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.)
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| 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
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PS. Any medical misinformation is allllllllll mine!
Sounds cool. Kudos on the coffee.
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