Kimmys comments – “Life and Death in The Village”

It’s strange being back in Zithulele Village where there is not very much. A stark contrast to my last two weeks in The UK where takeaways are on tap, corner shops sell valuable supplies and clean water and working electricity are a given.
Life is different here, polar opposite. After the trip home this seems more obvious to me than ever. And yet we try to surround ourselves with the comforts of home, as if to cope better. Watch a DVD on the laptop and escape into a story line. Tucked away in the hospital accommodation complex whilst the rain beats down on our nice sealed roof. All the while knowing that a big storm 2 weeks back blew the thatched roofs off a few rondavel houses in the area. I’m sure they’re not so comfortable or dry.
And so life is different here compared to home...as is death. I’ve been thinking a lot about it over the weekend. On Saturday night oncall I resuscitated a 1200g baby born prematurely. The baby was delivered by emergency caesarean section (cut out) at midnight(these things always happen at the most inconvenient times!). After 35minutes of adrenaline, breathing for the baby with a bag and tube and pumping it’s heart with compressions we had to stop and let it fend for itself (we don’t have any intensive care facilities and can’t ventilate (breath for) a baby for ever) so have to let it try for itself after a time). The Drs in Mthatha Hospital (referral hosp) are also on strike. In a nut shell this was survival of the fittest. The baby never breathed for itself, and I watched the heart slow and stop. It was a boy. He didn’t survive. It was tough.
This mum has had 13 pregnancies and only two live children. It must be like a recurring nightmare for her. Eleven premature labours all ending badly. I imagine how a UK woman might react to such a thing (from my UK hospital experiences) compared with this Xhosa lady. I just imagine lots of noise and tears and sadness. But women here are so tough, I don’t know, they just seem to get on with it. She said a brief goodbye to the pale fetus wrapped in its blanket and then took a deep breath and coped. Is this just a cultural thing? It is not the first time I’ve witnessed tragic death here believe me, and the reaction is often similar. Outwardly women are expected to wear black mourning clothes for a period of time, inwardly I am not sure what goes on. I wonder if they grieve properly? They don’t break down and cry, sometimes I see them smiling and laughing within days. Which reaction to death is right? Is there a ‘better’ way to react? Don’t they care? That is unfair, I am sure they do. Certainly we don’t comfortably talk about death back home, though it one of those certainties in life. Maybe death is just more exposed here, more expected, more witnessed by communities? All just thoughts running through my mind. No right or wrong answers of course. I think it is good to be challenged by these things and to think about patients’ health beliefs etc.
In the UK we love the whole ‘debriefing’ thing at work. Children rarely die, so if they do everybody has a moment to catch their breath and discuss things if they feel like it. Not quite the same here. I remember being called to a ‘gasping’ baby on my first evening oncall only to arrive to a blue breathless lifeless baby. I think I was more visibly upset by this than the mother whom I broke the news to. I was offering my emotional support to the nurses saying they did all they could....In retrospect 4 months down the line I think they probably thought me barking mad and overreacting for being so affected. It is just the way things go out here. Kids die. Anyway, this blog is sort of a debrief for me. My skin has certainly thickened in the last 4 months, and so I could carry on to the next sick patient this weekend after the awful resuscitation of that newborn baby. I can step back and objectively say that the baby didn’t stand much chance given the medical history of the mum, but still it feels like a failure on your part as a doctor when a fresh new life never really started.
My oncall has been rubbish this weekend. Lots of sleepless nights up on the wards. I am still oncall as I type. It’s Sunday night and I finish tomorrow at 8, well, not really finish because I then start the fresh working day of Monday. The break will come next weekend. My superstitious-ness comes out when I am oncall. I think if I look at my phone it will ring. Even as I type this blog I think my phone will go because I am thinking about it. If I put my socks on it’ll ring. Or if I leave the room. I go quietly insane having this hate-hate relationship with my ringtone. I realise I sound completely mad....if you’re a medic you might get it??? I thought I could set up the phone with a special ring for the hospital so that I wouldn’t jump if pete or a friend called. My phone is too basic for that. Damn. It hasn’t rung yet so I’m going to post the blog and not look at that bloody phone!

PS sorry this post is so dark.