Epiblogue

We’ve been back in the UK for over a month now. I’ve started work on the stroke ward and the medical on-call rota while Shivani does some locum Accident and Emergency shifts at another nearby hospital before she starts her paediatric training full-time.

When, during the course of my first night on call, I saw 5 people in their 80s all of whom had a fall followed by a young girl who’d taken an overdose after an argument with a friend on Facebook, I knew I was home. It’s such a huge contrast to the young patients with malaria I’d seen on the average day in Limpopo. While it’s great that in this country we can grow old well into our eighties the problem is that a lot of the medical problems by that age are not reversible so your success as a doctor tends to me limited. I will certainly miss seeing young people in their 20s come in on deaths door and bounce back to see them walk out of the hospital a few days later.

It is great to have senior colleagues to ask, “Is this right?” or “Should I be treating this patient with this or that?”. On the other hand I now find that it takes me a lot longer to get things done. Part of this is because I can do more with patients; CT scans are easy to come by, as are a huge battery of blood tests. But, all these extra resources mean a lot more paperwork and I often get the feeling that I spend more time writing than doing.

My new consultant has asked me to do a presentation on Friday about our experience in South Africa as a change from the usual discussion about an interesting journal article that usually takes place on a Friday lunch time. So, in order to prepare I have been sifting through all our old blog posts, but so far haven’t managed a single Powerpoint slide as it’s all too easy just to sit and reminisce.

A friend of mine who was also working in South Africa last year pointed me towards an article on the BMJ by David Barr, a doctor working in rural Kwa-Zulu Natal. (http://www.bmj.com/content/340/bmj.c2702.full?sid=1a02fad6-0368-4a47-830f-1ad76814d212) Reading the article it felt as though he could have been writing about our hospital. It’s a shame to see that we’re not alone in feeling frustrated at the state of public healthcare in SA. Maybe I can convince a few of the juniors in my hospital to take on the challenge of a stint in South Africa when I do my presentation.

We just wanted to say another huge thank you to everyone who contributed to our fund raising. In case you were wondering what’s happening with our fund raising it is still ongoing but there is a lot of admin involved on the part of Community Projects Africa with collecting the Gift Aid for each donation. We will keep this site updated with details of the final details of what we manage to purchase for the hospital.

The end of an era

So here we are. It’s our last night at the hospital, and what has been our home these past 10 months. We’ve found it hard to blog the last few nights, mainly because we’ve preferred not to confront our feelings about leaving. But now, as I sit here at 2am looking at all our worldly possessions packed away into a couple of rucksacks and holdalls, I can’t run away from the reality of us going away.

The last few days have been quite difficult. We’ve had parties to lighten the mood a little – first our own on Friday night that was a bigger success than we expected. We just made a few flyers and distributed them around the hospital and hoped some people would turn up, but it turned out to be a really good night, with doctors and nurses, security guards and social workers all dancing the night away to some Shangaan music provided by one of the other doctors on his very impressive sound system. James got a taste of what life must be like for Matthew Booth when the rest of Bafana Bafana enter the stadium dancing with a rhythm he doesn’t possess! I can’t say I’m much better, but at least I stick out less!!

Then on Tuesday, the hospital held a surprise party for us at lunch time. Everyone was there, even little baby Shivani! After speeches were made and even poems read out by some of our colleagues, we were presented with handmade Shangaan outfits – in my case, a top, beaded skirt, beaded shawl, beaded necklace, headgear and bracelet, but the pièce de résistance was a pair of beaded shoes!! James got a tailor-made shirt that matches my skirt. Everything was handmade by a lady in the village, and the nurses organised it all in secret, getting our sizes from the clothes and shoes we left in the theatre changing room!

James and Benny with the two Shivanis

The most you can expect when you leave a firm in the UK is a team lunch! All the effort the nurses went through to give us a good send-off was really touching, to say the least.

The hospital car is taking us back to Johannesburg tomorrow, the same one that brought us here way back in September. We will leave our hospital, and the community, better doctors and, I hope, better people, having had the most challenging but also the best 10 months of our lives.

Our time is running out

With less than a week to go before we leave our hospital, we’ve got a busy few days ahead of us. Tomorrow we’re throwing a farewell party/garage sale where we will be trying to get rid of some of the clutter we’ve accumulated over the last 10 months. Not that we’ve been living a decadent consumerist lifestyle out here, but there are a few things we’ve acquired that we can’t take back with us – most notably the rowing machine!! We thought Benny would be the only person interested, seeing as he’s the only one who’s used it other than us, but there has been a huge amount of interest in it. An admin officer with a BMI of about 50 came to try it out during lunch today, and I thought for a minute that we were going to have to resuscitate him on our living room floor! He wanted to buy it there and then, but we’ve had so many offers we’re going to auction it off tomorrow.

The reality of us actually leaving has really hit us this week. I was happily discharging a patient today after starting her on anti-retroviral (HIV) treatment, and I said to her mum, ‘We’ll see you again next week for a review’ – but then realised I won’t be here next week, and it is likely that there will be no regular doctor in Paeds from next week.

But I do have things to celebrate. For example, these kids below are recent graduates of the Paeds ward’s malnutrition recovery programme who came in for their check-up today. I’m sure you’d find it hard to believe, but just a few months ago, those twins had a combined weight that was still below what one child’s weight should have been. As for the little girl on the right, she could barely sit up when she was first admitted – and today she was cheeky enough to steal my stethoscope!

Two pairs of hands

It’s a quarter to 11 on Saturday night and we are almost halfway through our last weekend on call at our hospital. With only 10 days to go before the end of our contracts, all our feelings of guilt about leaving that had been successfully suppressed by training for, and then going on, our expedition to the Drakensburg, are coming to the fore. Word has got round the hospital, and everyone keeps asking us, ‘How can you leave?’. I don’t think they mean to be nasty, but each time they say it I feel a resurgence of guilt. We were hoping that the staff would be so excited by the prospect of some new equipment that they wouldn’t mind losing 2 doctors, but unfortunately a couple of extra pairs of hands are still worth more than a few BP machines and CTGs. Not to say that the equipment is not needed, or that it won’t be appreciated, of course.

It took us a few months to really get settled into work here, and our early days were spent frantically trying to get competent with anaesthesia and surgery and the other ‘bread and butter’ bits of rural medicine. It was only after about 6 months or so that we had the confidence to think that we had something to offer as well, which is when we started our teaching sessions for the nurses in our different departments. Even more recently, just a month ago, I decided to branch out and tackle the main problem I face in Paediatrics – malnutrition – at its root. Babies are seen on a monthly basis at their local clinics for weighing and vaccinations. Almost every child we see at the hospital with severe malnutrition has a growth chart that shows a slow and steady decline in weight that has been plotted by the clinic staff, with no action taken to prevent further decline. So with the help of the dietician, I held a half-day workshop on the identification and management of malnutrition in children for the nurses who work in the clinics that are in our hospital’s catchment area. The workshop went really well, and the group has decided to meet on a 3-monthly basis, but now I won’t be here to see it continue, and don’t know if all the enthusiasm will fizzle out in time. It takes time to build public health projects that make a real difference, and it’s time that I am not able to give this community.

On the plus side, I had a lovely surprise the other day, when an excited mother thrust a plump and giggling 2 year old child into my arms. Although initially confused, I eventually realised that this child was an ex-patient of mine, who was in the ward last year for over a month. She had terrible malnutrition and was also found to be HIV positive. We started her on treatment but the child wasn’t being reviewed at the hospital because she lives too far away (she collects her HIV treatment from a local clinic instead). The mother had come to the hospital to visit a relative and had been looking for me to show me how much her child has improved. The child certainly has improved – when she was in hospital she could barely sit, she was so weak, and now she looks so healthy you would never guess she had HIV.

I guess if you’ve positively influenced one person’s life, then you’ve made a difference to them, as in the famous starfish-on-the-beach analogy, and I should be happy with what I have achieved rather than thinking about what I am unable to, but it is hard. It’s like we’re trying to stop a sinking ship with two pairs of hands and a leaky bucket.

Cleared for landing

My day started calmly enough, with a ward round with a Paediatric consultant who makes monthly visits to our hospital. She’s a lovely Cuban lady who has been working at a nearby government hospital for nearly 20 years. She sees my patients who are either not sick enough to be transferred to Polokwane, or so sick that there is little more that can be done for them. I really enjoy her ward rounds, and have learnt so much from her in the last 9 months. Also, it’s very reassuring to have a doctor with years of experience agree with your management plans. If I ever get bored of long ward rounds when I return to my rightful position at the bottom of the medical ladder, I will remember the pressures of being the only doctor responsible for 30 incredibly sick children, and thank my lucky stars.

Anyway, after the round, as I was walking her to her car, I heard the familiar sound of a helicopter hovering, and thought that James had called for one for a patient in Casualty. But when I looked up, I realised that it wasn’t the usual red air ambulance, but a green helicopter belonging to Kruger National Park! It circulated above the hospital for a good few minutes whilst the drivers of the many cars who use the helipad as a car park moved their cars to safety. As the usual crowds gathered, I found myself the only doctor at the landing site, and so went up to a ranger, who had hopped out of the helicopter, to ask what the matter was. After all, if they had a helicopter, why not head straight to Polokwane?

The ranger explained that the patient was stable, but had gunshot wounds to the arm and leg. The patient was in fact a poacher, who had been shot because he was shooting at the Park officials who had found him! The ranger was being incredibly civil to this chap, I thought, especially considering the patient had been shooting at him with an AK-47 not 2 hours earlier.

We got the patient/poacher to Casualty, and the full story started to unfold. He was incredibly dehydrated, but otherwise quite well (if we don’t count the 3 entry and exit wounds). We found out that he had left Mozambique last week, armed with said AK-47, and had been in Kruger since then. He’d killed 4 rhinos in that time, and was onto his 5th when he was tracked down by rangers on patrol. The nurses took an immediate dislike to him (South Africans are very proud of their parks, and rightly so) and even asked if I would suture his wounds without local anaesthetic! (I did use anaesthetic…) He was a pretty nasty piece of work, and continued to rile the nurses up by boasting about how rich poaching has made him – he has 5 wives and many hundred cows – dispelling the myth, at least in his case, that poachers are driven by the desperation of abject poverty.

After all the drama had died down and I was having lunch, I got a phone call from a guy from the Ministry of Environmental Affairs and Tourism. He said that there had been a warrant for this chap’s arrest for nearly 3 years, and that he was an incredibly violent and dangerous man. He told me to make sure he was in cuffs and with a policeman at all times – because the patient knew he would be going away for a long time, there was a chance the desperation could make him do something stupid like try and make a run for it, or even try and take a hostage. This information would have been somewhat more useful had it come before I spent an hour alone in a cubicle with him, with no police escort, with a trolley full of lancets, needles and scissors, debriding and suturing his wounds.

Luckily, he didn’t try anything funny, and we got the police in to put him in shackles. The guy I spoke to on the phone from the Ministry arrived later in the evening, accompanied by armed guards, to take the patient away for interrogation. He was so incredibly pleased to have this guy in custody, he gave me his number and said that any time I wanted to go to Kruger, I should just give him a call and I would get extra-special treatment! If only they’d found this guy 9 months ago…

Football Fever

With the World Cup well and truly underway and us still lacking a TV of our own, we spent the weekend in a lodge crucially with a bar and a widescreen TV. On Friday we watched the French play out a tedious draw with Uruguay, but at least the bar was full of Bafana Bafana fans still revelling in the excitement of the match with Mexico. Saturday was a day of pure World Cup. We watched the South Koreans demolish Greece, Argentina threaten to demolish Nigeria and then came the one we’d been waiting for; England vs USA. We were back in the bar but sadly the atmosphere was really lacking. There were 3 people there, not including us or the barman. There’s something really depressing, not to mention incredibly annoying about a single Vuvuzela being blown inside a bar with a total of 6 people. Still, we stuck it out and watched England scrape a draw with a team they were widely expected to beat. England World Cup business as usual then.

Today, in order to size up England’s next opponents we went to Polokwane to see if we could get some last minute tickets for Slovenia vs Algeria. We were in luck as we managed to get our hands on 2 of the last 10000! Next we had to get to the stadium which meant negotiating the Park and Ride service. The bus ride to the stadium was our first experience up close with the South African fans and it made us realise what makes this world cup an African one.

I’ll let the video do the talking, but then please compare it to the one below of some typical English fans efforts at singing. Perhaps if they could harmonise like the South African fans they would enjoy a better reputation overseas…

Translated this means “Block them left, block them right, down with Slovenia!” (just in case you thought they were cheering for the Europeans)

 

Personally I thought the tenors were early…

The other fascinating thing about the fans was that they were throwing all their support behind a team from the opposite end of the huge continent of Africa with whom they share neither religion, colour, culture nor a common (recent) history. It was a real demonstration of Africa United. I can’t imagine England fans ever cheering on Germany or France under similar circumstances, or vice versa. Still for all the South African support and tinnitus-inducing Vuvuzelas the Algerians lost out to Slovenia who now top group C. Bring on Friday night and lets hope England can emulate Slovenia’s success!

Hope, Bafana give me hope

Feel it, it’s here! We woke up this morning to the sound of vuvuzelas and car horns heralding the day that South Africa has been waiting for since it was named the host nation for the 2010 World Cup six years ago. We had to make a quick trip to the market stall just outside the hospital before starting work to get our Bafana Bafana jerseys so we could join in the fun – you might have guessed they aren’t exactly FIFA-sanctioned originals, but it was all they had!

The atmosphere at work was brilliant, with everyone in their green or gold jerseys, kids (and a few doctors!) blowing vuvuzelas along the corridors and most importantly, Casualty was half as busy as usual, so we were able to leave work on time and watch the second half of the opening game at Benny’s house. There is a TV in Casualty and it was showing the game, so I managed a few glimpses of the 1st half whilst tapping an old man’s ascites.

James getting into the spirit of things

Unrelated to football, we had an interesting visitor at Casualty today asking after some lost property. It was the man who lost his arm in a crushing machine last week. He’s back from Polokwane, looking remarkable well, although they had to remove what was left of his arm (just a few inches) in order to stitch everything back together. He came to see us because he wanted his arm back!! Whilst the rest of us were left speechless, the head Sister told him to direct his enquires towards the Mortuary…

A sojourn in a different world

As some of you (those who weren’t too drunk at the wedding) may remember, we celebrated our 1st wedding anniversary last weekend. Thanks to some very generous friends, we spent it at a very luxurious 5 star safari lodge in the south of Kruger National Park. We’d been looking forward to it for some time, and it didn’t disappoint – we had an amazing room with amazing views (the concept extended to the bathroom and even the toilet, which had one wall that was just a glass pane from floor to ceiling looking onto the bushveld!!), wonderful food (warthog and springbok for mains) and impeccable service. The best bit about the weekend, though, had to be the game drives. Although we’d been to Kruger a couple of times before, we’d only ever driven ourselves through the park in our little car. The lodge had the advantage not only of an off-road vehicle, but amazing trackers who made sense out of the barely visible imprints on the gravel and helped us find the ‘big game’ we were looking for. We spent over an hour with a young male lion, and heard him practice his roar just a few feet away from us, and followed a lone lioness on her hunt for some tasty impala (she gave up after some time, but it was cool while it lasted).

That’s the funny thing about South Africa. That you can drive yourself from your poverty-stricken little town to a 5 star safari lodge. One minute a baby with gastroenteritis is throwing up on you, the next minute someone is asking you how pink you’d like your springbok. Ok, not exactly the next minute, more like after a 6 hour drive but you get the point.

Anyway, in other news, thanks again to all our donors for their generosity. The Virgin Money Giving site is now closed and the money is on its way to Africa Health Placements, the charity that recruited us, and we will be ordering the equipment this week. Talking about AHP, we received an email today saying that they have put our blog on their Facebook page in the hope that it might encourage more people to sign up with them. So, if you don’t know who we are and have been directed here by AHP, both of us feel that choosing  to move to South Africa was one of the best decisions we’ve made, and if you choose to do the same, you are in for the ride of your life.

No ‘arm done

During my time here in South Africa there have been many times when I have felt completely out of my depth. Yesterday was one of those times. A man working for a building firm was working with a rock crushing machine. Just as the machine was powered up he spotted that there was a large rock that was stopping the crushing wheel from rotating. He reached in to the machine to dislodge the offending rock. It was at about this point that he probably started to wish he didn’t have such long sleeves or better yet that he had opted to use a big stick rather than his arm. The sleeve got caught under the wheel and within a split second his arm had been torn off at the shoulder.

The patient was brought into casualty within a few minutes with the arm following shortly after in a friend’s car. I wasn’t about to start trying to sew the arm back on, despite requests from the man’s friends. Myself and Shiv tied off all the bleeding vessels and covered the stump with gauze. I then set about calling the orthopaedic surgeon and was a bit taken aback to find that he wanted us to handle the problem in our little rural hospital. After chatting with him for a few minutes and explaining that the man probably needed skin grafting amongst other things that were well beyond the capability of our hospital he agreed to see the patient, but not until the next day.

Later that evening, while I was sitting eating dinner with Shiv the ward called me to tell me that the arm had just arrived on the ward (always following the patient but one step behind). They wanted to know what to do with it. I resisted the temptation to suggest they use it for practical jokes and told them to send it to the morgue, where hopefully, the patient would not be following. Anyway, we’re eagerly waiting to see what happened to him, but it seems as though the orthopaedic surgeons must be taking care of him because if we ever send them patients with problems that are ‘beneath’ them, they bounce them straight back to us.

More bizarre than gory was a young girl I saw in casualty today with an acute asthma attack. She was bad, but fortunately not too bad. As many of you will know the treatment for asthma is inhalers or nebulisers, but she flat out refused to take them despite wheezing like a trooper. I asked her if she had been taking her inhalers at home  to which she replied that she didn’t take them. When I asked why, she said her dad doesn’t want her to. When I asked her why her dad doesn’t want her to take them she didn’t answer. Thinking I would get to the bottom of this before the young girl expired, I called her dad to ask why he objected to the asthma treatment and if he could tell his daughter to take them. Sadly we were on slightly different wavelengths. He began telling me about the inhalers being bewitched and that he was worried that if she took them she would die. I tried to explain that if she didn’t take the inhalers there was a better chance that she would die. Not seeming to understand the urgency of the situation he said he would have a discussion with the family and get back to me. Frustrated, I returned to the infuriating teenager who was still in the same state and arranged for her to be admitted to the ward and continually bombarded with nebulisers until she eventually gives in. As far as I know she is still resisting. Maybe they can sneakily spray her with it while she’s asleep…

On a lighter note, I now have a baby named after me too, but to be honest it doesn’t really count because it’s another one of Shivani’s success stories from the neonatal ward who happens to be a boy. When the mother said she wanted to name the baby after the doctor, one of the nurses suggested my name to save him a childhood of playground bullying for having a girl’s name.

How British are you?

It’s Sunday evening now, and we’ve nearly survived yet another Friday night till Monday morning on call. We got off pretty easy on Friday, although we had all the usual suspects on Saturday night – a drunk driver crashing into a tree giving his best mate a base of skull fracture, young lads assaulting each other with bottles and (for some reason) rocks.

We also had an unexpected visitor for dinner on Saturday night. An ophthalmology registrar based at Polokwane arranged to spend a day performing cataract surgeries at our hospital on his Saturday off. He brought all the equipment over from Polokwane himself, started operating at about 9am and only finished at 10pm, having performed 16 operations. We chatted to him several times during the day, and invited him over for dinner in order to save him from what would have been his third meal of pap for the day!We didn’t have very much in the house but he seemed happy enough with his beef and egg-fried rice.

This morning was pretty tame as well, so we spent it catching up on the news online. That’s when I stumbled across this article ‘Bill Bryson: I’ll cheer for England, but I won’t risk citizenship test’. I’d heard about how difficult and irrelevant to daily life the test was, but had never thought much more about it. Seeing as the on-call phone was still silent, I decided to go for it. I got a shocking 54% (pass mark’s 78 or something). But I’m not British! So the system works! What about my husband though? My British born and bred, Grammar school-educated husband? 46%. Try it for yourself! UK Citizenship test 

Jokes aside, I might actually find myself having to take it one day. Can’t wait.