Wednesday, 17 March 2010

Being too tasty for my own good.

In the middle of last week, I noticed that something had bitten me on my left thigh. This is not an uncommon occurence; the mosquitos are only partly repelled by the deet and net combinations (luckily malaria is rarely seen this high up the mountain). However as the week progressed so did the bite and when I noticed a golf ball sized lymph node in my groin on Thursday I decided that the time had come for antibiotics. The benefits of being a doctor meant that I could just help myself to these at 2am during my call (I balance it out that I'm saving them money by not taking time off). 4 days later and the red line tracking up my leg did seem to be slowing down but not exactly reducing. And the chat around campus was that a number of us had similar ?bites. Theories abounded; a spider that comes out in the late summer, tetse fly bite (with the accompanying possible sleeping sickness), and my personal favourite, a fly that lays eggs on your clothes which then hatch and the larvae burrow in to you. I was faced with a tough decision; go on to different antibiotics (but one of the few ones you can't drink alcohol on, just as my annual leave approaches, and more relevantly the ones all doctors claim to be on in early pregnancy to explain their abstinence; rumours would fly!) or wait and see (and potentially be one of the annoying A&E patients you would see with a bit of a temperature who would then casually mention that they were just back from rural SA. And had some dodgy bite...)?
Luckily the GP-style has paid out and the redness (and accompanying fever) does appear to be subsiding. Phew.

Shark attack.

So a belated update on the weekend. Headed down to Sodwana Bay to join our therapists who were completing their NAUI dive course (for those like me who are PADI trained, NAUI is apparently the one for 'real divers'). Was a lot of fun (well, not so much for the early morning divers who suffered after the night before with some underwater fish feeding...).
Sneaked in a couple of dives myself and saw lots of very pretty fish without feeding them, but sadly missed the whale sharks that were allegedly hanging around the Bay. I did manage to see a couple of sharks on the dance floor of the local Afrikaaner bar and was persuaded in to some energetic sooke sooke dancing but we fortunately left before the "lion lope" began (directly translated as "walk like a lion", it involves some nakedness from the boys).

Wednesday, 10 March 2010

A little s-hello.

Another day on the road, another creature throwing itself out in front of me. This time a small tortoise. I spotted it just as we were bearing down on it, with another 4x4 coming towards us. Slamming on my brakes I hoped the other vehicle would miss it. It did. But then an even bigger truck came up behind me (rush hour on the dirt road to Manyiseni clinic) and went to go round me, on a direct course for the shelled proverbial chicken. With hardly a moment's thought, I hopped out, dashed in to the road and snatched him up to safety. As my thanks he hid as far as possible inside his shell whilst I carefully placed him down on the other side.

Saturday, 6 March 2010

Bright ideas.

A weekend on call and some more frustration and anger, but this time at the EMRS (ambulance system). Last night in addition to the usual chest infections and malnutrion, I worked my way through 3 MVAs (with a total of 11 victims of varying severity and one very dead cow; black cows and no street lighting are a dangerous combination) and one stabbing to the abdomen. I'm no surgeon but I figured that bits of omentum hanging out wasn't a great idea and after consultation with some actual surgeons decided that it was probably better to stabilise and send to them rather than have a go here (although I'm thinking laparotomies aren't that different to c-sections, right?). The trouble was that having rung for the ambulance at 1am, when I rang at 3 to find out where it was they told me that there wouldn't be one until morning (6am). This was because out of the two ambulances we have, one "isn't fit" to drive the 3 hours to our referral hospital (although is fit to range around the dirt tracks in this area bringing in patients I then can't transfer out if it's needed) and the other had a broken light in the patient compartment so couldn't be used in the dark. My suggestion that they take a torch didn't go down well.

Thursday, 4 March 2010

Another dip on the emotional rollercoaster.

Today I was struck by just how unfair life is. Out in clinics I saw a child who is about 2 years old (her date of birth is unknown). She'd been brought in by her aunt who had fetched her from Swaziland the week before, following the death of her parents in January. She'd been in a Swazi hospital in December and her discharge summary states "HIV positive, TB, malnutriton". She'd started ARVs, TB treatment and feed-up but the family who handed her over from Swazi had no medicines for her. It's unclear when they were stopped. She'd weighed 7.1kg on discharge and now weighs 6kg. That's about half of what she ought to. I've brought her in to try to restart all the treatments and involve the dietician and social workers but it may all be too late.
And this brought up in me some emotions that I thought I had already dealt with but which caught me afresh today; I feel angry at the world that in 2010 this is still happening and I feel guilty that I can't change it. It is just too big and complex an issue. But mostly I feel very sad. She is just a child, and life has dealt her an incredibly raw deal that she may not be able to break out of. And the worst part is that she is just one example of many.

Doctors, I presume?

So the funny thing I didn't mention about last weekend was that our rafting group was made up of 6 of us and 4 other people. When we got to the meeting place we discovered the other four were a selection of doctors and medical students from other local hospitals. When you add this to the fact we bumped into a load of doctors in Sodwana Bay a few weeks ago (staying in the next door cabin to us) and were even sat at the next table to a bunch when we went out for dinner in Durban, northern KZN starts to seem very small. I guess we make up a big proportion of the tourists in this area (most SAs consider this to be too rural for holidaying), and there are only a limited selection of activities to do. And most importantly we probably all have the same edition of the Rough Guide.