Landing in KwaZulu Natal

Word on the street is that the blogs are too long. In fact word on the street is that, generally, when I talk or write, I bang on for far too long. That is a lifetime’s worth of advice that I have refused to take any notice of. Here’s to a new start.

I’ve been in South Africa for 6 weeks now, tucked up on the north coast of KwaZulu Natal, the countries most Eastern province. Cue map. I’ll be spending a year working in a very rural hospital which looks after an entirely Zulu population. We have no specialists here. Each of the 12 doctors is a generalist and expected to cover all departments – medicine, surgery, obstetrics, paediatrics, psychiatry etc etc. Everyone knows a bit about everything and gives it their best shot. There are no doubt going to be some sweaty moments..

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The largest burden of disease in this area by far is HIV. The prevalence, so the proportion of people infected with HIV, is the highest in the world at 35% – down from 43% a few years ago. I’ve spent a good deal of time over the last couple of years learning about HIV and treating patients with the disease but only now are the stark realities of the epidemic really becoming apparent. Most of my medical ward are suffering with the complications of HIV and unfortunately our patients often come late and there is sometimes little we can do. I won’t get too dark too early, and I’ll probably leave it there for now. For 5 minutes on the subject with yours truly being a bit melodramatic see a recent video blog I posted a few weeks ago – HIV: are we winning?

https://www.youtube.com/watch?v=jYdgfOkeXuE

It’s been brilliant to spend time working in the other departments as well. My other passion besides tropical medicine is maternal health and I’m spending a lot of time in the obstetrics unit and doing some Caesarians and removal of ectopics in theatre. I must share a truly wonderful moment from Friday morning of my second week here. I was operating on a lady with a large baby who had gone into obstructed labour. The Caesarian is done under spinal block so the mother was awake and conscious. As we proceed she began singing in Zulu, and it must have been a well known song as all of the theatre nurses joined in, rich African voices, off tones and harmonies. All were singing as I cut through the uterus and found the baby. It was no easy job delivering the head and a couple of manoeuvres were required but the baby finally came to a crescendo of voices. I was relieved to say the least as the baby cried. I had goose pimples and thought ‘do you know what, this is f*****g brilliant’. A beautiful experience.

I know it's an indulgent photo and yes that is a shoe cover on my head

I know it’s an indulgent photo and yes that is a shoe cover on my head

My first night shift in the casualty department fell on my first Friday, doing what you can with whatever comes through the door. The fun started as a 20 year old man was dropped of by the police, naked and covered in blood, collapsed on the floor with a bushknife wound to the back of the neck. An artery had been severed and he had clearly lost a lot of blood, freezing cold with a feeble blood pressure requiring may litres of resuscitation fluid. He had a tattoo across his chest with the words ‘Not Guilty’… An hour later he was talking again. A brief history revealed the cause to be an argument over a girl, as standard. Not long after another young lad was carried through the doors with a gunshot to his leg. The wound was not to impressive but the shin had lost all stability. An X-ray revealed the true extent of the damage, both shin bones shattered. A bit of a clean, some strong opiates, a bandage, and a nice referral letter to the referral hospital 3 hours down the coast. The leg would need extensive surgical exploration by the specialists. The story behind it? You’ll never believe it, a tiff over over a fair madame, not far off a femme fatale.

gunshot

It’s not all medicine, we’ve already had a couple of trips to the Indian ocean which is lapping at the sandy beaches just 5km away. The surfboard has had a couple of trips out, but nothing major to report with the winds blowing out the swell, as is typical of the August season, but the snorkelling has been sensational. First trip to Mozambique lined up for next weekend. So there it is, as short and sweet as I can possibly make it. You’ll notice a recurring theme in the ailments I have described, the HIV medicine, the obstetrics, the trauma. It all comes down to one thing. Be kind to us girls, we get over-excited.

Kosi mouth

Kosi mouth

Black Rock

Black Rock

Tembe elephant park

Tembe elephant park

Full moon brai at the mouth

Full moon brai at the mouth

Crossing the channel when the rope has snapped

Crossing the channel when the rope has snapped

Crested guinea fowl

Crested guinea fowl

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