1. Flying pumpkins’
2. Throwing yourself out of a moving vehicle
3. Fish slaps
4. Pus balls
5. Bush knives
6. Accidental midazolam flushes
7. Snake bites
8. Ataxic dung beetles
9. Starving
10. Gluttony
Monday, 29 March 2010
The children of Mseleni
I have basically been running the Paediatric ward by myself – it has been quite terrifying for a while as well as just plain upsetting on many occasions. The children can be so sick when they present and it’s inconceivable how they were allowed to be so sick before bringing them hospital. Malnourishment is a major problem particularly those with underlying HIV that hasn’t been diagnosed yet. More than often I have felt quite helpless as medical management alone doesn’t suffice and they inevitably die. And there is little hope of transferring these children to referral hospitals when their baseline is poor and they lose the battle for beds – equity versus pragmatism.
I remember the cry of one Zulu mother quite vividly. The manner of mourning in the Zulu society is quite an audible process. When her poor baby died, after a haggering battle with severe sepsis, dehydration and malnutrition, she had inconsolable shrieking which i remember just piercing into my heart. I was truly very dismayed.
However, after the perpetual toll of admissions and 24 hr takes, you realise pragmatism has to supersede in order to survive this, particularly when dying babies is a common place phenomenon and actually accepted.
I began to analyse the steps to this process of demise and you realise that so many factors beyond your control determine the likes of these children. The likes of socio-economical factors, culture, access, government, politics etc..... we at the hospital front actually sit probably at the end of this chain of events.
On the happier end not all the babies die here, there are some really cute chubby ‘Michelin’ babies and not all sick ones have a miserable end. It can be quite dramatic when the helicopters land in the pad and the emergency service crew waft through to carry your kid to somewhere ‘safe’ with facilities! That does give you a feeling of change and you climb a few steps on this slippery ladder.
It’s important to utilise the weekend, a visit to the beach and watching sunset, does wanders to wash the burden of the week away into the vastness of the universe. It is a beautiful place with much beauty to discover.
I remember the cry of one Zulu mother quite vividly. The manner of mourning in the Zulu society is quite an audible process. When her poor baby died, after a haggering battle with severe sepsis, dehydration and malnutrition, she had inconsolable shrieking which i remember just piercing into my heart. I was truly very dismayed.
However, after the perpetual toll of admissions and 24 hr takes, you realise pragmatism has to supersede in order to survive this, particularly when dying babies is a common place phenomenon and actually accepted.
I began to analyse the steps to this process of demise and you realise that so many factors beyond your control determine the likes of these children. The likes of socio-economical factors, culture, access, government, politics etc..... we at the hospital front actually sit probably at the end of this chain of events.
On the happier end not all the babies die here, there are some really cute chubby ‘Michelin’ babies and not all sick ones have a miserable end. It can be quite dramatic when the helicopters land in the pad and the emergency service crew waft through to carry your kid to somewhere ‘safe’ with facilities! That does give you a feeling of change and you climb a few steps on this slippery ladder.
It’s important to utilise the weekend, a visit to the beach and watching sunset, does wanders to wash the burden of the week away into the vastness of the universe. It is a beautiful place with much beauty to discover.
Sunday, 21 March 2010
Part 1 - The Initiation
My Dear Friends,
I have just survived my second week as the Paeds doctor and seen three babies die in front of my eyes, stayed awake for more than 36 hours as I got shat on my second 24 hr oncall and just had my interview for the post today!!!
But it is pretty amazing out here and now as I write this I am hoping this crazy temperamental internet dongle doesn’t fail on me again.
When I arrived more than two weeks ago in J’burg I had Jo meet me at the airport and pick me up (Jo for those who don’t know her is my sanity saviour now, we are on the vts together and very fortunately have come out here together). I already had my drill of preconceptions of J’burg hammered into me from everyone, so when i got to the airport i had my belongings strapped and taped to me (almost) and gave daggers to anyone who came near me ;)
So Jo came very gallantly and picked me up in her monster 4x4 killer machine and just as we exited the airport w e had the pleasure of the police officer pull our vehicle over. He was a dodgy, pot-bellied specimen of an officer and after requested Jo’s drivers licence, bless poor Jo, she thought she’d forgotten it and when the officer didn’t get the licence he said there was a fine for not carrying ones license in J’burg, we did try the whole ‘we are new in town and fresh off plane’ but then he proceeded to claim that you can be put in jail for not carrying your license! The banter went on for a bit and was heading in the direction of what kinda bribe can I get out of you’ and then like a sudden spark of lightening Jo remembers she brought her UK drivers licence and showed it t him quick – poor guy, looked really pissed off and shooed our car away!
We took a long drive over two days to get to KwaZuluNatal and our destination and luckily had prepared for the basic minimum J
Jo and I ended up with a ‘parkhome’, it looks like a port-cabin with two bedrooms and a living rooms, after an intensive few hours of scrub down with bleach and other forms of bug and mould killer – it started to look more like a home..... few shopping runs later, we have some cutlery and pans, butternut (yummy) and I am waiting to buy a specialised dustbin for the kitchen.
Being here is really surreal, though everything is so universally different to what we are used to you just adapt and get on with it. I suppose having a reasonable degree of pre-knowledge (thanks to Neera’s help and advice) was what as helpful, having very low expectations of the place and remembering – this is Africa so nothing happens fast ;)
Before I talk medicine, I would like you all to picture this:
We had induction yesterday; it couldn’t have been a more comical event. The induction board contained all the important bureaucratic bodies and the opening speech was given by the hospital manager – after five minutes the medical manager (Dr Fredlund) interjected and told her she must speak up because he was sitting next to her and couldn’t hear a word she was saying! Unfortunately when we could hear her - the essence of her speech was the number of children she had, when she became a widow, where she lived and which tribe she belonged...hope your getting the idea J The hospital manager enthused us with hope and inspiration by telling us not to get HIV, be faithful and don’t travel alone as Rapes were not uncommon. .......to top it up the useless excuse for a HR manager ended his tuppence worth with ‘we force you to join a Union of your choice’ – can anyone point out the oxymoron????
Sorry guys, to give you such a pleasant impression so far but had to share the delights of African bureaucracy with you all J
On a more serious note, there are no brown people here and everyone is really friendly, like freakishly friendly, it’s a bit of a shocker for the British reserved front. There are a really nice gang of doctors and physio/OTs and as we all live on the hospital camp we have to get on.
It’s beautiful though – the African sky is gorgeous and there is a phenomenal grandeur about the clouds – i know clouds!! But they don’t move and seem embedded in static motion.... The game is good – though just seen zebras, giraffes and impalas so far.....
Medicine is really crazy, people are properly sick but because everyone is so f!^#ed you end up having to decide who is the most f?@~#ed to get admitted. HIV is rife and malnutrition is tragic – such a basic failure in health development. Kwashior/maramused children are very difficult to manage and having HIV and TB and being poisoned by witch-dr meds ontop mean they just don’t have a chance sometimes. Things work in a much slower pace here. Bloods take 24 hrs, sometimes can get them is 10hrs. Xrs may or may not happen. Any special test like LFTs (??) and Ca2+ and PO4+ can take longer.......
Oh man, it’s the weekend and i feel i have scribbled more than enough for now. I hope you are well and getting as enough excitement as me (?).....If anyone wants to come out here, its a gorgeous so lemme know in advance and will bk annual leave. If my portacabin doesn’t excite you guys there are lush resorts in the vicinity and tourist areas too xxxxxxxxx
Afsana – (yebo gogo)
PS sorry its on facebook for those of you who are specifically adverse to it – Hitesh! – but I don’t have your email address ......
I have just survived my second week as the Paeds doctor and seen three babies die in front of my eyes, stayed awake for more than 36 hours as I got shat on my second 24 hr oncall and just had my interview for the post today!!!
But it is pretty amazing out here and now as I write this I am hoping this crazy temperamental internet dongle doesn’t fail on me again.
When I arrived more than two weeks ago in J’burg I had Jo meet me at the airport and pick me up (Jo for those who don’t know her is my sanity saviour now, we are on the vts together and very fortunately have come out here together). I already had my drill of preconceptions of J’burg hammered into me from everyone, so when i got to the airport i had my belongings strapped and taped to me (almost) and gave daggers to anyone who came near me ;)
So Jo came very gallantly and picked me up in her monster 4x4 killer machine and just as we exited the airport w e had the pleasure of the police officer pull our vehicle over. He was a dodgy, pot-bellied specimen of an officer and after requested Jo’s drivers licence, bless poor Jo, she thought she’d forgotten it and when the officer didn’t get the licence he said there was a fine for not carrying ones license in J’burg, we did try the whole ‘we are new in town and fresh off plane’ but then he proceeded to claim that you can be put in jail for not carrying your license! The banter went on for a bit and was heading in the direction of what kinda bribe can I get out of you’ and then like a sudden spark of lightening Jo remembers she brought her UK drivers licence and showed it t him quick – poor guy, looked really pissed off and shooed our car away!
We took a long drive over two days to get to KwaZuluNatal and our destination and luckily had prepared for the basic minimum J
Jo and I ended up with a ‘parkhome’, it looks like a port-cabin with two bedrooms and a living rooms, after an intensive few hours of scrub down with bleach and other forms of bug and mould killer – it started to look more like a home..... few shopping runs later, we have some cutlery and pans, butternut (yummy) and I am waiting to buy a specialised dustbin for the kitchen.
Being here is really surreal, though everything is so universally different to what we are used to you just adapt and get on with it. I suppose having a reasonable degree of pre-knowledge (thanks to Neera’s help and advice) was what as helpful, having very low expectations of the place and remembering – this is Africa so nothing happens fast ;)
Before I talk medicine, I would like you all to picture this:
We had induction yesterday; it couldn’t have been a more comical event. The induction board contained all the important bureaucratic bodies and the opening speech was given by the hospital manager – after five minutes the medical manager (Dr Fredlund) interjected and told her she must speak up because he was sitting next to her and couldn’t hear a word she was saying! Unfortunately when we could hear her - the essence of her speech was the number of children she had, when she became a widow, where she lived and which tribe she belonged...hope your getting the idea J The hospital manager enthused us with hope and inspiration by telling us not to get HIV, be faithful and don’t travel alone as Rapes were not uncommon. .......to top it up the useless excuse for a HR manager ended his tuppence worth with ‘we force you to join a Union of your choice’ – can anyone point out the oxymoron????
Sorry guys, to give you such a pleasant impression so far but had to share the delights of African bureaucracy with you all J
On a more serious note, there are no brown people here and everyone is really friendly, like freakishly friendly, it’s a bit of a shocker for the British reserved front. There are a really nice gang of doctors and physio/OTs and as we all live on the hospital camp we have to get on.
It’s beautiful though – the African sky is gorgeous and there is a phenomenal grandeur about the clouds – i know clouds!! But they don’t move and seem embedded in static motion.... The game is good – though just seen zebras, giraffes and impalas so far.....
Medicine is really crazy, people are properly sick but because everyone is so f!^#ed you end up having to decide who is the most f?@~#ed to get admitted. HIV is rife and malnutrition is tragic – such a basic failure in health development. Kwashior/maramused children are very difficult to manage and having HIV and TB and being poisoned by witch-dr meds ontop mean they just don’t have a chance sometimes. Things work in a much slower pace here. Bloods take 24 hrs, sometimes can get them is 10hrs. Xrs may or may not happen. Any special test like LFTs (??) and Ca2+ and PO4+ can take longer.......
Oh man, it’s the weekend and i feel i have scribbled more than enough for now. I hope you are well and getting as enough excitement as me (?).....If anyone wants to come out here, its a gorgeous so lemme know in advance and will bk annual leave. If my portacabin doesn’t excite you guys there are lush resorts in the vicinity and tourist areas too xxxxxxxxx
Afsana – (yebo gogo)
PS sorry its on facebook for those of you who are specifically adverse to it – Hitesh! – but I don’t have your email address ......
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