tag:blogger.com,1999:blog-91277105894167038502024-03-13T23:52:30.218+02:00Caroline goes ruralSo, heading off to rural South Africa for a year to work in a hospital in a village called Ingwavuma.
Keeping a blog seems a little geeky but no geekier than people logging on to read it...Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.comBlogger102125tag:blogger.com,1999:blog-9127710589416703850.post-91388133404205249162010-06-16T17:21:00.003+02:002010-06-16T17:25:46.031+02:00How to alleviate middle-class guilt?The other emotion complicating things is guilt. When I first came out, a year seemed a really long time, but now that it is nearly over, I can see how short it really is, and how I am only just getting settled and beginning to understand how life here works. And I feel terrible that just as I get to this point, I leave, abandoning patients and staff.<br />What this rural community needs is doctors who can commit to them for a long time. Young foreign doctors aren't the solution.<br /><br />Fortunately for me, someone previously had an idea for a solution and set up "Friends of Mosvold", an organisation that sponsors local kids through health-related courses at university, on the proviso that they commit to coming to work at Mosvold in their holidays and for a set period after qualifying. These are the staff who not only understand this community (literally speaking the language) but are also the most likely to settle here.<br />It's an amazing organistation that I have personally seen benefits from (our lovely social worker is a graduate of the scheme and due to marry and settle here in a few months time).<br /><br />Watch this space for a way for me to alleviate some of that guilt...Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com2tag:blogger.com,1999:blog-9127710589416703850.post-11516667615882583032010-06-16T17:19:00.000+02:002010-06-16T17:20:29.187+02:00End of a year-a.The day after our leaving braai, and our final day (bad combination?).<br />Last night was a lot of fun with all the nurses, doctors, therapists and security guards coming round for a braai. It was Zulu-style, with plenty of meat and pap, quaito music pumping and some serious booty shaking. Some serious heaadaches today too.<br />As today is a public holiday I only worked until 12 but what an almost final case; an imminent pre-eclamptic with a blood pressure of 211/143. Yikes.<br />Once that was sorted and she was rushed off to theatre (luckily I'm not on for that) I just had a few dog bites to vaccinate against rabies and I was done.<br />And now I am finished at Mosvold (with only the procrastination over packing to get through).<br /><br />I have quite mixed feelings about going; I shall really miss some aspects of life here (my two minute commute, people just popping round unannounced, everyone saying hello to you). But it's time for me to come home. I miss family and friends and realistically, coming here has meant putting life on hold in many ways, and it's time to come back and restart it.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-74939791085059112252010-06-13T20:30:00.002+02:002010-06-13T20:47:09.448+02:00Feel it, it's here.So, the World Cup has begun. And how. <br />It felt like it had started some time ago with all the countdowns, huge numbers of distinctive yellow Bafana Bafana tops (mostly fake) and Wednesday's "5 minutes of blow your vuvzela for SA" (with lots of warm up going on in the days before...). However, on Friday I realised that I hadn't seen anything yet.<br />We made a last minute dash to Nongoma to watch the opening match on a giant screen erected in the college, with a hall full of thousands of yellow-clad Zulu fans screaming and blowing their vuvuzelas like crazy. The atmosphere was incredible; so friendly and happy and just bouncing.<br />On Saturday we moved on to a rural fan park in Mtubatuba which did not live up to the dangers predicted, helped by there only being about 30 people there (and about half of them were security). Not sure if it was a lack of interest in Korea-Greece or in the fan park.<br />It was on to Richard's Bay for the Nigeria-Argentina match where we were taken aback by the lack of interest in the football from the Afrikaaners (at one point, someone was sat in front of the screen). I think rugby is more their game.<br />So in the end we headed to Durban for the England match where we were joined by thousands of Australians in town for tonight's game. The vibe was incredible, the whole town alive and pumping.<br />The next month looks to be amazing, and I'm excited to be here for it.<br /><br />Oh, and I found that blowing a vuvuzela is a lot more difficult than it looks.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-1203241536088940672010-06-09T19:25:00.003+02:002010-06-09T19:31:22.026+02:00Ups and downs.The end of our time here is rapidly approaching and I'm surprised at the very mixed feelings I have about it. A year ago when we arrived, I couldn't imagine lasting 6 months, let alone a year. Let alone be feeling in any way sad at the idea of leaving.<br />Driving back from clinic yesterday, sun shining, bumping along a red sand road and waving to all the kids running alongside I realised that London will seem very grey in comparisson to life here. I also feel very settled; last night we had "xmas in June" and as we sat in our party hats eating xmas pudding, I realised that I will really miss a lot of the people I have met here and the social life we have.<br />Fortunately, when I got in the shower, I was reminded of some of the downsides of living here; not only did I have to manouvere myself under a small dribble of hot water but when I reached for the shower gel, I had to have a stand off with a preying mantis. <br />I lost.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-39464166995964406682010-06-02T17:49:00.003+02:002010-06-02T21:18:57.843+02:00Not quite feeding the world.Like parents, doctors probably aren't supposed to have favourites, but I do.<br /><br />Nkosinphile is a 13 year old boy with learning difficulties who had a prolonged inpatient stay back when I was running male ward (oh yes, anyone over 9 years is no longer a child- if they can't sleep in a cot, they have to go to the adult ward). He'd come in with severe burns to his legs requiring skin grafts, but it then transpired that there was a fairly dire home situation. He and his 3 younger siblings were orphans under the care of an uncle who found Nkosinphile too difficult to manage so had farmed them out to an old gogo who wasn't really able to take care of the kids. <br />The social workers spent a long time negociating with the family, during which period Nkosin charmed everyone in the hospital, getting them to play ball games with him and eating so well that we had to find him some new clothes when he went home as he had gotten too fat for his own. <br />Eventually it was agreed that the family would build a hut about 200m away from the family home for the kids to live in, and they would pay a slightly younger gogo to stay with them and cook for them. <br />I visited the hut with the social workers as it was being built. It was a concrete two room affair, each about 4x4 metres, one large bed and some cooking utensils and a separate hole in the ground out the back to serve as the toilet. Quite a nice place by local standards. Once it was completed, the children moved in and a week or so later I saw Nkosinphile at his local clinic. He looked happy and well and was keen to play ball games.<br /><br />When we drove by his hut today it was a very different story. He was sat outside, dirty and dishevelled with weightloss to make a WeightWatcher envious . He was with his younger brother who had had to stay home from school to look after him as the gogo hired to do so had gone off to visit someone. They told us that she only stayed with them during the day, leaving Nkosinphile in charge overnight. They also showed us their kitchen area where there was an array of empty shelves, their uncle who is supposed to buy food for them apparently isn't.<br /><br />It was heartbreaking to see the dramatic changes in Nkosinphile and even more so when he, who had been desperate to come home to his family, asked me to take him back with me to Mosvold. <br />The social workers have made a plan to find a place of safety for him but in the short term, all I could offer him was my lunch for the day, which he gratefully took. It's not really a solution ("give a man a fish...") but faced with a child who is literally starving, it felt like the best thing I could do.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com1tag:blogger.com,1999:blog-9127710589416703850.post-48303094000274589702010-05-31T17:11:00.002+02:002010-05-31T18:07:02.482+02:00All 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. <br />It also lived up to the ultimate festival expectation by pouring with rain on the Sunday.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-27156946662600453302010-05-26T21:09:00.002+02:002010-05-26T21:13:43.719+02:00Smelling a rat.This week's issue is that of unwanted house guests. Or more specifically attic guests. Rats.<br />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.<br />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.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com1tag:blogger.com,1999:blog-9127710589416703850.post-89012526773272938762010-05-18T16:49:00.002+02:002010-05-18T18:04:48.101+02:00Not 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.<br />She looked suitably sheepish. And was fine.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-48430949231136891852010-05-16T12:19:00.002+02:002010-05-16T12:43:45.785+02:00Life and death.An unbroken night's sleep and I'm much less grumpy.<br />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.<br />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.<br />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. <br />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.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-87849888781017661352010-05-15T15:52:00.003+02:002010-05-15T15:59:19.382+02:00And...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.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com1tag:blogger.com,1999:blog-9127710589416703850.post-9047233755574966882010-05-15T14:59:00.002+02:002010-05-15T15:49:44.198+02:00A 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;<br /><br />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.<br />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.<br />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.<br />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.<br />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.<br />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.<br /><br />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.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-26130091111745018342010-05-13T18:44:00.005+02:002010-05-15T14:57:30.677+02:00Treading 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.<br /><br />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.<br />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.<br /><br />Sometimes I just feel so frustrated that we seem to only be managing problems here rather than looking for solutions to these problems.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-57672737567687290962010-05-10T20:18:00.002+02:002010-05-15T14:11:40.070+02:00Fishing 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.<br />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.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-78925130424963366642010-05-10T20:06:00.005+02:002010-06-09T19:35:11.896+02:00Resigning 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).Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-70525458533033310682010-05-05T16:18:00.003+02:002010-05-05T16:56:28.329+02:00A 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.<br />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.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-10024842980138987622010-05-05T15:38:00.003+02:002010-05-05T16:12:24.947+02:00A 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...Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-86921075168224886242010-04-29T19:58:00.004+02:002010-04-29T20:47:58.403+02:00The ultimate post-code lottery.Another Thursday, another on call (but I don't complain too much as it gives me a long weekend). Nothing too drastic so far but I have just been to confirm a death on the Isolation ward. A 33 year old woman I admitted on Monday night. I noted that she looked very sick, likely TB, and admitted her for iv antibiotics and TB work-up. I see tonight from the notes that she deteriorated over the next few days, becoming confused. I was then called this evening to confirm her death.<br />The thing that gets me is that she was HIV negative. In a different setting, her level of care would have been escalated to a much greater level, and her chances of survival would have been good.<br />We see a lot of young people die here; barely a week goes by when I don't write a death certificate for someone my age or younger. But generally these are HIV related. Tonight's death reminded me of just how much disparity there is in healthcare in the world.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-26225602606155242212010-04-26T20:15:00.003+02:002010-04-26T20:31:35.959+02:00Not quite sat-nav.Having arrived at clinic today to find that they weren't expecting me, I then got to tag along with the social worker on a home visit. There is a child on Paeds ward who needs to start ARVs but can't until a family member does adherence training so we were going to see if we could find someone appropriate. The first thing we had to tackle however, was finding them at all. We knew that they lived around Madadeni store so drove to that area and began asking around. We quickly found someone who knew where they were and hopped in the car to show us. It struck me that this wasn't ideal for patient confidentiality (though nor is the hospital emblazoned car) but in an area with no streets, let alone street names, it's about the only option we have.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-2396272454607225352010-04-25T20:56:00.006+02:002010-04-26T20:35:25.475+02:00A hopilless situation.Thursday was a bad day for pharmacy. Not only were we out of one of our antihypertensive drugs (this is quite normal. I've given up pointing out how unhelpful it is for us to be telling patients how important it is that they take their meds only to then not be able to dispense them as we are out of stock), but we also had no warfarin (we have a lot of heart valve replacement patients due to rheumatic heart disease), no second line HIV drugs (for those patients who have failed to improve on the standard ones. 'Defaulting' treatment is a sure fire way of making sure that the second line ones don't work. And we don't have third line ones) and no TB treatment (a good way to increase our already prolific drug resistant TB). A fairly bare cupboard.<br /><br />And then we heard that our chief pharmacist is leaving at the end of the month. With no replacement in sight.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-32799665391954618322010-04-21T18:43:00.004+02:002010-04-21T22:41:50.192+02:00Best of 3?So the rest of the GP-led weekend was a little more challenging; our first c-section on Sunday morning and a black mamba bite that afternoon. <br />Deyo woke me at 7 to say there was a section. We rock, paper, scissored and I got to cut. All went smoothly until it came to actually getting the baby out when I discovered that it was making a valiant bid for freedom the more usual route. Some pushing from Deyo and pulling from me and we persuaded him to trust us that there really wasn't space that way; a real team effort.<br />Later that afternoon I was called to a snake bite. A black mamba. From my previous experiences I've learnt that the antivenom (and it's 1:4 chance of anaphylaxsis) only has to be given in certain situations but black mamba bites are one of them. So yet again, team GP bravely stepped up;<br /><br />C: It's been a while since I've done this<br />D: I've never done this<br />C: Oh. Fingers crossed then.<br /><br />Fortunately luck was yet again on my side (3 out of 3) and the patient didn't react.<br /><br />So Deyo and I not only survived our first weekend on call together but actually faced my two fears of things we wouldn't cope well with.<br />As future poly-clinic workers, I think Darzi would be proud.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com2tag:blogger.com,1999:blog-9127710589416703850.post-85886259007305282242010-04-17T08:54:00.003+02:002010-04-17T10:23:40.501+02:00Sticks and stones.My first weekend on call with Deyo. I'm feeling a little anxious in case there are any theatre cases (the untrained leading the untrained...) but we do have 3 seniors around Ingwavuma on standby. And we're one night down with out any problems. <br />There was the usual selection of chronic cases (and unlike in the UK, asking "why have you come in with this on a Friday night? Has something got worse?" adds nothing except a shrug and a convoluted explanation about a lack of transport) and drunken assaults. One of the latter of these was a well-dressed (albeit fairly blood stained) English-speaking 30 year old who had been hit in the face following an altercation regarding another man talking to his girlfriend. After a quick assessment I suggested we get the blood off his face so I could see whether he needed any stitches. I lead him to the sink and handed him some swabs. He looked at me increduously. Was I suggesting that he wash the blood off his own face? I laughed and told him I wasn't his mother. At this he rounded on me, was I being racist? After a brief consideration I assured him that I didn't think I was being, that I would treat any patient the same way but that around here, that probably wasn't great evidence of a lack of racism. He didn't seem to appreciate that but did let me stitch up his face.<br />It was an interesting question though and one that I haven't faced here before, presumably for the reason I pointed out. I can't deny that skin colour is something you notice (an unkown white person see in Spar, let alone OPD, will cause a flurry of discussion) but I genuinely don't think that my patient care differs as a result.<br />More interesting perhaps, would be where his assumption that someone telling him to do something he doesn't want to do must be doing so based on his skin colour, comes from. Does he really believe that or is he just an angry young man? <br />Personally I think he may have missed where I do think my patient care differs; English speaking patients. I find the inability to communicate with the vast majority of my patients a constant source of frustration, so when I see someone with whom I can have what I consider a proper consultation, I revel in it and they undoubtedly recieve more information and are more involved in their treatment decisions. But then that would be a discrimination that benefited him so perhaps it was less of an issue.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-81350970787921905882010-04-14T18:53:00.002+02:002010-04-14T20:18:31.968+02:00Read all about it.Recently I've had the rather obvious realisation that with writing a blog, my thoughts really are open to everyone. <br />I was aware that people I know at home have been following it and as that really was it's purpose, I'd be disappointed if they weren't. Out here, I haven't made a secret of keeping a blog and I know one or two people have looked at it. <br />But I was a bit taken aback when our new physiotherapy elective students arrived and after 5 minutes of conversation announced that they had read it. And even more taken aback when one of the managers in Spar mentioned he had read it. Apparently it now comes up quite easily on Google if you type in the right combination of Mosvold, Ingwavuma and hospital.<br />I think it was the idea of people who I didn't know having read some of the things I had written. As I've said before, it's become a sort of online diary and I try to write it entirely as me, with at times rawer emotions than I would share with people on first meeting them. I was worried about opinions that people might have formed about me based on things I had written. Particularly people I then see regularly.<br />However, the students said they appreciated the insight before they arrived (and they've even got in a car with me!), and Spar not only still serves me but has in fact recently started stocking a variety of cheese other than Cheeso, so perhaps I shouldn't worry. Now, did I mention how much we all crave bacon...?Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-21655716616542264242010-04-11T17:39:00.004+02:002010-04-11T17:43:41.814+02:00A bit cheesey.Fortunately I only had to get through a few hours of Friday's frustrations before I was done for the day and started my long weekend in Kosi Bay with my parents. Had a load of fun hippo and croc-watching and snorkelling (not at the same time, but not as far apart as you might think wise) and stocking up in the fancy Spar there that stocks not only bacon but 4 varieties of cheese. Hopefully those should get me through next weekend's on call.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-907543758277234712010-04-11T16:14:00.003+02:002010-04-11T17:38:54.543+02:00Frustrations.On Friday I was incredibly grateful that I had had an almost unheard of 6 hours sleep on call the night before, or I think I would have flipped out and lost my post-holiday calm. I was phoning our referral hospital to get the results of a scan that a patient had had there 2 weeks before. They told me that it still hadn't been reported. I asked to speak to the head of department to discuss that this wasn't really appropriate, particularly as our patients travel a long way to see us for their follow-up which is difficult to do without results. She explained that they had no one to report the scans (the hospital has not renewed the one of the radiologist's contracts as they don't have money to pay him, and the other one is on prolonged leave). They're continuing to do scans in the hope that the situation might get resolved.<br />Next up I rang to book an endoscopy (a camera test down a patient's throat) for a patient. I was told that the piece of equipment needed was broken. It has been for the last 4 months and they're not sure when or even if it will be fixed. Their manager told me that in urgent cases they are using their colonoscope (the one for the other end) but otherwise they advise phoning again in another month.<br />Situations like these make me feel so frustrated. Things that should be available suddenly aren't and no alternatives are arranged. And part of the problem is money, but it also sometimes feels like there's a lack of desire to provide a good service. <br />These situations also make me feel fairly useless. I am still so dependent upon tests to help diagnose patients problems. Coming here has certainly improved my clinical diagnostic skills but I think I still have quite some way to go.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0tag:blogger.com,1999:blog-9127710589416703850.post-86264103023541318742010-04-07T22:34:00.003+02:002010-04-07T22:47:17.545+02:00Good medical practice?This week has however, not been without it's thought provoking moments. This one a legal and moral quandry. I saw a lady in OPD who was 8 weeks pregnant and who had come in the week before to request a termination. She had been counselled by one of the doctors and referred to the social worker for further counselling. However when she came back to collect a letter to allow her to catch the bus to our local Marie Stopes clinic (some 4 hours away), the doctor who saw her refused and sent her away. Confused by his notes I asked him about this and he informed me that due to his religous beliefs he was not willing to refer her, and that the 3 other doctors avaiable at the time also held similar opinions. He had advised her to come back another day.<br />I appreciate that this is by no means an ethical issue limited to Mosvold; I have worked with doctors with similar views in the UK and Australia. And I do appreciate that for some people it is a very emotive issue. Normally I can accept that those of us who feel less strongly on this issue should take over these cases. However, in a hospital of only 8 doctors serving a very poor community who can ill-afford multiple trips to hospital, let alone another child, I can't help but feel that refusing to refer a patient on the grounds of our beliefs is a luxury that we do not have.Carolinehttp://www.blogger.com/profile/01916004569514537485noreply@blogger.com0