Mthatha admin

Yesterday I went to Mthatha to get the new (and first) Jabulani Foundation vehicle registered in our company name. I took the book ‘Bravo Two Zero’, by Andy McNab with me in case there was any waiting involved. I knew that it was going to be a long day, but as it was a good while since my last admin trip to Mthatha, I was confident of success.

The first thing to do was to collect the mail for three people at Mqanduli Post Office. This was carried out with no problems and I sped onwards. Prior to departure I had already read a good chunk of B20 and I learnt that preparation was everything for a mission to be successful. I had a list and I had checked and re-checked the documents that I needed.

I like the VW Citigolf. It is basically a VW Golf (for the UK folk) with no trims. 1.4l, no power steering, aircon or other dangerous electronic stuff to go wrong. Andy McNab would approve, but he would also probably call me a ‘big bag of bollocks’ as the SAS is prone to involve a lot of abuse of one’s peers. Anyway, it corners better than the big car and it feels like you are going fast all the time.

The next thing was to get the car checked for the insurance company so they knew it existed. I was nothing but charm. Make the personal link as quickly as you can so that they don’t torture you to death (or decide to be unhelpful, in my case). Job done, had a brew (well, a drink of juice).

Next to the Traffic Office for registration. My navigation intelligence had been from Shannon, one of the occupational therapists. She had done a good map and I was in there fast. The queue was pretty long. I spent the time talking to some dudes with great English. They were really helpful to me, so I didn’t shoot them.

When I got to the desk it all went a bit wrong. Two large ladies were firing info at me. I had to register to get a number as an SA driver first. I also needed an affidavit from the lady who sold us the car. The intelligence had been wrong. My mission was foiled. I decided to go and get the car’s ‘roadworthy certificate’ (one requirement that I knew about) so that all would not be lost. The last thing I did was to get a phone number for the office so I could double check details for next time. As I departed, I rang it. It rang out, as had all 3 of the other numbers I have for the office. They were clearly masters of obfuscation. Or some other big word.

I came to a vast, shiny warehouse with a sign on it saying “KSD Vehicle Testing Centre”. The process was to drive to the end of a queue and wait. There were 5 vehicles in front of me. I left enough room in front to maneuver out, as any member of B20 would have. The fat man with pretty good English told me that I was likely to have to wait an hour and a half. Not bad. I settled into the book.

Time passed. 2 hours passed. I realized that, like Andy McNab, there was no point in getting stressed out. I needed to bang some food and water in me, because I did not know when I would be able to do so again. Over 3 hours later I looked the wee man in the face. He was like a Scottish footballer in that he had only 2 teeth and was not very good.

I asked him how much longer it would take. He told me that I would need to come back tomorrow to collect the certificate. I asked why and pleaded with him that he try to do it ASAP. His response was to say that he did not want to commit to anything as he was the only man there working (there were two others). This was when I started to think about what Andy M had said about how to kill a man making minimum noise, but I wasn’t prepared to saw my Leatherman backwards and forwards across his windpipe just yet. I went outside to see fatman as he seemed to be in charge (ie doing nothing). He said that the guy inside was the only man working and that is was not possible. I said that I lived very far away and this meant me losing a whole day. I said the word “hospital”. I said “please, please, please”. He wandered off.

When he walked back past I gave him an eyebrows raised look that asked whether it was going to happen. He gave a small thumbs up. I walked round to see Toothless MacGinty. Toothless was clearly losing his mind. He stuck his tongue out and jerked his head forward as if he was walking like an Egyptian. I said “thank you so much for helping me today”. He stuck his tongue out. He then pissed about printing the form slowly.

The important thing was that I hadn’t shown him how I was really feeling. I was physically tired, but they had not broken me mentally. Andy McNab would appreciate that. When he was getting tortured by Iraqis he went through something similar. We both came through. As I started the engine, Toothless was at the window with his tongue out like a mentalist again. I did the international sign language for YOU ARE MENTAL. He nodded. Back again next week then.

Kimmy's comments-they pull you down then they pick you up

Yesterday was a funny day what with the DG stuff and a ward full of sick people. I had a 14 year old girl who suddnely looked terirble with breathing troubles yesterday. I put her on oxygen and strong antibiotics through the vein, but after lunch I took a look at her and she looked worse despite my attempts. me and some seniors spent an hour or so trying to get her breathing better with various potions, but she didn't improve. At 5pm I decided we should refer her to Mthatha Hospital , after all she wasnt my usual patient - she was HIV -ve, previously well, and only 14 years old. Unfortunately it was too late to get the helicopter to come as apparently it doesn't fly at night, so i had to settle for the Metro Ambulance along the bumpy wet dirt road to Zithulele (at least an hour away). Unfortunately before the ambulance arrived she stopped breathing and her heart stopped beating. We tried to rescuscitate her for about 45 minutes with adrenaline, atropine, the lot - tried everything we could think of but unfortunately had to give up eventually as she wasn't coming back to us. She died. I think it was a super nasty pneumonia. It was bleak. Only 14. So today at work bumbling around my busy ward and I was feeling pretty broken and sad about it all. Things just carry on you know and sometimes that's hard.

Just as I was feeling utterly bummed I got a call from Liz one of the other doctors and my good friend. "guess who's back" she said excitedly "who?" I asked.....it turns out that my favourite Paeds baby a 2 1/2 year old girl called Aphiwe who I'd sent very sick to a great hospital 3 hours away in East London had survived and was back with us! There was a lovely letter to me from the consultant saying 'thankyou for your excellent referral' and that our diagnosis of TB everywhere (chest, abdomen, liver...)was correct. She was changed to pills instead of antibiotics through the vein, which means she can go home soon!

I ran down to Paeds ward to catch a glimpse of her and she looked wonderful - fat faced and much healthier (she was wee scrap with a buddah belly before, adorable). She was wearing this cute flowery dress. This girl was the one that captured my heart for some reason on Paeds, I think I wrote about her granny being awesome a while back when I said she might be on the ward for 6 months. I am delighted she is better. Sometimes there are happy endings too!

Also yesterday Taryn one of the other doctors called me to see her kiddy for a peek, and it was a boy who'd burnt his leg a few months back and had been on my ward getting his burn cleaned up for a few weeks and then was sent to Mthatha Hospital for skin graft (no, not the one I wrote about a while back, he has disappeared, but another one). His leg looked great, graft had taken well, a wonderful result and another happy story.

So, it is funny that things pull you down but then something else lifts you back up. I think some people think these kind of things are the work of god or something. I'm in the 'of something' category, I'm just happy they happen when you most need your faith in yourself and what you are doing restoring.

Kimmy's comments - The ugly side of poverty

Firstly, I realise I always write sad things on the blog, I’d like to say that it is awesome out here too, and I;m happy, but I don’t want to make you all jealous by writing happy stuff all the time, plus the most interesting things are usually grim. But that is life...if you want cheering up then don’t read on.

Only a few months to go until we go back to The UK and it is strange looking back on my year here. I had a great three months on Paeds ward and now have moved on to female ward. Each ward change brings new challenges and it is a thought provoking time.

I have 25 beds on my ward, most people are pretty sick. One room is full of TB and there is a good scattering of HIV +ve women too. 25 year olds with brain damage from fitting for a day (a reflection of poor transport links here and inability to reach medical care.

To start a HIV+ve person on Anti retroviral Therapy (ARVs) they need counselling and also a treatment partner, someone who also understands that the pills are everyday for the rest of your life, and that they MUST be taken at the same time twice a day. Having a treatment partner means that if you are too sick to remember your ARVS they can give you them...pretty essential to the whole theory of ARVS needing to be EVERY DAY not to miss ANY as it risks the HIV will become resistant to the pills. And don’t forget these pills are horrid...nausea, vomiting, diarrhoea, numb feet to list but a few side effects. But they’re a life saver too....so you bear the side effects.

Anyway, one poor lady on my ward has a very suppressed immune system from HIV and needs ARVS but they say she has no treatment partner. So today on the ward round she sits in bed looking gaunt and thin and ill. Her lips are purple from the gentian violet liquid we put on her blistered mouth. She looks so sad and weak. I ask her (via the nurse) if she can think of ANYONE to be her treatment partner, and she says no. Her father and mother I ask?...dead. Her sisters and brothers.....dead, her husband...died 2004. No friends. The only person she has is her 14 year old child. I discuss it with a colleague, we have no choice, we’ll have to try and get the 14 year old to be her treatment partner or she’ll surely die in the next year or so and then that child will be entirely alone. It seems the best option, the only option really. Shame to put such a big thing on a 14 year old but I guess already there life is a struggle finding money and shelter etc. As they say in SA...’Hectic’.

The other thing I’ve noticed today is “the ugly side of poverty”. Just to give a background, unemployment is massive...it’s rare to find anyone with a job here. There simply aren’t any jobs round here, just rolling hills with rondavel huts on them but not much economy or work. The govenrm,ent gives grants for children, old age (>60 years) and disability. We have to fill out forms for them to be assessed, and they collect the grant monthly from a local shop or something. It isn’t much but large family networks of 8-9 people or more end up relying on a few family members grants from the government to get them through each month. Even more so with the HIv deaths in 30 something year olds leaving orphaned children being looked after by their gogos (grannies). They’re surviving on £30 for all of them or something like that. The problem comes when the gogos die and they wont be replaced with new gogos because lots of them are not living long enough. A flaw in the plan of life round these parts.

Disability Grants (DGs)are a nightmare for us, everyone wants them but the government lays down strict criteria. Unfortunately you don’t qualify for one just because there is no work, it’s more about whether you’re fit for work. And, no job centres out this way, oh no no no. But, in times not so long ago people could ‘buy’ grant, so there is still a lot of unrest because people who may be used to have a grant are now ineligible. And the families are so desperate that they waste time and money and effort on trying to get a grant, when these efforts would be better spent on finding work or working the land and planting food instead. Apparently in other parts of the country there is a black market on TB sputum. You get a temporary grant for having TB treatment (6 months usually) and some clever souls have cottoned on to this, that because TB is often diagnosed by culturing a sputum, they can sell their dirty Tb sputum to health people who hand it in as theirs then get put on TB meds (which are potent and have SE but they don’t care) and then get a DG.

Anyway, back to the ugly side of poverty. So today is grant collection day, or ‘epaye’ as they say. So all these young relatives of the old ladies on my ward with TB and strokes etc who are over 60 come crawling out of the woodwork to drag their old gogos to the shop to collect their pay. It just made me feel furious seeing these poor old ladies being wheeled out in wheelbarrows and all sorts to go sign for their pay (they have to go in person.). I am asked for permission to let them take the old ladies, what can I say....from a drs point of view NO, I want them on the ward being treated, but from a broader perspective you can see how this grant is essential for the families survival on a day to day basis. It is just that fair enough, if the family had been around before hand caring for their relative and then took them for grant that would be more palatable than them just turning up randomly on grant day.

So, I say yes, they can go, but I think the relatives sense my anger. Sometimes I long for the UK and its functioning welfare system. People just don’t know how lucky they are back home. I am going to be SO ANNOYING when i get back referencing my time here, I just know it! Sorry in advance, but poverty is ugly.

Romance, gluttony and elbow shaped punishment for the previous two

Kim and I just got back from a romantic weekend at Mngazi River Lodge. It is posh and nicely done up and feeds you til you rupture something. When it is only for a weekend, you can really go for it and eat everything to destruction. Seafood platter, cooked breakfast, soup and a roast... We met a couple at the end of their week. When asked if they were hungry they answered that they did not know anymore and that all they knew was that they had to keep eating. They were broken and they still joined us in having seconds of pavlova as well as trying the fudge cream cake.

We got a couples massage. Me and Kim, not the other two. Needless to say, Kim was responsible for booking this frivolous package and I was all to prepared for another crap, soft, Swedish massage with too much oil and not enough pressing. I asked for a “hard massage, please”. Let me explain, I have had several excellent thai massages in my time. I used to have one every week when I was in Thailand and they were hard and they were great. So when I said to Loreen that I wanted a hard massage and that, yes, I had had massages before, she could see that I meant it.

She kicked the shit out of me. She went straight in with the elbow and relentlessly continued as I silently screamed through my face-hole at the bowl of pebbles and twigs that ornately faced me. Kim, it seems, was going through similar turmoil next to me, equally afraid to protest. Seems I am not the man I was in Thailand and I have simultaneously gained tension and lost hardiness in my back. After the beating, we retired to a spa bath thing with some pink champagne, which helped.

Things that I saw this weekend that you probably didn’t

I was driving along the pothole road. I’ve got pretty good at dodging them by now. But there is a new scam. The kids have got spades and piles of dirt and act like they are filling the holes when you get close. They stop immediately after you pass. I encouraged the work by smiling and putting (both of) my thumbs up to them. I suppose they felt much improved after the exchange.

On Friday I attended and spoke at a ceremony to mark the official opening of Ngcwanguba clinic’s new (ish) prefab unit. You can try to pronounce the name of the clinic now and I will wait for you. Finished? That was pathetic. But at least you tried. A Joburg firm called Fabricated Steel Manufacturers donated the building, which now houses consulting rooms from which the ARV programme is run. There is also space for the HIV support group to meet – an improvement on a bit of grass in the rain.

FSM is run by a bloke called Felix Clemens. Felix attended and was accompanied by a classy pair in Hans and Elody, Chairman and shareholder, respectively and not a couple. They were delightful and pleased to come and see where we are and what we are about.

The ceremony was ace. Lots of ceremonial dancing and ululating (you can say that and all) went on, with local school kids performing traditional dancey stuff, as well as a short skit where a girl tried to persuade her boyfriend to test for HIV. He was not convinced at first but ended up getting into it and getting some counselling. The ARV support group gave a rowdy performance with drums and awesome singing. Doctor Iber whispered that he was pleased to see one woman who had once been at deaths door gyrating like a goodun. Good old ARVs; they keep you alive and enable you to live a full life. Some anyway. Best bit for me was when 4 teenage guys came in traditional garb, topless with beads on and sticks in hand. They did some facing off and a mad vibrating of the chest and shoulder area that I would struggle to imitate. The culmination was two facing off, nearly touching and giving it a good old vibrate. It was intense.

The event started bang on time at 9am. Except for the fact that it didn’t start until nearly 11am. I am getting used to it by now, and thus may well struggle when I get back to working in the UK. Hans gave a lovely speech, emphasising that FSM was a 3 generation family business and one which looks after its workers. It went down well with the crowd. I simply had to say thanks and give a quick bit on what the Jabulani Foundation is. It was a pleasure.

Near the end of the event, when we were all losing the will to live after too many speeches, the ANC bloke got up. He started by admitting that he hadn’t been to school, before proving it by stating that HIV is caused by poor nutrition (wrongly interpreting a previous speech from a nutrition manager) and going on to say that the government was doing A LOT to improve things. The irony of him saying this at an event devoted to the private and NGO sector delivering what the public should was lost. He said that he was pleased to see this Foundation, “I forgot the name...”. I was delighted to hear the front couple of rows shout “JABULANI!”. So they know our name, which is good. I realised the importance of getting out and doing formal things to spread the name and what we are doing. My speech included a last minute spiel on the waiting mothers’ accommodation, which we need to advertise so that pregnant women know they can come and be near the hospital at the end of their term.

Today, at the Superspar in Mthatha, we were loading up with groceries and looking for the shortest queue. I could see that one had 4 guys at it, but they were huddled real close and looked to be together, and with no trolly. I pounced. And verily took the space behind them. They were, it seems, pissed. And they were also buying only one item – again, well done me for choosing that queue. The item was a pack of sanitary pads. What would 4 pissed Xhosa guys be doing buying a pack of Lillets? We will never know. They did not buy them. I can only assume that they didn’t have enough money.