Monday, 31 May 2010

All fired up.

This weekend we headed down in to Swaziland for BushFire, a three day music festival. Essentially it's a mini-Glastonbury but with African bands and a much better shower:camper ratio. It was a lot of fun, lazing around in the sun listening to local bands and then dancing until dawn in the crop circle, before crawling in to our tents.
It also lived up to the ultimate festival expectation by pouring with rain on the Sunday.

Wednesday, 26 May 2010

Smelling a rat.

This week's issue is that of unwanted house guests. Or more specifically attic guests. Rats.
We've been gradually aware of increasing noises from above our heads but this week it has got to the point where it is waking us up in the night (and I'm living in fear that the ceiling is going to give way and they'll come crashing through) and on Tuesday night's braai, one of them made an unwelcome appearance in our paw paw tree. At head level.
Fortunately the hospital kitchen also has some unwanted guests; a cat and her 4 kittens. And I think I can see a solution to both of our problems.

Tuesday, 18 May 2010

Not exactly a partridge.

So Sunday's comedy case; I got called to see one of our Kwazihambi (the place where women in their first pregnancy go to wait out the final few weeks before they deliver) ladies as she had a painful ankle, having fallen out of a tree. Whilst picking avocados. At 39 weeks.
She looked suitably sheepish. And was fine.

Sunday, 16 May 2010

Life and death.

An unbroken night's sleep and I'm much less grumpy.
I've had some sad news from yesterday- a lady whose labour I was augmenting delivered a flat baby and despite all resuscitation efforts, the doctor on yesterday was unable to revive it. Labour is a dangerous time anywhere in the world but the risks here are definitly greater as we don't have the facilities to monitor as closely as we would like to, nor to act as quickly as we should.
On a happier note, when I went to Paeds ward, I found that all 3 of the babies who were dicing with death yesterday are improving.
Sadly the one who had the enema, whilst less acidotic and more likely to survive, seems to have some neurological deficits. We will have to wait to see how things progress, but it may well be that some permanent brain damage has been done.
When I consider that the child had made it safely through the dangerous delivery period only to be potentially disabled by well-meaning relatives, I am again frustrated at how hard it is to change a community's beliefs.

Saturday, 15 May 2010


Oh, and I forgot to add that whilst struggling with the cannula for the enema-poisoning child last night, I suggested to the second on doctor (one of our community service doctors; 3rd year post qualification) that perhaps we should call our third on (normally when two junior doctors are on call together, a third, more senior doctor is available for dire emergencies). It was then that we realised we don't have one. So yours truly is the most senior doctor in a 100km radius. Quite a scary thought.

A post-call rant.

On calls can, like at home, be so variable. But this one is a bad one. I barely slept last night and am totally exhausted. But I am also just tired of some of the things that happen, or don't happen here;

It all started at half 3 yesterday afternoon, I was just sending everyone else home early as the department was quiet (almost unheard of) when a rape case arrived. I began by counselling her on her risks of exposure to pregnancy, STIs and HIV and prescribing her appropriate prophylactic drugs for all of these, only to discover that we don't have emergency contraception in our emergency drug cupboard. And with the current pharmacy situation, we don't have an on call pharmacist. So I was faced with using an unlicensed (and less effective) treatment or having the poor girl wait 60 hours for contraception, by which time it's effectiveness has greatly reduced.
An hour later, I was finally completing the rape evidence kit when maternity rang to say they had a cord prolapse. This is an absolute emergency and involved rushing the woman to theatre for a c-section. In the UK, the baby would be out in a matter of minutes but here there can be difficulty impressing such urgency upon staff and everything takes longer. When we finally got the baby out 45 minutes later, he reassuringly cried and I hope that the delay hasn't adversely affected him.
During the section, the theatre sisters enquired how maternity was looking as with no water this week, we haven't been able to sterilise and so only have enough theatre sets for 3 c-sections. Apparently we are unable to borrow these from our nearest hospitals, so have to wait for a central supplier to send some out.
Just as I was closing up, the OPD sisters came to seek me out to tell me that they had a baby with enema poisoning who was shut down. This is a common problem here; people believe in using them on everyone, even very young, healthy babies, and they use anything from herbs to washing up liquid. This can create terrible imbalances in electrolytes causing respiratory compensation and often ultimately death. We actively discourage it but are fighting against a commonly held cultural belief. Ultimately it is child abuse and potentially man slaughter.
An hour of struggling and we finally managed to get iv access in the baies scalp to give fluids to try to combat the imbalance but the child is still very sick.
My final frustration came at 3am when female ward phoned to tell me that a patient had died. She was a 57 year old lady who had been admitted last weekend. When I saw her on Wednesday it was apparent that she was bleeding profusely from her gastrointestinal tract. I rang our referral surgeons to arrange a scope where they could find the bleeding point and stop it. Sadly their scope remains broken and they could offer no help. We rang on to their referral centres in Durban but were told that they weren't accepting patients in readiness for the start of the World Cup. Despite all available medicines and blood transfusions here, the lady bled to death, with what essentially should be a treatable condition.

I knew when I came here that I was coming to a place with less facilities than I was previously used to but I find that 9 months on, I am still totally frustrated by this. Particularly when it seems more logisitcs than just money that is affecting patient care.

Thursday, 13 May 2010

Treading water.

Our perinatal meeting this morning revealed that last month just over 10% of deliveries were to mothers under 18. This is fairly standard for here but pretty shocking compared to the UK. And in addition to all the added complications that young mothers face, in view of our 30% HIV rate in pregnant women, a sad inditement on HIV education in young people.

The meeting then turned to a discussion on ways to decrease this. There was quite a lot of support for encouraging abstinence amongst young people, something that I personally think is an unrealistic solution.
We also discussed increasing access to healthcare (and therefore contraception) in an open and non-judgemental way. One of the problems of the whole local community recieving healthcare at a clinic is that the teenagers face a lack of confidentiality and the judgement that goes along with that. I am keen that we recognise that teenagers are having sex and tackle the unprotected nature of it. We need to increase our school-based health education programmes but we are hampered in this by an education minister who is set against the provision of condoms in school.

Sometimes I just feel so frustrated that we seem to only be managing problems here rather than looking for solutions to these problems.

Monday, 10 May 2010

Fishing for compliments.

Another weekend off, another border hopping adventure to Mozambique. This time we headed further up the coast to a more secluded beach resort where we shared our unending white sand beach with a handful of people and yet again, ate prawns until we were sick.
However, the highlight of the weekend occurred on the dance floor of Pintos where we were initially mistaken for South Africans by a couple of UK medical elective students, and then when we set them straight, and exclaimed over the medical coincidence, they asked if we too were elcetive students. Made my night.

Resigning ourselves.

So the leaving process has begun; we handed our resignation letters in and have begun to fill in the endless forms that claiming our pensions back involves. We still have a couple of months to go but in the strange way that time has I suspect it is going to fly by (whilst the first couple of months here felt like a lifetime).

Wednesday, 5 May 2010

A cop out.

The bit of my job that I least enjoy here is the role of police doctoring that is forced upon us. So far I have avoided having to do any post mortems, but we see all the assault cases, rape cases and child abuse cases. All of these come with specific forms to be filled and sample kits (that involve swabs being folded up in boxes that require a high level of origami skill) that take a frustrating time to complete. What I find most frustrating though is how unqualified I consider myself to be to be completing these kits (goodness knows how many samples of my DNA I have accidentally provided) and writing down whether I feel a person's injuries could be consistent with their alleged assaults. The knowledge that my opinions can have huge implications for these people's lives in terms of prosecuting is overwhelming.
I also feel that it isn't entirely appropriate that we are seen as part of the police service (taking blood tests for drink driving and rape suspects). As doctors, patients should feel that they can trust us, that we act only in their best interests, as we have sworn to do.

A bum deal?

The long weekend was put to good use with a quick getaway on Friday to St Lucia. There we fully indulged gender stereotypes with the girls going horseriding and the boys going deep sea fishing. Given that we got to eat amazing fresh fish without a 6am start or a dose of sea-sickness, I think we had the better deal, but there again the boys were able to sit down for the braai...