evening of braii fun of the afore-mentioned not-deer and poker with the guides and then a day in the spa today and we're like new people (particularly our feet which being permanently in flip flops/ slops, are becoming increasingly hobbit-esque).
We were a little taken aback by some of our fellow-guests who it turned out were on a weekend's hunt. Something the park allows as there are no natural predators to the animals (they have no cats) and the money brought in by the hunting goes in to conservation. Shockingly the list of available animals includes rhino, but the starting price of 250,00R (plus a cost per inch of horn) is inhibitory to most. It made us think twice before pointing out animals from the breakfast balcony in the morning.

Wednesday, 9 September 2009

Stemming the tide of the comfort-eating muffin-top...

So, you are now reading the blog of Ingwavuma Running Club's newest member. Well, strictly speaking it's more of a jogging club. And I think calling it a club is a bit overambitious, but it is a group of people (and not even all people who work at the hospital!) who meet and go running. Some faster than others. Personally I'm blaming the altitude. And we're working towards a goal; the Ingwavuma Half Marathon in October. 7 years in Newcastle and my first half marathon is in South Africa. Why aye indeed pets.

Bloody 'L'.

Today's scary thing wasn't medical. It was a driving test. Not something I was expecting 10 years after first passing my test, nor when I am currently in possession of not only a full, clean British license, but also an international one (available from the AA for only £7.99 and the cost of a photo but that's not the point). But apparently, that's not enough for Mosvold hospital Transport Department.
Let me explain why they care. Twice a week the hospital runs clinics in outlying areas (one so far away that we used to go by plane but sadly they cut the plane a couple of months ago. Something to do with costs I think. Now we just drive there). Access to these areas is pretty bad so they don't send us off alone in cars. They send us off alone in 4x4s. We can also borrow the hospital vehicles for approved trips out, like our HIV course in Durban next weekend. But to be allowed to drive these government vehicles, you have to be ok'd by the afore-mentioned Transport Department. Hence the driving test.
We'd already gone through the bureaucracy of having to get certified photocopies of our passports and licenses. No, showing them the real thing and allowing them to copy it wasn't enough. Instead we had to take them to a local public notary (oh yes, notaries, I've come across these before...) who didn't look at the originals before stamping the copies as accurate. Then today's test.
Was feeling a bit nervous; would the bad habits that I'd picked up over the years count against me? Walked over to the normal car (yes, I know that the test is for whether we can drive 4x4s but this is SA, why would they test us on that?). Got in, carefully adjusted the seat and mirrors, checked the mirrors (in the very obvious way that you're supposed to), slowly reversed out, checked the mirrors, then horror of horrors, crossed hands on steering wheel. Damn. Carried on, out the hospital down the mountain. Would I be penalised more for driving on the wrong side of the road or for going through the tyre-busting pot holes? And what about avoiding goats, pigs and dogs? I know in the Uk you're supposed to keep going straight at them but I don't think the South African livestock are aware of this rule. Longest driving test ever although admittedly we did only go straight down the one road for half an hour, turn around and come back. No emergency stops, 3-point turns or reverse parking in sight.
And I passed! The only comment I got was that there was really no need for me to slow down as we approached the group of children walking on the road (there being no pavements) because "they'll get out the way".
So now the outlying clinics await.

Saturday, 5 September 2009

What it's like when you have a baby?

36 hours in to my first weekend on call. I've had a grand total of 2 hours sleep overnight (when I was first on) and 4 after getting home this morning (I'm second on today). Called back in to do a c-section, interrupted by calls from the Paeds ward for a child who is fitting and the OPD for a snake bite. Offered to stay and help the first on but she assures me that I need to rest today as I'm first on again tomorrow (and may get woken through the night). I'm fairly certain that this is a form of torture used in interrogation, and I can see why. If there was anything they wanted to know now I'd tell them. Although I seem to be struggling to recall any helpful medical knowledge right now.

Thursday, 3 September 2009

Not exactly a piece of cake.

So, the first on call. Started well with a quiet afternoon, leading in to a quiet evening (I had time to come home and bake a cake, not something I've ever done before on call. But pretty useful as I took it in to bribe the OPD nurses. Some things really are international). Pottered back in about 9 to sort some things out and agreed with the nurses in OPD that they would ring me if anything urgent came in, or once there were 5 or so pateints waiting (not for "every Tom, Dick or Harry". Their phrase not mine). I would then come back at 5.30 to mop anything up before they hand over at 6. Came home, went to bed. And there it started to go downhill. A phonecall at 10 that I managed to deflect, then a call at 11.30 for a pregnant lady haing contractions and ?ruptured membranes. Went to see her, unsure of the baby's position so took her to scan and discovered one of the delights of the OPD at night; as many of the patients live a long way from hospital, if they are going elsewhere for an appointment the next day, they will come and sleep in the OPD the night before in order to catch the 5am transport. So to do the scan, I have to kick about a dozen people (including babies and elderly patients) out of the scan room. Wonder how sensible it is for the MDR TB patients to be sleeping in the same room as the babies. Fortunately baby is the right way up (or down really) so I send her off to the midwives. Deal with the minor injuries waiting and head back to bed about 1. Called again at 1.30. A really sick and gasping patient, GCS 7, massive ascites and hepatomegaly, previous diagnosis of ?a heart problem ?a liver problem. The neighbours accompanying are unsure of HIV status. So I jump in with a plan to do some obs (the nurses sometimes take some encouragement), send some bloods and get some x-rays. And discover that what appears to be limited resources during the day is non-existent at night. No bloods. No x-rays. It really is all on clinical judgement (guess work). Discover a blood sugar of 1, head in with some dextrose and he perks up a lot. Chuck in some diuretics and iv antibiotics for good measure and cross my fingers. Then do some stitching on the knife attack patient in the next bed (head and chest, I leave the hand for theatre in the morning). And it's now half past 3. Renegage on my originally agreement of half past 5 and tell them to ring me at 6 if there are any patients waiting. They ring at 6 to tell me there aren't. And my alarm goes off at half past to start the day. A morning of OPD (reviewing all the patients that I lodged overnight) followed by a well-earned afternoon off!
Apparently this does count as a busy on call (phew- I'd been thinking that if they were all like this I wouldn't survive the year!). Let's hope this weekend (my first weekend on) is better.

Apologies to non-medics for medicalisation of this post but I'm sort of hoping some clever doctors might be able to send me suggestions of what else I could have done for the poorly patient. He's now alert but still massively swollen up with an ECHO (USS of his heart by me) that suggests poor contractility.