get it off my chest...(kimmy's comments)

I never realised coming here that I'd end up doing neonatology as well as everything else. I am currently posted to maternity ward on a day to day basis. It is weird being the only doctor on the ward (in the Uk there would be a whole flock of you). I can call a senior for advice if they're around but much of it can end up being over the phone advice. So the ward is busy busy right now. Lots of pregnant women who tend to have complications. The biggest one being checking their HIV status and syphilis status, two common infections which affect the babies outcome. Frequently they're HIV +ve but not on any medication to try to reduce transmission to the baby. It's heart breaking really as it is the worst start to life you can give your baby giving them HIV.

The maternity ward also doubles as a neonatal ward, so for example I have a 3 day old baby with hypoxic ichaemic brain injury (not enough oxygen at birth) who is well, basically, pretty gubbed really, and has only me to look after him. So I now do neonatal resusc, put drips in tiny babies heads and take bloods, insert tiny tiny nasogastric tubes to feed them. So I put all this effort in, and then they inevitably die, so I do wonder what's the point sometimes doing all these things.

Today consisted of a busy ward rounds of about 25-30 patients, then trying to get blood off tiny babies and putting drips in them, then I put the anaesthetic in a womans back (spinal) in theatre and assisted one of the seniors in a tubal ligation(TL). TL is basically having your tubes cut, and is female sterilisation. About time for this lady since she had just popped out her TENTH baby at 42...she must be very fertile. Seems mad to have so many kids when you probably don;t have money to feed them all. ON the plus side she wasnt HIV +ve which was a refreshing change! Anyway, so we try to do these elective operations for TLs whenever we can since they are a good thing if your family is finished.

I'm oncall overnight tonight so prob will be a sleepless one, though sometimes you can be lucky. there always seems to be someones head to stitch up or someone or other dying. At least I know the maternity ward well because it my turf, it helps for the night shifts and things usually kick off there.

On a more positive note, it is another long weekend tomorrow and we are goign to explore Mdumbi which is another hippy backpackers place. I can't wait. after the mega hike of last weekend I need some chilled out book reading time.

I do wonder how I will react to the UK patients when I get back. It will be nice to be able to speak to them first hand rather than depending on a translator, and I think I'll appreciate the organised-ness of the UK health system a lot.

Oh yeah, I didnt get paid today either, which sucks, and I only got paid half last month. Apparently loads of drs in the other capes are striking, like properly NOT working at all and so tonnes of people have died as a consequence. Seems rather unethical to me, as emergency providers we can't really strick. it isnt on, but as doctors you do need a way to protest if things aint right....someone here suggested refusing to write death certificates, and interesting idea because it would fill up the mortuaries and so the authorities woudl maybe listen, but it wouldnt risk lives (since they'd already died). An interesting idea.

Sorry for this misery pants morbid whinging post, but I feel better for typing it! Kim

See Spot Get Dragged and Beaten

I have just witnessed something truly Transkein (purely of the Transkei region and generally not to be seen elsewhere in South Africa, or the UK) on its nature. I cannot decide whether it was awful, hilarious, symptomatic of something significant, or just one of those things. I have decided that getting that gate put on the pre-school is a priority so this doesn’t happen on my turf. There are too many animals milling about outside the front door as it is.

Tom was sitting down painting the pre-school in his wee pad. He said “there’s a dead dog over there”. He was right. Rigamortis had set in and Tom confirmed that, after poking, it was not moving, despite having open eyes.

So here we have a wee dead pooch outside the rondavel (round house) next to the pre-school rondavel. I wondered what dead dog policy was in Zithulele. My gut instinct was that there was not a rigorous procedure for disposal. I asked a local granny, seemingly the owner of the rondavel outside which the corpse was lying, “Is it dead?”. “I think so, yes. Oy”. Then she said something about children (I heard the isiXhosa – “abantwana”). Evidently it was “hey kids, come and look at the dead dog!”, because they came in droves. Thereafter she set about managing her new team. “You, get the leftover IEC (Independent Electoral Commission) tape from the gate/fence”. Tie it around his dead legs. Yes, both of his rear, dead legs. Now, pull him away somewhere. My thoughts about dead dogs needing to be kept away from little children, clearly had not come over in my facial expression.

Following that, I witnessed - and just failed to get a good photo of - a dead dog being pulled at pace by a big group of 6 year olds, some of whom were hitting it with sticks. As they disappeared down a dirt road, I had to wonder where they would end up and what state doggy would be in after it’s drawing.

In a place where no-one has thought to pull down the IEC tape over a week after the election, with random litter scattered around the ground, it is no wonder that dispatching off a dog corpse does not involve a burial ceremony and reassuring the little ones that he is in doggy heaven. They know he is not in doggy heaven, because Derek, Steve and Betty have got him by the hind legs and are running about town with him.

RIP, Spot. You were a mangey dog. You never bit me when I was running, but you wanted to. Now you are dead from having dirty dog disease. I hope you get buried before you go off.

Zithulele shack

This is one of the many shacks around Zithulele. This is one of the nicest and biggest. It where Tarzan lives. Tarzan is called Tarzan because he wears a leopard print top over several other layers all the time. He usually sleeps in the mid day sun outside the shack under a sleeping bag. Word is, he is mental. His resistance to heat is incredible, though.

Hospital (paeds ward) is in the background and far away is the sea.

Mangey dogs abound.

The photo was taken from our residence entrance road.

Election Day

Church and state not massively removed from eachother as voting took place in a church, but there you go.

B to the unlungula

On the way back from Bulungula. Tired, but not a bad view really.

Bulungula 2

It is really most pleasing when you get a group of people who are comfortable with the same level of chat. I have always been most happy when talking absolute crap, at times utilising sarcasm. There have been instances when i have enjoyed an irreverent moment or a joke about bums and wee. These times are so precious when shared with others. Yes i am 30, but that does not seem to matter.

Tom, Monique, Kim-Kimeny and I walked to Bulungula on Friday after work. And we verily walked home today (Monday). At 5 and a half hours each way, it was a bit of a mission, but well worth it and better than driving. Indeed, we felt like heroes when we did the last wade through the river and walked up the short hop to a roaring fire pit. Word had spread of this merry gang of four, who were audacious enough to walk, and arrive in the dark. Head torches are very good things and we pretty much knew the way, but finishing work at 1pm did not give us much hope of getting there in the light.

The next day tom and i went on the herbal healer tour. We were very pleased to find out that it involved A LOT OF WALKING. But it was fascinating, with a good, vibrant guide and a lovely temperamented healer chap. We were shown 32 different trees or shrubs and told what they could heal. Most of it was innocuous enough, but a cold moment was experienced by all when we looked at the tree bark that treats TB. I just couldn’t believe it, I’m afraid. And Kim has told of two children who died after being treated by a traditional healer person. It is a tricky area. I asked if there was anything for HIV in the forest. The answer was not clear, but he did say that he had never had anyone come to him with HIV. We left it at that.

JZ didn’t get his two thirds, then. Which is really good for the country, mostly in a symbolic way, as I am sure that they can buy off opponents to get things through parliament.

Bulungula is a really cool place. Kim may have mentioned it before as we drove there last time. It is very hippytastic with a well thought out vibe. I am constantly impressed by the people who run these backpacker places. They manage to run a business, whilst giving an air of chilled-outness. Poor Dave, the boss, was on the phone to yet another cancellation. Laid back kicks you in the ass when you have turned away several people, only to have your concrete booking not turn up. I sometimes feel like i am not cool enough to hang out at places like that, but Bulungula has got it right and we played Scrabble in the midst of it all, feeling smug because we are nearly local.

Bulungula also has a community project organisation called the Bulungula Incubator. They are similar to us (Jabulani), but a bit more mature and with a different market. We have a hospital, they have tourism. We also have a larger catchment area than their solo small village. Still, there are things to share and I hope to learn from them and give them some of our good ideas too.

One month until the Comrades Marathon and Monique tells me that the old school version had an 11 hour time limit, not 12 as it is now. Cheers, Monique. So now I have a new bar. And if you don’t finish within 12 hours the clock stops and everyone goes home. You don’t get a t-shirt. And i need a new t-shirt.

Kim's Saturday night

It’s been another tough night for Kim. She was first on call for Saturday (24 hours to 8am this morning) and got called over to the hospital a lot. Lots of tiny (1kg) babies and very sick people. A lot of death, which must be hard to take, even though she is desensitised to an extent. The final chapter is playing out now as the hospital called the guy who should now be first on call but he didn’t answer. So Kim is now back there when she shouldn’t be. I went round to his house to wake him up, but she was already on her way. He went behind her wheel-spinning and honking at the guard to open the gate. Not, I think, from a desire to heal the sick quicker, but to avoid getting his balls booted for being unreachable. The problem is that there is little ball booting around here and no chance of getting him sacked.

It is heart-breaking for me to watch and there is nothing that I can do to help, really. I feel guilty laying in bed and I wish they would stop calling her so I could get a better sleep too. Now I am tired and pissed off, so how Kim feels must be an order of magnitude more crap.

Today we are going to Hole in the Wall to have a braai and muck about. As second on call, Kim can be 30 mins away from the hospital. If something major comes up, like a caesarean section, she will need to be driven back immediately. So fingers crossed for a quiet Sunday. I am running to HITW with Tom and the reliable Riana will do the short drive over with her.

It would be really hard to be a doctor here for lots of reasons that are obvious and lots that are not so obvious.

Pottering

It is Saturday and I am sitting in bed. Kim has gone off to do a ward round with Tom, the medical student. She is on call this weekend. So I get a bit of time to bugger about and it is nice. As much as escape is important and exploring is fun, it is nice to spend a weekend pottering here. No driving, for a start, and time to write this and read the BBC website.

I need to do a big run today, really. Maybe tomorrow. Dunno. Yesterday Tom and I ran left. It was a quite an eye opener to see what is to the left, having previously lived my life solely on the right. Zithulele is pretty scabby really. Little shacks around the hospital and extremely mangey dogs. But a kilometre to the left you get to lovely rolling hillocks with tiny farms on them and smiley people. The scenery was breathtaking as the sun went down. It was like fell-running in mini size. We got to the sea. Not a beach as such, but the shore. It is only 4k away. I definitely need to do more exploring down there.

We will be having several braais this weekend and Riana, the pharmacist, will cook tonight. She is an amazing cook and all round good egg. She is my fixer, really. Gets me what I need and tells me where the best shops are for whatever I need. She knows where the nearest cash, diesel, beer and other important things are. And all of this whilst casting aside her natural Afrikaans hard-wiring to kill me for being British.

Now it is past 10 so I think I better have some brekkie.

Oh, no. JZ is going to win

Jacob Zuma has the most sleezy smile that I have ever seen. Every time you drive to Mthatha you see him in massive-o size on a billboard in Mqanduli. On the back side of the poster is a beer advert. He looks corrupt, but that may be me just deciding that after I know he has a bad rep for corruption. Anyway, the National Prosecution Agency just effectively cleared him of doing dodgey arms deals, so he looks to be in the clear.

He also said some nasty/stupid stuff in his rape trial (he was acquitted) and is endlessly mocked for saying that he had a shower to minimise the chance of getting HIV after sex without contraception. One cartoonist draws him with a showerhead permanently coming out of his collar over his head. I hear that someone is selling a new shower gel to take the piss, but with the warning that it doesn’t cure HIV/AIDS. Good craic. Hope they don’t get censored.

I asked someone in the village why they are going to vote for the ANC. They said that even though they don’t have a job, they get money. So that is good. That was the ANC. There seems to be a fear that anyone else would take it away, when I don’t think that would be very easy.

If the ANC get two thirds of the vote, they can do whatever they want. They can re-write the constitution. They can make the national anthem “Bring me my machine gun”, JZ’s theme song, which gives the media endless yucks. So that would be bad. But trying to describe that to folks is pretty challenging. It seems obvious to politics geeks that competition is good for parliaments, but that doesn’t get anywhere near the voters here (that I know of) and actually probably wouldn’t sink in to much of the UK electorate.

I heard that Malema (I think that’s his name. He is the vocal leader of the ANC Youth League and seems to be a wrong-un) was in Cape Town saying that all black people will get a free university degree and stuff. What about white people? This guy is a real rabble-rouser and he has a lot of power.

The trouble on election day will be in Kwa-Zulu Natal, so I am glad in a way that we didn’t end up there. I am sure it will be localised, but Inkatha Freedom Party and the ANC are big enemies so fights are expected up in Zulu territory. We get the day off and I am keen to go see a voting station out of curiosity. Kim may over-rule me and make us go to the beach. Yes, it is still sunny and warm. Well done South Africa!

Anyway, back to elections. There is no way any other parties will get anywhere near the ANC but it is possible that they will reduce the majority to less than 66%, which would make for a more balanced parliament. Fingers crossed for Weds.

Biblionef

I took receipt of two boxes this evening which made me very happy. One, I didn’t have to go and pick them up from Mqanduli (70k away along the pot-hole road of doom) and two, they are full of useful free stuff. A big thankyou to Brian, who also brought me beer. The circle o favours goes round and round.

Biblionef are an organisation that give you free books in the local language. Simple as that, really. So I got in touch and they sent me two boxes of books and posters for the pre-school. Bingo. They give you brand new stuff because often kids get crappy old old gear and they really deserve better. Which seems like a nice thing to me. There is also Duplo in the box, which I am taking as commission. I may also take the Miffy book. You have to skim some off the top to make volunteering worthwhile.

So well done, Biblionef (tell your friends) and happy days, because now we have lots of cool pictures to put on the walls and books for Thandeka to read to the kids.

Today we got up to 12. We started with 6, so that is progress. One of the kids is the boy of the road engineer lady. Mad props to her for being a black female in a high powered job in a male dominated industry, but her son is a bit of a brat. He cried and snotted out of his nose a lot, whilst displaying the lollies that he brought that none of the other kids could afford. In fairness, he did share, but I think that was Thandeka’s doing. I think she is going to bring him round. He played pretty much on his own today, but you could see he was eyeing up the big group of kids that Thandeka was working with and praising, etc, and feeling left out. Kids are mental.

Stole a quick chat with Ben Gaunt (One of the founder doctors and Chief Medical Officer for hospital) this evening. His time is precious and he is rarely not busy as hell, but he always listens if he can. He is extremely ambitious and looking ahead to when we have 100 pre-schools in the area, similarly run and stocked. It is good to have someone looking ahead like that because I am pretty narrowly focused at present.

Sunday

Did a three hour run with an English chap called Tom yesterday. Tom is one of those guys who does 3 hour runs without any training. We call them idiots. But it was ace to have the company and we had a good stream of chat. He is a great guy. His wife, Becky, was here last year doing her elective (med student abroad thing) and he is now.

My silly baseball cap with add-on tails to protect the neck works really well and does not chafe at all. The heat was still quite full-on though as we didn’t set off until after 10am. Legs are a bit sore today but okay really. Going to go for a short run to loosen off whilst almost everyone else plays Cluedo.

I also just fixed the car. It is a simple pleasure to sort out a little thing that you knew nothing about before. Yesterday as we drove the run that we had done to find the mileage (only 24.6km, disappointingly) the indicators stopped working. The hazards were also not going on, but all else seemed okay. So today I had a ferret around in the car to find two goosed fuses and, luckily, two spares of the same ampage. I also didn’t know that the hazards fuse would do the horn too. All now works and I need to get two knew spare fuses.

Everyone else went to church this morning so Kim and I watched two episodes of 24. We had some very good craic with Karen who calls us pagan scum. She has an extremely refreshingly irreverent attitude to religion, despite clearly having her own strong Christian beliefs. I think it is a double bluff to get me to take up the bible, but I am on to her and remain a heathen. I did eat a hot cross bun though. And I loved it.

Last night we braaied. We cheated and used coals as opposed to wood, but there was still a reasonable amount of fire management. I have to say that it went well and that with a stationary grill. Without the opportunity to raise or lower the grill, fire management becomes even more important.

Thank God it is Easter

Once again it has been a while. It is weird, but it is hectic here. Even though i often feel as though i am not achieving a great deal, I still find myself exhausted and with little time at the end of the day. Currently the blog and other communication is suffering, as is my education in isiXhosa, the local language. It is a shame as there is a lot to write about and it always helps me to get my head round it.

We are away now for the Easter break and both well ready for it. I am surprised at how knackered and stressed I am and almost feel worse because I see Kim facing her own serious challenges at the hospital and coping. She has had a really hard few weeks with lots of getting called out at night and the weekends, but she cracks on with it. Meanwhile I have been tetchier than ever before in my life and having real ups and downs on a daily basis. I think i took the whole culture shock thing for granted, though i have experienced it before. And working as a volunteer is a weird beast indeed. Lots of feeling that i am not doing enough or working smart enough (just like starting any job), mixed with the occasional thought that i am not getting paid, so bugger it. Resenting the fact that I have little support or guidance, whilst enjoying the freedom and challenge of that. There is also the dynamic of working with others who are being paid and are not working as hard as you. Easy to get annoyed about that. But this will all sort itself out. Easy to say now over a beer, but i have found it hard going this last week or two.

Hopefully kim will come on and speak for herself, because i couldn’t do justice to her experience. Some of it i hear about and some of it i have seen, but i don’t think i can really empathise. They are up against it in the hospital and each has to look after their self and others. Her mate Liz has been incredible and they really look after each other. Liz went off to Cape Town today looking utterly exhausted.

The Preschool is coming on. I am not going to talk too much about it because i have been obsessed with it and i need a break. We have 6 kids enrolled and a renovated building. Tuesday will be busy as it is on Wednesday that we open. We negotiated with road construction workers to get them to dig a long-drop toilet hole for the kids, which was a great success. So all is coming on, in stages. All the time I am wondering how sustainable this all is as I am not here for long and we have no-one set up to take over when I go. There is time to sort that out.

So we are here in Bushmans with Karen and Roger, who just got engaged. Roger and me are setting up a support group called ‘emasculitis united’ as we are both unpaid and entirely supported by our girlfriends. Karen is a physio at the hospital. Sometimes we go and pick up (relatively) heavy things. We dug a hole yesterday and it felt good (although I have some awful blisters on my baby soft hands). We would talk about cars if I knew anything about cars. Roger and I are content that we are are helping the poor in our own special way and making that difference. We also drink beer.

There are 5 others here. All lovely and good craic. Tom, the medical student has agreed to do a 3 hour run with me tomorrow, which is awesome. My training has been pretty crap of late. Been letting it slide big time. We played speed Scrabble tonight and had some beer. That was all after a swimming race across a river and some sprinting through knee deep water (tiring). Now looking forward to a sleep. This is feeling good and comfortable.

IsiXhosa has three clicks in it. A big mental block for a new speaker. You have to try to make a click or a tut or a tsk whilst adding on the rest of the word. To add insult to injury, the word for the language has a bloody click in it. isiXhosa is pronounced with a click sort of like the sound you make for horsey clicking at the side of your back teeth. Apparently the hardest thing to say is “I am sorry. but I only speak a little isiXhosa”. It sounds like “click-bang-whrr-boing-dingdong-shala-lala-click-smash” or similar. Ironic, no?

Kimmy Comments

I am tired. But it is Easter long w/e so I must forget work and enjoy the freedom of four days away from the hospital. It is hard to describe why it is so exhausting but I’ll try...firstly there aren’t enough doctors so we are running around like headless chickens most of the time. Also I too am trying to master Xhosa and so communication with patients is hard. Also the nurses are not exactly efficient...this is a lethal combo (literally at times). I have seen many people die, kids through to adults...it seems to be shelved in my emotion box somewhere in my brain and I just carry on. Funerals are a big thing here. They have to slaughter a cow in honour of the dead ancestor and if the cow doesn’t squeal good when it is slaughtered then they have to kill another one as the squeal is the important bit calling to the ancestors in respect. If the slaughter doesn’t go well then they get bothered by bad spirits. The flaw in this tradition is that we’re talking about big families with v little money and then when someone dies (as they inevitable do from HIV/TB) they have to slaughter a cow and they may only have one, so there it goes. And they have to share it with the entire community, even if they didn’t know the deceased. This may be an extra reason why they scream and wail beating their fists on the floor when you tell them their family member has ‘passed’. It is quite disturbing to see. Maybe they should rethink the tradition and just slaughter a mouse, or one of those pesky street dogs...there are loads of them, though i don’t think they’d taste too good.

Today we hunted Easter eggs in the garden. My ideal activity, firstly since it is a competition and everyone who knows me knows i am highly competitive, secondly because it involved chocolate sweeties, and thirdly the association with bunnies....I love bunnies!

Locals have funny names. They like to mix the traditional with the new... the old names usually start with No******* eg Nosilike or Nothambe, but the newer names are things like Noparrafin, colgate, NoOmo, cellphone, and the best one I heard.... ‘fullydilated’ (this family was obviously influenced a lot by the doctor delivering the baby! They really are moving with the times. When I was up in Zanzibar people had equally funny names like Michael Jackson, James Dean and Madonna. Crazy hey!

Last week we crossed the cultural barrier by finally plucking up the guts to give a lift to someone at the side of the road. It was a wee school boy, about 12 y o – he spoke great English. It felt good to give him a ride down the big hill. Obviously i won’t be offering lifts to blokes, but old ladies I think is okay.

We are making a firepit. There is a big grassy area by the accommodation begging for something to be put there. We managed to grab some massive logs from a giant tree that was pulled down by the people who are modifying the road from our hosp all the way to the big N2 (1 ½ hr drive). We now have 4 nice big logs which we’ve placed in a circle and we are digging a wide shallow hole in the middle. This has a drainage area at one side and we plan to line the hole with cement then it si perfect for having big fires for us to sit round. I brought a candle out the other night and we all sat round the candle on these logs getting excited about our new entertainment venue and imagining the big fire that will burn in the middle soon. Quite sad what gets you excited out here.

Although I’ve talked about the negatives of the stress at the hospital, there are many positives. We finally feel we are living in a community. Within our hosp accom there is a nice little community. Everyone invites each other to dinner most nights, we do Frisbee, Pilates, Braais, girly movies and building firepits. It’s a great thing compared to London where you hardly knew your neighbour. Also i spend more time outdoors, and weekends off are fun and active. I don’t take things for granted, and a piece of chocolate tastes so much better out here when you really need a boost. I am addicted to fizzy pop though-my teeth will suffer! we have a car which is cool, juts need to improve my driving skills now! I don’t have to sit on the London underground trying not to accidentally make eye contact with anyone for fear of offending them. I think me and Pete just laugh more out here, and I hate to admit it but Pete is Mr hilarious...his sarcasm seems to go down a treat, everyone LOVES him. He seems himself out here. I think London was wearing us both down.

I like feeling like I’m ‘surviving’ and using my initiative to solve problems or being resourceful like turning an empty plastic bottle in to our toothbrush holder, or an old box in to a magazine rack. Granted, our flat looks like a bluepeter studio with all this home made stuff, but I get a sense of achievement every time I used one of my homemade tools. Pete manages to hold his tongue and not slag off my creations too much. But I will say something like “isn’t this cutlery drainer I’ve made really useful” and he’ll quickly reply “I was just thinking that” and my heart will soar with pride “really pete” and he’ll reply “No , only kidding” – he thinks he’s SO funny that one!