Goodbyes.

As in most of the Southern hemisphere, the academic year runs January-January here, so for our community service doctors and therapists, their year in Mosvold is shortly to come to an end. We are also losing our dietician and speech therapist as well as the other British doctor who has been here for 18 months. That's quite a lot of people for a small community. We're still awaiting confirmation of their replacements (we've all recently recieved a copy of a letter from the Dept of Health stating that as KZN is anticipating a high level of year-end over-expenditure, they are implementing a Provincial Recovery Plan. They are freezing all posts. Oh and only heads of dept are to travel buisness class to meetings).
Anyway, going back to the leaving, it was felt that a formal xmas/leaving party was required so, Fancy Stitch was opened up for the evening for a sit down dinner (with all the guests providing various dishes) and a photo-montage power point display.
Now we are 6 doctors until January 1st. And we await our new colleagues and hopefully friends.

Papa don't preach.

So, apparently there is a first time for literally anything. I was asked to preach in the chapel on Wednesday. Really. Admittedly it was just the venue for the start of the '16 days of activism against violence to women and children' (catchy title) and I was preaching on the doctor's role in domestic violence (evidence suggests that women who are being abused want to be asked whereas those who aren't don't mind). It was good to see so many people from different areas (nurses, social workers, local NGOs) coming together on such an important topic. If only it hadn't all been in Zulu... But I think I got the gist of it and even joined in on some of the raised fist shaking and shouting, which I think was "no more violence" but could equally have been something totally different.

A brownie in the oven.

I find myself in an interesting and unexpected moral dilemma. A non-local family living in the area have asked me to provide them with antenatal care through their pregnancy until they travel to Cape Town for the delivery. This in itself is not the dilemma (actually it's my job). What they do however want is to be seen consistently by the same doctor at specific times (dictated by me) rather than join the potentially all day wait in OPD and see whoever happens to be free. In so many ways this doesn't seem to be an unreasonable request, it's what most women in the UK expect. However, it isn't what is done here so would be providing special services for people because they are friends (and make excellent chocolate brownies). I guess ultimately it's like providing a private medical service (with the payment in cakes not cash) and I don't know how comfortable I am with the inequality in health care that that represents. On the flip side, the concept of providing medical care of a standard I feel is good, rather than just about acceptable, with some level of continuity, really appeals to me. And they are exceedingly good chocolate brownies.

The elephant in the room.

I don't want to speak too soon but I think my automobile curse might be lifting. Not without the final blow from the insurance company that our car is to be written off (some sort of internal bleeding apparently) and that they won't discuss payment until we produce a Swazi police report, which is tricky to get as they need a written request, don't have e-mail and their fax is broken. They suggested that I drive the 3 hours to the police station to request it and then back 4 days later to collect it, but I pointed out that that would be tricky, having no car and all.

However, this weekend, I managed to go to Tembe Elephant Park and go on a game drive without any vehicle mishaps at all. Well, there was the mock charge from a female elephant, cooly dealt with by Tom our driver who ignored our pleas to reverse and sat there as she stamped around, flapping her ears and trumpeting before finally walking off. He summed it up "she's just a young girl, showing off". We all felt she might be young but she was still pretty big.

The weekend was organised by one of our neighbouring hospitals, with a discount rate for doctors working in local hospitals to stay at the 5 star resort. It was a lovely weekend; relaxing and fun, and it was really good to meet other local doctors and compare notes on our experiences, some scarily common. It was also good to have hot running showers as we have yet again returned to a waterless Ingwavuma. The joys of rural SA.

An awfully big adventure.

So the conclusion to the car problems was the return of the hire car to Durban this weekend and a debauched night out with some friends.
We then piled in to a car for the 5 hour drive home. 2 hours outside of Durban we came upon a mini-bus crash.
Mini-buses are the transport system used by most locals and some more foolhardy doctors. They charge very reasonable prices by packing themselves full (I've heard tales of being squished between a Zulu-mama and her chickens). And they don't have seatbelts.
It was unclear what had happened but this one was lying on it's roof, with passengers in pools of blood around it. One ambulance had arrived but it was clear that the number of casualties was more than they could handle alone.
With three doctors in the car none of us thought twice as we pulled up and jumped out; it really is a legal and moral obligation. However, we were all quite relieved when one of the boys pulled gloves out of his bag for us.
In trauma speak the crash had 3 reds (severe cases), 5 yellows (moderate) and 9 greens (the walking wounded). There was also a baby without a scratch on it. We spent an hour at the scene, working alongside the paramedics to stabilise patients. At one point a patient's airway was obviously compromised and as he had smashed his face to pieces, the only way to secure his airway was to insert a tube through his neck. The other doctor and I faced each other; I knew the theory from a book and he had done it on a pig. Bravely he picked up the knife. And did an excellent job. Sadly despite all of this, the patient died in the ambulance on the way to hospital.

For non-doctors this would probably seem something we as medical professionals are equipped to deal with however, there is a big difference between being at work and being on a motorway, both in terms of available resources and emotions.
The experience has left us all quite shaken.

Holiday horrors.

We had planned a week long roadtrip to Mozambique, driving up the coast to Tofo, a beach that Lonely Planet refers to as 'legendary'. What we got was a cyclone. And after 24 hours with no sign of letting up, we decided to abandon Mozam for Swaziland (which the weather forecast assured us would be better). And whilst the weather certainly was, our luck was not; we managed to crash the car into a mini-bus just over the border. Fortunately the only injuries were to Bev (the car). There followed an amusing hour or two of hanging out with the Swazi traffic police (at the end of which they asked us for our e-mail addresses so that they could "keep in touch") until a tow truck arrived to take us to the nearest town. Needing to regain our holiday cheer we hired a car and headed for some of Swazi's game parks; a delightful afternoon of horse-riding amongst zebras and impalas was followed by a less delightful self-drive where we got stuck in the mud and had to hike through the game park for help (not the lion enclosure fortunately!).
After all of that, I was almost relieved to be coming back to Mosvold!

Mosvold as a holiday destination?

November has been a month of visitors. Firstly one of my former O&G registrars came for a week (handily the week Deyo was away so I didn't get too lonely) and then my friend Lizzie, who is a Paediatric ITU nurse.
It was interesting to see their impressions of Mosvold and to be reminded of some of the very shocking things that we see here, that I think we are starting to adjust to, but that fresh eyes remind us aren't what we are used to back home. In particular, during the first week we had a maternal death from a post-partum haemorrhage. The review of the case notes the following day would have been laughable had we not been facing a child orphaned through what appeared to be a chain avoidable of clinical errors. Susan helpfully did a presentation on management of these cases but even some of the simple management steps are lacking here (in particular we currently have no blood products).
Lizzie's arrival strangely brought a week of paediatric emergencies with another 27 week premature baby born. This one battled through the night and was actually transferred out but sadly died at our referral centre, leaving his young mother alone and 4 hours from home. My on call was another night of poor sleep, an emergency c-section on a pre-eclamptic woman with APH and the slow demise of a young child from what appeared to be enema poisoning, something that is not uncommon practice in this area.
After all that, Lizzie and I both felt very in need of our relaxing week off in Mozambique...