The Incredible Journey

Last Thursday I took my life in my hands and made the very long trip to Umtata to meet up with Sarah and Hannah, some other Project Trust girls who are living it up in a children's home there and go for a long awaited weekend away to Port St John's which is up the coast a bit.






After a hectic day at work in which I tried to leave everything in some semblance of order I picked up my rucksack from the rondavel, said goodbye to Sammy [this is the first time we have been separated since the beginning, bad times!] then started walking along the road in hope of a taxi. Thankfully, a taxi came past after about 15 minutes of walking, and fun fun times, drove me back to Zithulele Hospital. Strange place. Anyway, we finally turned around again towards the metropolis that is Mqanduli and since I had the front seat and therefore a low chance of being pick pocketed, I had a sleep.





Two hours later we arrived at Mqanduli and I jumped out and made my way to the taxi I needed to take me to Umtata. We waited for around 30 minutes for it to fill up i.e. for enough people to populate a small country to cram into the rusty excuse for a vehicle. [Okay, it really wasn't that bad!] Forty minutes later, the city was upon us. Not having been anywhere near civilisation in over two months, it was a little overwhelming at first to be in a place that was so busy, noisy and where I was the only white person and therefore attracted lots of attention. Less than one second after I disembarked from the oven on wheels, a lovely man called Desmond had declared his deepest love for me and asked if I wanted to marry him. I think the Notting Hill reference was lost on him when I replied, 'Tempting, but no,' and ran off in the complete opposite direction.

After some worried phone calls and confusion in the big city, I finally met up with Hannah from Thembilihle children's home and we went back to their project. It's a brilliant project and I have to admit I am pretty jealous of their set up there [even though Zithulele is, like, the best place EVER]. They live and work in the children's home with about 20 kids between ages of 6 and 16, teaching six days a week. It's pretty clear that their kids love them as they were climbing all over them :D Hannah, Sarah and I then went out for dinner at Umtata Country Club with Andrea and Amanda from Bethany Children home [more PT volunteers], and various other volunteers from around Umtata. It was great to have a meal out other than Papazela's pizza for once and I thoroughly enjoyed my smoked springbok and mixed fried noodles. It was Amanda's 18th birthday so there were celebrations all round including the weirdest cake ever made [make that three extra weeks of Lent, but it's rude to refuse birthday cake when you've only just met someone!] - it consisted of one squishy layer that was not cooked but tasted goood and a second one that was like a crunchy biscuit and it was all covered in pink icing that must have contained all the E numbers ever created. When we asked Andrea and Sandra how they made it, they replied that they had no idea how to cook a cake so had just bought all the ingredients they thought they might need and added half of the packet, mixed it, put it in the oven but then took it out after 10 minutes when the greaseproof paper caught fire. A winning formula indeed.

Epic jungle hiking

The next day we set off on the epic journey to big Port St John's (or PSJ as the cool kids call it). There were six of us: me, Andrea, Hannah, Sarah, Sandra and Stephanie. After three-ish hours in the crazy taxi we finally pitched up at Amapondo backpackers, a very very cool place. We had a dorm to ourselves and the bunks were about 3m off the ground which made for interesting attempts to get into bed.








First thing on the agenda was chilling on the beach. Or not chilling as it turned out. The arrival of six white girls looking like tourists prompted the arrival of every bead selling entrepreneur on the planet and we were soon surrounded with blankets covered in necklaces, bracelets, anklets, all manner of things that none of us particularly wanted to buy. We eventually managed to fend them off with the old 'Maybe Tomorrow' line but one unusually persistent girl ended up staying for over an hour just chatting. It transpired that she was only 15 and sold beads in the afternoon after school to earn some extra money. She was actually really funny and told us that she wanted to braid our hair. First of all she decided she would count all of our hairs [err...what?] but not Hannah or Sarah's because they had too many [err...what?] then proceeded to braid Andrea's into a style which resulted in all off her hair being plastered to her head. The girl then proudly announced to Andrea 'You look like a spear now,' which made me laugh a lot until she started to do the same thing to me and I realised what a painful process it was. She pretty much pulled out most of my scalp and made my eyes water but I was also rewarded with the prestige of looking like a spear. Once satisfied that we had weapon shaped heads, we made our excuses and got out of there as fast as possible before she offered to pierce us or give us tattoos or worse, get the damn beads out again...







Dinner was ultimate good times at a restaurant called Delicious Monster. We had to get a lift to avoid getting mugged outside a notorious shabeen on the way there so all six of us piled into a car on top of each other. The meal was stunning, we had these things called schwarmas which are big pitta breads filled with meat, onion, tomato, cheese and tzatziki. Yum Yum. A quick drink in the Amapondo bar and then it was time for bed.







After possibly the best night's sleep since I got here [since a) it was dark, b) it was cool and c) it was quiet] we awoke and went for milkshakes. Milkshakes are possibly the greatest drink ever; I could drink them all day long. [It's only due to budgetary constraints that I didn't.]







The day's adventure was a jungle hike of epicness into the wild African bush under the watchful eye of our guide Bongs. First up we had to do one of three Amapondo challenges, the rope swing of death. I looked at the rope and I looked at the drop and my brain did the necessary calculations and came back with the odds of 100% imminent death if I agreed to do it, but for some reason my mouth said yes and imminent death it was. Except it wasn't [hence you have the pleasure of reading my ever so eloquent words], it was actually really fun, especially when I swung back in and knocked Bongs down the hill...







We trekked through the bush, hacking our way through with machetes and pulling away the cobwebs of deadly spiders as we went. Okay, only Bongs was doing that, but it was humid and baking hot and everywhere was jungle and bugs and trees so it felt pretty epic. We even managed to catch a rare glimpse of some monkeys which was pretty cool. We did a little abseil-thingy down a little waterfall and crossed some rivers and had general banter until we finally arrived at our destination of Bulolo waterfall.

Bulolo waterfall

Plunge pool jumping

Can you spot me in the pic?




The waterfall was the next Amapondo challenge: jump off it into the pool below. So I pretty much hate heights with a deep passion so the thought of jumping off a ledge into a cold pool of undetermined depth filled me with er, no excitement whatsoever. Rather a deep dread. But, lo and behold, I found myself 7m up in the air, taking a very deep breath and leaping up, up, up, feeling a moment of extreme thrill, then falling down, down, down and feeling the kick of the freezing water as I hit the plunge pool. It was worth it, what an adrenaline rush! I jumped off a few more times, as did the others, then we continued the trek.







The third and final challenge for the day was another rope swing, this time out of a tree. You had to hold onto the tree with one hand, have one foot [one foot!!] on the swing and then let go and swing out over a river. It was pretty damn cool; obviously by this point in the day I was a hardcore thrill seeker so I was totally up for it. Sadly for Bongs, he had to stand in the river and catch us, but I kicked him over...ooops!







Back at Amapondo, we decided to take a trip up to the airstrip for sundowners. Apparently it was used as a location in Blood Diamond...anyone know? We got a lift up there in the back of this guy's 4x4 and were standing up as he sped through the forest up to the top of the hill where the strip is. When we reached the strip, Tim revved up the car as fast as it could go and we were getting that G-force thing going on where your face goes all funny, EPIC! Anyway, the view from the top was incredible, you could see for miles and miles and miles so we had our sundowners and chatted, good good good times.

Sundowners at the airstrip

I left the next day at ten for what was to be a very long trip back to Zithulele on my own. Four taxis, six hours, seventy seven rand and lots of stress later I was back home, what a relief. I had spent the last three hours in the back seat of a taxi squished in beside four guys with my rucksack on top of me and when I got out my shorts were covered in condensation, how disgusting. To my horror, I discovered I had no house key, but I'll save that story for next time...








xxxxx

Swimming in the deep end

So, last Monday was a fun day. I went into work after our Monday foundation meeting to find the place eerily quiet, just me and shelf upon shelf of pills. After a while it transpired that a minor mix up had resulted in all the pharmacy staff being given the day off, leaving the task of running the dispensary to, guess who? Yes, that's right, your neighbourhood pharmacist in training/totally unqualified random!




Luckily for me, the legend that is Sammy G came in and took over all the down referral stuff, leaving me free to see to the patients who were piling up outside the door. It was a fun start when all the ward staff came in looking for injections that I either a) couldn't find b) didn't know what they were or c) had a completely different generic name. After consulting the SAMF [South African Medicines Formulary] a few times and calling on the expertise of, er, everyone else, I managed to struggle my way through the morning. For once I was very glad of the torrential rain [yes, feel free to gloat, the weather here hasn't been so great!] as it kept lots of patients away and made life just a bit easier.



We finally shut at half five, quite a victory considering! I stayed later sorting out an order for the dentists (it didn't take long because every item except gloves was out of stock, and even then we only had massive ones that would only fit the BFG) then did some paperwork. I'm fast learning how much admin [ha] is involved in medicine, fun fun fun! At seven I decided to pack it in for the night and went home to see what delights Sam had prepared...



Turns out it was sweet potato shepherd's pie [nice!] - we have the emptiest fridge ever seen. It literally has tomato sauce, mouldy cheese and a slice of bread in it. I think we have gone a bit too long without shopping! It's coming up to 5 weeks now!



Monday as per meant Grey's night and although we have skipped 2 seasons it's still good to get a weekly fix of television. Funnily enough, tonight's episode saw Alex Karev using a technique called Kangaroo Mother Care used in looking after premature babies that was seen to be radical and amazing in the US – particularly interesting to note that almost every premature baby in Zithulele and in fact across the third world is treated like his...you've got to love the drama of Grey's.

Pictures wooo

Jess and I

Horseriding on Coffee Bay beach

Galloping along the sand :)

Me being introduced to the world of Jaegermeister

Jess has been kind enough to let me a) sleep over b) cook for me and c) use her internet today so I am going to upload some pictures!

On that subject I also owe serious thanks to Liz and Lisa who have cooked breakfast, lunch, tea and let me use internet, watch movies/tv and sleep on their floor all week :D goooooood times!

And I watched a caesarean section at 5.30am on Monday, more about that later :D
More blogs will follow soon enough...

Surprise Weekend!

Ok so this is all a bit behind, this blog is from the weekend of the 14th March.

Hannah, if you're reading, there are a lot of blogs so maybe check your time before you are late for university :D

Will update this weekend (19/20/21st March) epic trip to Port St Johns asap. Enjoy:

I appear to be living in a conspiracy theory here, because one surprise after another just keeps on rolling in! On Thursday afternoon as I was leaving the pharmacy, I felt a pair of hands grab me from behind and cover my eyes – luckily I was not being mugged by a rogue Tsotsi, but Sam had organised a surprise visit from the PT volunteers in Durbanville!

Catherine, Flo, Rhiannon and Sarah [a German volunteer] had driven all the way from Cape Town on their holidays and had come to visit us in Zithuele :D It was a great surprise to see them and we had good chats. Etienne and Anita hosted a braai for us complete with a tonne of boerwors, chilli bread and red wine. It was a fun evening but we were all a bit tired so we came home at ten with the intention of an early night. Sadly, due to some kind person stealing R2000 out of Catherine's bank account, we were all up until half one as she tried to sort it out with banks in South Africa and the UK to no avail. The next day they had a brief tour of Zithulele [cute babies, amaguena, all the important stuff], then headed off to Coffee Bay for the weekend, little did I know I would be seeing them again sooner than I thought...

My next surprise was organised by Anita, Etienne, Jess and Shannon who booked for Sam, me and the four of them to have a night in Bomvu backpackers in Coffee Bay. They came and picked us up at 10am yesterday [Saturday] and we had pancakes with cinammon sugar in the car on the way there.

Sam, Catherine and Flo

We arrived at Bomvu and were shown to our dorm which was really cool. Bomvu is all decorated in an African/surfer style so it has a nice vibe [vibe is a favourite word around here]. We met up with the other PT girls and went to look at the little shops in Coffee Bay which sell jewellery and t-shirts and avoided the men who lurk about and try to sell you magic mushrooms and other such things. Lunch was in the Ubuntu Kitchen, cheese toasties :D Goooood times! We had a Savannah over at Coffee Shack and chilled for a bit before Sam and I embarked on an exciting adventure...

We had booked for an hour's horse ride along the beach and through the hills - I haven't ridden in about five years so wasn't sure how it was going to go, and as there were no riding hats and I was only wearing flip flops I kept imagining that I would end up falling off and ending up in a coma, but oh well. We rode for a while along Bomvu beach through a couple of rivers before ending up on Coffee Bay beach itself which must be beautiful on a sunny day given that today was pretty overcast and it was nicer than most British beaches are! The guide asked us if we wanted to run and we said yes so next thing we were flying along the surf on our horses :D It was amazing, I've always wanted to gallop along a beach so that's another thing to cross off my list!

We left the beach and went up into the hills, the guide constantly urging the horses to run so there we were, cantering along in this beautiful valley covered in rondavels. It was like going back in time because you couldn't hear or see any cars or roads, just trees and farms and livestock roaming around free. As we crested the hill that looks down into Coffee Bay we got the most gorgeous view, exactly the kind of thing I guess people come to Africa for. When I got off the horse however, I had very sore legs, [not something I came to Africa for] so may not be doing that again for a while! But seriously, it was amazing.

The rest of the afternoon and evening was spent drinking, playing pool and eating. Everyone convinced me to have my first shot (Jaegermeister) which I proceeded to spill all over myself, then my second (Tequila) which despite actually making it into my mouth was not particularly pleasant! Something tells me that shots are not my thing. I played some pool, very badly, then got some coaching from Etienne and actually sank a ball or two before it was time to eat.

Dinner was a Poitje [I think that's how you spell it] in the Ubuntu kitchen which due to a power cut was candlelit. I couldn't see much of what I ate but it tasted brilliant [Mum, we are going there for dinner at least once]. There was salad, rice and curry and this delicious Xhosa bread which I ended up eating many many pieces of. We went for cocktails at Coffee Shack but by this time most of us were waning so after a Long Island Iced Tea [why is it called that?!] we went to bed. In bed by 10pm – what a wild night!

It was a really fun day so thanks to Shannon, Jess, Anita, Etienna and Sam for organising yet another birthday surprise for me :D:D

xxxxx

Cake Hangover

I woke up feeling very ill on Tuesday, thanks in no part to the large amount of cake consumed the previous night. I had stacks and stacks of work to do on Tuesday due to the lack of work done on my birthday so I went in and started on that. Disaster struck when I went to pack the kids prescriptions for Ngcwanguba clinic that day and discovered that we were completely out of stock on Kaletra syrup, as was the depot in Mthatha! If the kids don't take their ARVs correctly, not only will they get ill, but the drugs that they are on won't be effective if they do start again. There also isn't any alternative treatment to Kaletra available here in Zithulele so we were in a bit of a quandary.




I phoned the HIV hotline who agreed that it was a bit of a disaster and said we either had to send our pharmacist to wherever in the country they have Kaletra [oh wait, we can't do that as we have no pharmacist!] or phone the hotline on a case by case basis to discuss if there's any way we can use the drugs we have here to treat them on a temporary basis. In the end I had to leave without a clear plan because we were getting later and later for Ngcwanguba clinic.



First we went to Mapuzi to pick up the uncollected packs from the previous week and, joy of joys, one of the Kaletra patients from there had deigned not to come, upping our stock level from zero to three! That meant that at least one of the four kids at today's clinic could go home with their meds. I must be becoming a familiar face around there because all the staff and patients seemed to know me when I showed up [maybe they remembered my pink wellies/shorts combo...] and I even recognised a fair number of people there too,



Ngcwanguba was heaving when we arrived and set up. Nokuthula the ARV counsellor got the ball rolling and Sam and Sarah were also there to dispense, giving me plenty of time to sort out the Kaletra situation when the various patients rolled in. It worked out alright in the end because one of the patients was changed off the drug by the doctor and two didn't turn up before we left so I was able to give my miniscule supply to the one who did arrive. The other two would just have to come to Zithulele next week and we'd make a plan for them.



Back at work we were busy again, and I ended up running the pharmacy on my own between 5pm and 6.30pm when Liz and Sally dragged me out of there. Then, guess what I received from Emma [Sally's three year old daughter]? A cake! Yay! Lent has gone down the drain this week, looks like I'll be playing catch up until May!

An Unforgettable Eighteenth :D

I'm officially an adult! And it's been some day...

I awoke to find the house covered in streamers and a poster courtesy of Sam :D We had the usual Jabulani morning meeting and Kate brought a massive plate of flapjacks (which are actually small pancakes) as a birthday present, thanks v. much to her for those :D Sarah and Bernard came by to give wish me Happy Birthday and give me a cute bracelet from Coffee Bay. Sally sent me a text saying she had a surprise waiting for me in OPD so I made my way into work to see her walking down the OPD corridor with a massive bag of post :D

Opening my presents in the pharmacy

I was excited to the max to see all the mail I had – everyone here has been in on the plot to make me think I had no birthday post so it was a great surprise to see all the parcels, letters and cards. Cue cheesey grin which didn't leave for a considerable amount of time! I better get around to thanking everyone, I will try my best to reply in a decent amount of time to all the people who wrote, you've no idea how amazing it is to get so many letters. My wall is covered in them all, it's like something out of A Beautiful Mind...

My room

Thanks to: Mum, Dad, Gregor, Kirsty, Fiona Cleat, Megan, Hannah, Auntie Denise, Uncle Richard, Robert, Beth, Eddie, Auntie Lynda, Steve, Nicola, Christopher, Oliver, Auntie Kathryn, Uncle Phil, Eleanor, Sarah, John, Amy, Uncle David, Auntie Helena, Isobel, Alice, Aunt Gerda, Auntie Fiona, Uncle Donald, Cameron, Bruce, Grandma and Grannie! I loved all the cards, letters, presents, sweets, DVDs and the tea towel of the London Underground!




Throughout the morning people came in to the pharmacy to say Happy Birthday so I really did very little work, and kind of made a mess of the place with all the wrapping paper. At around 10am I got a call from Liz telling me that there was a delivery taking place right that second so I rushed down to maternity to watch.



When I got there it turned out it was a vacuum delivery and it all happened very fast. Within about 5 seconds of my arrival the baby had been born. I had expected it to be particularly unpleasant to watch but it really wasn't as gruesome as I had been warned! It was very strange when the whole baby suddenly shot out and began crying - the whole thing seemed pretty surreal and I couldn't quite believe it had just happened. The woman must have had an incredibly high pain threshold for she barely made any noise the whole time despite the fact that she had no analgesia whatsoever. After the baby was born, Liz had to suction it a bit so it could breathe properly but he was otherwise fine and was sooo cute :D [I guess that's kind of a given for a 1 second old baby] However, there was more to come when Liz was called to resuscitation in paeds while she was writing up the notes for the delivery.



We ran across to paeds to find a young boy in cardiac arrest [he was one of the kids with Kwash I'd seen with Liz on Saturday]. All the other mums and babies on the ward had left to stand outside, nurses were going in and out with equipment for the resuss and his mother was sitting sobbing on the floor at the foot of his bed. Seeing her all huddled up in tears was one of the most tragic things I've ever seen.



Liz set up for the resuss and asked for someone to do the chest compressions but for some reason no one was did, so there I was putting on gloves and doing CPR on a kid. It was crazy, surreal, horrific, all at the same time. I got some kind of morbid adrenaline rush – I've never seen someone die before and I didn't want to see it now. Liz was calling someone, telling them to come and help and bring a laryngoscope from the OPD and seconds later Sally came in. I think they intubated him at some point, it's all a bit of a blur, then there were adrenaline injections. All the while I was doing the chest compressions, looking at this kid as he slowly faded further and further away.



We continued for a short while, but I could see for myself that nothing was going to bring this little boy back, and I could see it in the other doctor's faces when the second adrenaline injection provoked no response. Finally, after a final round of compressions, we let him rest in peace, having done everything we could. I didn't really know what to do next, this was the first time I'd seen a dead body, let alone watch them die, let alone help to do CPR on them while they died. I just switched off and felt absolutely nothing. The staff put him back into bed and closed his eyes, and then later on the nurses came and put him in a cot to take him away to the mortuary. I found it hard to believe that he was actually dead – he was still warm, and looking at him it was like he was asleep. I'm not sure why, but I expected a dead person to look different. I'll always remember the moment when the nurses lifted up his limp body and carried him away, truly heartbreaking.



I think it will be a long time before I experience such an intense 40 minutes – seeing the start of one life and the end of another immediately after kind of blows the mind! We went for a break to recover, then returned to our separate days. It was a huge deal for me, but it happens every day here and I don't really know how all the doctors and nurses here cope, they really are incredible.



Since this is a blog about my birthday I guess I should revert back to less depressing topics! Sam had given me a brownie mix for my birthday so we made that, then went for coffee and chocolate at Liz and Lisa's. We went for a lovely dinner of chilli con carne at Kate's house, then had a party in our rondavel which almost everyone came to. Shannon made me an enormous 18th birthday cake which was stuuuuuning, then Liz brought round a tiramisu and there was wine and other food too. I got a South Africa soccer top from the Gaunts and Le Roux, a candle and Oreos from Anita and Etienne, soaps from our neighbour Ncediswa, chocolates from Megan and Joff – thank you very much to everyone :D I'm bound to have forgotten someone else so I'm sorry for that! We had a good night and I really enjoyed myself :D After everyone went home, Sam and I stayed up late chatting and eating far too much cake [I was ill for 4 days afterward, that’s how bad it was!]. Yet another unforgettable day!

The birthday table

Our victorious thirty seconds quiz team :)

Zithulele: week eight

Blog from week beginning 2nd March:




Things have settled down into more of a routine now and I'm finally getting my head around the universe of ARVs and pharmacy and down referral and all the other stuff that I get to do as well.



Monday was a busy day of dispensing and last minute packing for Mapuzi clinic. I've now put a big poster up in the pharmacy with the master plan for down referral on it but there's so many different parts that I think it just ends up confusing me more...I've no idea how Monique managed to just do down referral as an aside to her job as an actual pharmacist! Sam and I spent a riveting evening with a book we found in the office filled with Would You Rather? Questions which ranged from 'Would you rather have one massive eye or four tiny eyes?' to 'Would you rather light a fire or put it out?' to 'would you rather watch a birth or an execution?’ You've got to wonder who writes these things. [But I won't lie; it is still keeping us entertained!]



Tuesday saw a frantic rush to complete the pharmacy order and fax it to the depot. It's technically meant to be done on a Thursday then faxed first thing on a Monday, but things are just a tad hectic [ha] around here so I ended up getting the list late on Monday then a whole load of additions at 8am on Tuesday. The order includes all of the drugs, medical and surgical supplies for the hospital so it's kind of important to get it out on time! After chasing down Drs Gatley and Gaunt to sign the thing [multiple times due to the constant additions that were handed to me each time I returned to the pharmacy, out of breath from running back from the ward], I finally was able to hand it to Siphokazi to fax it for me as it was now time to leave for Mapuzi clinic.



Tom, Sarah and I drove to Mapuzi in the torrential rain and I arrived looking pretty hot in pink wellies and long shorts, as always the picture of professional. The counsellors were efficient in getting everything set up and we were able to hand everything straight over without assisting with the dispensing which is a big step in the right direction. Sadly though, there was only one sister there and she was busy with other things so there was no one to take any of the twenty blood samples needing done. After ascertaining that no, I was not qualified to take the samples even if I wanted to, the ARV counsellors decided they would just have to make sure all the patients came back for their bloods on another day. [Note: I reckon about three of them actually did] We didn't really have much option but to leave and hope for the best – hooray for staffing shortages!



We journeyed to Ngcwanguba in the trusty/rusty JRHF Golf and as we pulled up to the clinic gate I got a call from Mapuzi saying four unexpected patients had arrived, just great. After sorting that out over the extremely shaky phone line, we had a meeting with Dr Meents [the one whose wedding we went to] then went to Ngcwanguba store to pick up gas to rectify our freezing cold shower situation. It's the coolest shop, I think it can be summarised by the fact it has a room that is only filled with crisps :D



In a miracle of modern times, I managed to finish work at 4.45pm, just in was time for a Coffee Bay pizza night with Sam, Anita, Etienne, Shannon, Jess and Ross (Jess' boyfriend).



On Wednesday I went to the maternity mortality and morbidity meeting where the medical team discuss the birth and death stats for the month. There were something like ninety births and three deaths in February and for each death the possible improvements to patient care that may have changed the outcome were discussed. After the meeting, Karl gave us a lecture on the new protocol for ARVs which is an exciting new development because it means that all the patients on a drug called Stavudine (D4T) will be changed to a better one called Tenofovir which doesn't have any of the terrible side effects like lipodystrophy and peripheral neuropathy (go look those words up...haha) [actually don't, they are probably the wrong ones and spelt wrong;)].



My morning in the ARV clinic was spent chasing after two problem patients who had been here, there and everywhere and had their files either lost or mixed up. This week I was shown how to find the blood results in the lab so now have to joyous task of doing that every now and again too. The hospital has just had a brand new lab built but it is sadly right at the other end of the site to the clinic so it’s a lengthy trek to get there. Karl is the most epic when he goes to get his blood results because he just jumps out the consulting room window to run down to the lab. I would love it so much if people did that in the UK!



Thursday was the day of one million patients flooding out the main dispensary. I came down from an empty clinic to see patients queuing all down the corridor. At one point during the afternoon, there were two doctors, Zandile and myself dispensing and it still took over half an hour to get the queue back down to a manageable size.



Apparently, every drug that is dispensed by the three pharmacists and I is done so illegally [not our fault, and there's nothing that can be done given that we have no pharmacist] because none of us have the training to do so. We are all able to hand out some pretty strong drugs like valium, ketamine, haloperidol, amitriptyilline etc. [One of the drawers is labelled cocaine, but I haven't looked in there...] I don't think I'll be allowed to dispense those sorts of drugs until a good few years of medical school are over!



Continuing on the theme of exciting work days, I'm sure you are bored sick of reading my blog by now, I spent all of Friday in the pharmacy prepacking drugs and doing paperwork, ably assisted at various points by Lisa and Sam :D After lunch courtesy of Lisa, thanks very much, I was back in on my own until Liz came by and lent a hand. She enlightened me to the genius idea that is 'taking your work home' so we took the files and pills and worked in front of the TV at the Gaunts all afternoon.



Dinner was macaroni cheese but we put it in a big pot and took our bowls down to a fire pit outside Roger's house and Sam, Megan, Joff, Liz, Lisa and I ate out dinners and chatted until quite late at night, good times :D:D

The women of Zithulele at the White House

xxxxxx

Another day in the life...

Well, guess what happened AGAIN - I forgot to save my blogs in the right format so all I can upload right now is this one about births :D




I would have just resaved them in another format except that I've just got back from a holiday weekend in Port St John's and my key has gone away with someone else so I am homeless! I'll try and put the one about my birthday and the last two weekends which have been epic 2k10 asap.





This blog is from 10th March:



Wednesday is late start day at work (8am) so I rolled out of bed around half seven, still feeling the cake hangover [i.e. feeling ill from excess cake eating, either that or I have some kind of food poisoning]. In the pharmacy I worked on some paperwork, joy to the world. This morning's particular delight was sorting out defaulting patients which is not fun, especially when you see that young kids have missed their treatment through no fault of their own, but because of their parents' lack of responsibility. Anyway, enough about that for now.



The ARV clinic today was not the best ever - despite being quiet, the patients seemed to have taken it upon themselves to forget how the clinic works and all came and sat in the dispensing room before seeing the doctor and I, lacking the necessary isiXhosa words, had very little success in making hem leave. I worked alone for a long stretch until half two, only stopping for a brief break where I ended up in paeds watching as the doctors struggled with the powers that be to try and get a sick kid air ambulanced to Nelson Mandela hospital. [In the end they succeeded, but it's a bit ridiculous how difficult it is to do anything around here!]



I had only been back in the clinic for a few minutes after lunch when I got a phonecall from the sister in maternity alerting me to the fact that a lady was about to deliver. Worried that I might miss it, I sprinted out of ARV and down through OPD, endangering the lives of many with my lightning/snail speed. On arrival I felt truly epic, until I saw the woman casually lying on the bed and got the sinking feeling that we would be there for a while.



Not long after, a similarly excited Sam came through the door after receiving a text from me saying 'Sam, birth, now!' which would have been more accurate if it said 'Sam, maybe this woman will give birth before we have to return to the UK'. We went and got a bench from the ward and sat and waited in the labour room for the next three hours, fun times. At one point we had a thumb war, which I reckon is high up there on the list of inappropriate things to do when a woman is trying to give birth...



A note about birth here, it's HECTIC. Most of the woman deliver with no family or friends present and without any analgesia whatsoever. We sat with a woman for three hours and during that time she did little more than groan quietly when her contractions came, the people here really are tough, and its nothing like the drama that you see on TV!



The patient we were sitting with was 7cm dilated when we got there and it was her first baby so it was actually unlikely she would deliver for about 3-4 hours. Pretty sure there was a miscommunication somewhere when they called me! We watched the sister do some PV exams, listened to the fetal heart rate etc etc but nothing much seemed to be happening anytime soon. Fortunately for us, the lady in the labour room next door was ready to go at half past six, so after watching one woman for nearly three hours, we swapped to see a different one deliver!



I could tell we were in business when Sam and I were told to don the sterile gloves and plastic apron ready for delivery. We brought our bench through and waited for the big moment, sweating away into the lovely powdered gloves [cue extreme rash on hands].Eventually, the woman felt that the time had come and suddenly the baby's head was there, and I was delivering a baby boy! :D



The baby was sooo cute [the mass of blood/placenta/rank fluid that exploded out with it was not] and we dried him and placed him under a heat lamp. He was lovely and healthy and had cried as soon as I pulled him out so there was no worries there. After cleaning him up and putting some ointment on his eyes to unstick them we weighed him [2850g], measured his head circumference [33.5cm] and his length [54cm]. The mum, who did nothing more than grit her teeth during the whole thing, had to get a bit of suturing done to repair the damage then got cleaned up and it was all over!



It was such a great experience and definitely something everyone should see. It was so cool to help deliver the baby and however cheesy it sounds, there's really something intense about when you pull that baby out and it cries for the first time :D Unforgettable.

On Call with a Rural Doctor

Prepare yourselves for a long and complicated post, yesterday was a long and complicated day.




Having been here almost two months now I thought it might be best if I started acting more like a future medical student and take advantage of the world of medical experience available here, so yesterday I shadowed Liz (Dr Gatley) when she did the Saturday on call shift. Zithulele Hospital is only really open properly Monday to Friday, so at weekends two doctors are on call and have to do all the ward rounds and see 'emergency' patients in the OPD by themselves. It's an enormous job – is there anywhere in the first world/UK where a young doctor would be left in charge of maternity, paediatrics, male and female general wards? Plus TB and measles wards? Plus any random person who walks into out patients with a problem? The breadth of knowledge required for rural medicine is pretty astounding!



Anyway, I had been expecting a call around 8am to say we were getting started, but when I woke up and looked out my window into the hospital, I could see that both of the on call doctors were there, which could mean only one thing – an early morning emergency. Sure enough, around half eight I got a call saying there had been an emergency vacuum birth and the woman had had some complications which ultimately resulted in Liz getting covered in blood and having to go home to change, what a great way to start the day. (I'm pretty sure the mother and baby are fine though, don't worry.)

Zithulele Hospital :)

So, first up was the paediatric ward round. The kids here are all sooooo cute, and don't even get me started on the babies. At the weekend we don't have blood testing or X-ray so the ward round is basically a check to see that nothing is deteriorating and making a plan for the next week. Most of the kids we saw had some kind of malnutrition or other, and lots of them had a condition called Kwash (that’s the abbreviation, I can't spell the whole word!) which is when their growth is much below the expected and they have oedema (swelling) plus marasmic babies which were not as malnourished. I am probably talking a load of rubbish here but I was trying to take at least some information on board...




The children here are so tiny – I saw a three year old who was so malnourished that he looked about 9 months old. A big thing they are fighting for here is to encourage breastfeeding because it can prevent so many problems in infants. HIV+ mothers are afraid to breastfeed in case they pass on the disease to their children, even though I think I'm right in saying that if they take certain ARVs they can prevent that. In HIV- mothers it’s impossible to understand why they don't breastfeed, especially when breast milk is free and formula feed is expensive, and no one has any money anyway!



Halfway through the paeds round, Liz got called up to female ward to a patient with both HIV and TB – you may think that sounds like the ultimate death sentence but the sad thing is that many many people here have that combination, and lots of them are kids. When we got there, this woman looked absolutely horrific. I've never really seen a sick person like that before – she was sweating, writhing about, breathing at a million miles an hour, it was horrible to watch, but around here that is nothing out of the ordinary. The patient was in full view of the rest of the ward because there aren't many curtains; I can't imagine what it must have been like for the others to watch.



Liz decided she would give this woman a new drip because the other one wasn't in properly then give her some IV fluids/injection [I think it was furosemide] but I'm not sure the prognosis was ever going to be good. I spent the next half hour or so watching Liz struggle to insert the cannula because all the woman’s veins were so hard to get into. Finally she managed to get one into her jugular vein and do the injection but to be honest the woman didn't seem to improve much and probably I'll find out in the next few days that she has passed away. Puts things into perspective a bit...



Back in paeds there was more malnourishment, more cute kids and some measles cases too, much fun to be had there. The most infuriating thing to see on the wards are the kids who are ill because they took traditional Xhosa medicine [aka poison] which kills so many of them when they could have been saved had they come to the hospital instead. The hospital is constantly fighting with the traditional healers because their methods are dangerous and cause unnecessary pain and suffering. One child had been given a herbal enema, I mean, come on, it's ridiculous that things that are so harmful to the children are done and the healers get away with it! In happier news, I learned lots of new abbreviations so I can understand doctor speak at this week’s grand rounds and I finally learned why you should be shocked if someone's potassium level is 2 ;) [See previous post].



Next up was maternity, cue one million of the cutest babies the world has ever seen. There were six women waiting to give birth in antenatal ward, but all of them weren't very far along in their labour. Sam and I are going to hopefully see one today so we are awaiting the phone call! We then went to review three caesarean patients who had all been done on Thursday [I think – three in one day was a very busy theatre day!] and their beautiful little babies. I learned more exciting stuff like the meaning of grava [number of pregnancies a woman has had] and para [number of viable babies delivered] and the Moro (?or something like that) reflex etc etc. I'm sure that the tiny scattering of words that I now know the meaning of will be oh-so-helpful at med school, but oh well, may as well get started while I can! The nurses in there have the best job ever because they see so many babies at the cute-just-been-born stage but don't have to endure all the sleepless nights :D



After we were finished in cute baby land [this was after 1pm] we went for a coffee [yes, I drink coffee now, can you wait until I get back and we can go for coffee in Starbucks?] break and had a miniscule rest. I was tired and all I had done was watch so I don't know how Liz was staying on her feet. Restored by about 1% by the caffeine we traipsed back down into the OPD to start on a massive queue of patients in varying conditions ranging from dying to just here for a day out.



We saw a tonne of babies who were ill in one way or another, and since there are no diagnostic tests and most of them live too far away to come back in a hurry if they deteriorate, they have to be admitted for observation, or even just told to sleep in OPD. The people here are pretty hardy – I've seen elderly mamas here bedding down for the night on the wooden benches because they can't get home that night. It's not uncommon to wait all day to see a doctor as there is absolutely no such word as 'appointment' here in Zithulele. Suddenly the NHS seems like the most brilliant system in the world! Never again will I be able to complain about anything having seen how much of a mission everything is here.



One particularly pleasant patient was a psychotic and epileptic man who had earlier been sedated by Liz in the middle of maternity ward round but had come around in remarkable time. He was gibbering away something crazy and refusing to sit down, occasionally lashing out. We had three guys in the room ready to restrain him if he started being violent [which he did, cue me running out of the room]! Eventually after some deliberation, Liz gave him some Lorazepam in a high enough dosage to knock a horse out but even then he didn't seem to change. He was going so mental during the injection that he had to be tied at the wrists and held down by two nurses! Crazy stuff!



The most awful patient of the day was a woman who came in in a wheelchair with wide staring eyes, unable to lift her own head up and salivating like some kind of waterfall. She looked like she had been brain damaged by something or other and couldn't say any coherent words and just groaned at Liz. The family said she had just woken up like that having been fine the previous day, but there's no way that is possible. She had to be admitted but she was in a seriously bad way and on top of it all was four months pregnant, so there is trouble down the line if she doesn't get any better. Finally at around half four, we decided it was time for lunch and went for a veritable feast of spaghetti and pizza bread :D I now owe Liz so many dinners it's silly...



Back to work again, this time for a short time only to see measles patients who were discharged which was nice to see – success for once :D There was one woman in OPD complaining of 'left jugular pain', whatever that is, and a man who had been beaten with a stick by his three brothers. Classy. Three admitted patients after that, we were out of there, my first proper shadow shift done. I have to thank Liz for patiently enduring all my questions [for one million hours], explaining things and showing me many sights that I wouldn't be seeing under any circumstances at home! (Oh, and feeding me...)



Hopefully I can repeat the experience some time, and finally get to see a birth and a caesarean. I'll keep you all posted. More blogs from last week will go up tomorrow :D



So that's my last blog as a child! Actually, it's two minutes past midnight here so I'm officially eighteen! YAY :D







xxxxxxxxxxx



PS. Any medical misinformation is allllllllll mine!