Tuesday, 26 January 2010

The Mother City.

Last week was a week off and I headed to Cape Town. And fell head over heels in love with the city; awesome mountains, white sand beaches, funky bars and beautiful people. Basically a completely different world (or at least a country) to Ingwavuma.
Or so it appears on the surface. However scratch it with a township tour (not quite as naff as you might imagine, although did feel a little uncomfortably like being on safari in people's homes) and I realised that South Africa's problems are widespread, they're just hidden a little better in some places.
And I also began to understand why so many of the mothers leave their small babies in the rural areas with their gogos rather than taking them to the city where they work; 17 people living in a small room is not an ideal place to bring up your child.
The rest of the week however I managed to ignore all social guilt (except the guilt of laughing at a couple of tourists who managed to get three, count them, three, baboons stuck in their car) by exploring the delights of Cape Point, Franschoek, Constantia and the Waterfront.
All too quickly it was back to the Vuum, and after 2 days (and half an on call) it feels all too familiarly like I was never away.

Wednesday, 13 January 2010

Making a difference?

This week has seen the start of my new role as the clinic doctor. I am going out to the outlying clinics 4 days a week to see patients and do some teaching to the sisters there. This will surprise anyone who read my comments on my first clinic visit but since then I have begun to recognise the importance of providing good care to patients near to their homes (so many patients cannot afford to make the journey to hospital) and also the need to support the nurses who work so hard out there and can sometimes feel very isolated from us (as we feel isolated from our referral hospital).
So daily, I will pack up my little lunch, climb in to my enormous 4x4 and bump off down some dirt road to a small building where up to 40 patients are awaiting my arrival.

Day one was however not a good start. At about half past 9 in the morning I saw a baby who had been born at home the day before as his mother couldn't afford to come to hospital. It was her first baby and luckily she managed a normal vaginal delivery (due to the commonest pelvic shape here, a lot of women struggle with this). She had come in for a check-up and the baby had been found to have a very high temperature but otherwise seemed well. In such a young child you admit them to hospital for intravenous antibiotics whilst looking for the cause of the fever. I duly organised the paperwork and drugs and the nurses called an ambulance.
At half past 3 as I got ready to leave, I realised that they were still there.
Officially the government vehicles are only supposed to be used for transporting staff and goods and ambulances are to be called for patients. Apparently if you are found with 'illegal people' in your vehicle it can be impounded by the police. However, I felt that I could argue my case for this one (he had already waited literally half his life for an ambulance).
I bundled them in to the back of the car, teaching the mother how to use a seat belt and trying to ignore the complete lack of a car seat. We then drove the 45 minutes to Mosvold.
On arrival, the baby was dead.
And I know in my heart that I couldn't have done anything differently had I known at the clinic or en route, but the idea that it died in the car, or possibly even worse that I didn't notice as they got in makes me not only feel like a bad doctor, but also quite sick.

Monday, 11 January 2010


Deyo and I are three again. The addition of a cute little white Ford Fiesta to our family has delighted us both. She will give us the freedom to get off the mountain when (much-) needed and explore some more of the area. She drives like a go-kart, and has enormous alloy wheels that have bought us some serious street cred with the Zulu male security guards.
Sweet as a nut.

Tuesday, 5 January 2010


Another life-event in Ingwavuma this evening. The running club (now just me and Deyo) was cut short when we came across a tiny grey kitten on the road outside the hospital. It was obviously in a lot of distress and limping. A closer examination revealed a worm-infested wound on it's right back leg. Much to the amusement of the watching Zulus we scooped it up in my t-shirt and brought it back to the hospital.
We realised that without any vets around the wound meant a prolonged and painful death. Even with vets, it would probably have been at least an amputation and then a disabled kitten dependent upon people who leave in 6 months time. After some discussion we felt that the kindest thing would be to put it out of it's misery and so we gave it a lethal dose of im ketamine. Obviously putting animals down is something that even animal-loving Brits are aware of the need for, I've just never personally done it.
I also couldn't help but draw some parallels to some of our work here where we give patients life-prolonging treatment that makes them dependent upon the health care system which may also not be around forever (money and staff deplete as it is).

Monday, 4 January 2010

You're only as old as the ?woman you feel...

Some of the more amusing sorts of cases that we see in OPD are requests for changes on id documents. Mainly these are people claiming that their date of birth has been incorrectly filled in and that rather than being 54 (or even 39 in one case!), they are in actual fact 60. Conveniently the age at which the government pension starts... It's a little unclear to me what exactly the state department think we can do to confirm the ages of people who often have no birth certificates and don't even know their birthdays. Perhaps they imagine that we can cut their legs open and count the rings like a tree.
The other change that we are asked for is the sex. In 5 months I have seen about 10 cases of people whose id documents state them to be male when on examination they are clearly female, or vice versa. Those are easier to confirm.
Today's case was a highlight; a heavily pregnant lady came in most upset as the state department were refusing her maternity benefits as her id document stated that she was male. The proof quite literally was in the pudding.

Saturday, 2 January 2010

Feliz Ano Novo!

2010. The year of South Africa. And we saw it in in Mozambique. What a party! And what a shame I came back to an on call shift...