30 October 2007
It’s hard for me to believe this is my last week in Mthatha. I suppose it is to be expected at this point that I would try to analyze what I’ve been observing and I find myself doing exactly that. At times, I don’t feel like I’m in Africa since it hasn’t been the exotic place that I’ve always pictured it to be. Africa was supposed to be so different. Maybe that will hit me when we become real tourists in the wild animal parks next week. The raucous birds in the morning, the new faces and unfamiliar language do remind me I am in a different place but the people are as alike to “my people” as they are different. I have not had a comprehensive view since I was only out of the Eastern Cape province once and I haven’t been to any of the large cities. There are certainly daily reminders that I am not at home. The roadsides are almost constantly busy with people walking both short and long distances. This is a society that moves by foot primarily and I continue to notice the number of people on the roads because it is so different from home. It’s not that there aren’t lots of cars but that there are so many people on foot as well.
The animals roam freely in town as well as the more rural areas. I’ve heard the locals jokingly refer to the big five as the cattle, goats, sheep, pigs and dogs that are a real road hazard because of their numbers and free roaming practice. (The big five usually refers to the big game animals in the wild animal preserves) The problem with garbage being dumped anywhere and everywhere is a sad but constant reminder I am not at home. The unusual clothes and colorful headscarves have become barely noticeable to me as I have become accustomed to them now. I like the lack of uniformity and conformity here. Anything is accepted although there are still stigmas against some of the styles for women that are considered immodest. Those clothes are worn here but I have seen them very infrequently although the Islamic influence here is minimal compared to the European and East Indian.
After I have been away from here for a while, I think I will make my conclusions about the medical system here. They are already quite different than the first week I was here. It seems to take time to interpret what I see. It also depends on the context of location. I think it may be different when I consider it again from Minnesota. I’m not sure. I wonder what effect it will have when I try to explain it to those who haven’t been here. I expect there will be questions and opinions voiced about society and medicine here that I haven’t considered. It is a luxury to be able to think for awhile about what I experience without the influence of the opinions of others. The volunteers certainly discuss this and it is not as uniform a response as one might think. We all come with our prejudices, experiences, personalities and politics. I know there isn’t a “right answer” to solve Mthatha’s problems any more than there is a “right answer” to America’s problems. (I can already hear those of you who think you have the right answer ready to disagree with me on that!) These are better questions for philosophers, sociologists and politicians to spend their time debating. I’d prefer to use my time to deliver the needed health care but it is the other disciplines that seem to hold the power so I hope they get it figured out. That’s enough editorial for today as I need to spend time getting ready to leave. This will be the last post, at least for now. I don’t believe I will have internet access again until I am home. I am looking forward to seeing everyone again soon.
Wednesday, October 31, 2007
Monday, October 29, 2007
26 October 2007
The last 2 days have been very interesting. Yesterday I went to morning report as usual and then did ward rounds before going to the clinic. There was one colposcopy scheduled. I had understood that they had done colposcopy here in clinic previously but found they weren’t sure what to have set up for colposcopy. Once we had everything we needed, we got started. Although we had one patient scheduled, three showed up. No one knows how that happened but I was glad that we could do several since it would be the only chance we would have. Everything went very well. I was able to do all 3 colposcopies and show the residents and students quite a bit since the system they have has a video set up so they could all watch on the video screen. The colposcope has the video screen but not a direct view eyepiece so that took some adjustment on my part. Overall it was a great experience and it felt like the most effective thing I had done since I got here. Following that, I had lunch with Dr Mdaka and we discussed the colposcopies we had done and then how they might structure an ongoing colposcopy clinic. Then we discussed how to start doing laparoscopic surgery at NMAH. This would be such a benefit for the patients but also hopefully use significantly less hospital resources and open a severely clogged system allowing more patients to be treated.
Last week I had asked the interns about foods that were part of the local traditional diet and that I wanted to find a place that served these foods. They were going to think about where to send me but had concluded that there wasn’t anywhere that served good local cuisine so they were going to cook for me. They decided to have a braai which they described as an African barbecue. It was held at one of the intern’s homes and there must have been 30 people from the department there. They asked me to invite the other volunteers as well so 5 of us went. The meal is largely centered around meats. They have a large grill outside and cook massive amounts of sausage, pork and chicken. They served it with chakalaka, a dish called pap which is a stiff porridge made of maize and spinach cooked in a sauce. The chakalaka is cooked tomatoes, peppers and cabbage and can be quite spicy. It was all very good. I made chocolate chip cookies to bring as my American contribution. We had a chance for conversations outside of medicine. I heard some of their stories about coming to South Africa and the political unrest they experienced before leaving their home countries. We spoke about the fall of apartheid. Dr Mdaka was at the university during apartheid. He spoke about being involved in demonstrations. There were several banned political groups and the students formed new ones to replace them but much of it was done in secrecy. They got a copy of Roots and smuggled it in because it was banned. They had to watch it secretly and it had a profound effect on many students that motivated them to fight apartheid. It was quite a dangerous time for them. He was arrested once with a large group of student protesters. They were jailed for several days and eventually convicted en masse but then released since it wasn’t practical to keep them all locked up. In spite of the risks, his family was supportive. It was a risk to be in the movement to fight apartheid but it was also a risk for a university student in the Transkei not to join. After dinner they turned up the music and danced in the living room. It was a very nice evening. I was so pleased that they included all of us and how willing they all were to share themselves and their culture with me. It felt like a very successful day.
I have a new appreciation for the term African although I am not sure exactly what it meant to me before. The term is used on forms that ask for race but they use it in conversation as an identity of heritage and at the same time to identify where they live. The country of origin is also an identifier as is their native language. South Africa has been an attractive destination for refugees of other African countries affected by political and ethnic violence or by suppressive regimes, even before apartheid, but much more so since. After living here for years they will still refer to themselves as Ugandan or Nigerian etc. but also as African. I am having difficulty describing it but it’s very different than saying I am white. Black is used only as an adjective for skin coloring. There is a sense of identity in being African and there isn’t a similar term for me. Being American seems more like a political than even a geographic term. To me it is a statement of collective commitment to freedom and democracy rather than nationality. African is a description of origin and of culture at least as diverse as American but doesn’t seem associated with a philosophical identity. There is a definite pride in their tribal heritage and histories. They recognize their different backgrounds but the African concept brings them together.
Friday morning starts with the usual morning report but also is the time set aside for educational presentations. I gave an update on contraception today. They have a somewhat vigorous style of discussion following a presentation. For some reason it seems like the difference in style of debate that I have observed between US congress and British parliament…..perhaps not quite as loud as the British. In any case, I had not thought of this topic as being controversial but they found points to discuss. Some of them were things I had thought about but didn’t put into the presentation such as the lack of availability of some of the options because of economics. I didn’t see the abortion issue coming but it did. One of the doctors expressed his objection to offering contraception to teenagers because it would encourage them all to be promiscuous and get HIV. I obviously disagreed with him and was pleased to see that several others strongly voiced their disagreement as well. What I thought would be a 20 minute presentation took most of an hour with all the discussion. Everyone seemed pleased with the discussion. I was also thankful that the power didn’t go off until the time for discussion so I was able to use the power point with my video of the Essure procedure. We finished our ward rounds. I gave a photo to a couple of the patients who had requested one when I was taking pictures earlier this week.
I went home and packed and we set off for Coffee Bay. It is very quiet little town on the Indian Ocean. We are hoping for a nice sunny weekend.
27 October 2007
It has been a relaxing day on the coast. It is a very different environment from Mthatha although not that far away. Some of it is simply being away from the city.
Shortly after breakfast, Megan noticed a group of Africans on the beach having some sort of ceremony. There was a group of twenty or so. They had drums and did chanting and eventually some were taken into the ocean and appeared to be dunked reminiscent of a baptism. There were some chickens being held and a goat tied up nearby but I never saw them being harmed or really involved. So the event was interesting to watch but no one seemed to know what it was about.
Some of our group decided to rent ATVs to make a 15km trip to a site called hole in the wall. It’s really the only thing to ‘see’ here. It’s a massive rock formation just off the coast that has an area in the middle that literally came out leaving the ‘hole in the wall’. This wall creates a protected area of ocean that provides a fabulous place to swim and we took advantage of it. The rest of the coastline has much rougher seas and other nearby beaches aren’t as nice for swimming. The wild coast, as it is called, seems very aptly named. The ATVs had some technical problems but the man who owned them rode along and was very nice and knowledgeable and got everyone back safely after a variety of problems en route. I had no interest in riding an ATV but we were told we could hike out to the ocean after parking the ATVs so 3 of us followed in the car since there were only 3 ATVs available for hire. The weather was gorgeous as were the views. The ocean behind the wall was a different place and wonderful for swimming. The hike was unfortunately short so we spent much of the day in the car especially since the ATV problems really slowed the trip down. This is a tourist area and unfortunately the local children have developed the culture of asking the tourists for money. Some come right up to you when on foot or in the car and ask for money or “sweets”. They also may have necklaces made of shells they wish to sell. This has become a real problem in the area from the standpoint of numbers of children and also how aggressive they have become. Tourism is important to the economy and being constantly barraged made it so unpleasant that I preferred not to leave the hotel grounds. I had been warned by many people that this is a problem in this area. If you give them any money you will be swarmed by more children. It is a terrible situation and honestly the children do not appear to be starving. The children in Mthatha seem much worse off to me.
The rest of the day has been spent relaxing. Perhaps I’ll get to hike tomorrow, depending on the weather.
28 October 2007
We have returned to Mthatha. This morning Megan and I hiked up a large hill that looked over the ocean and surrounding area. It was a very easy hike but we had great views. She spotted a group of dolphins playing off the coast and we watched them for a while. The ocean was not as wild today and we enjoyed walking the beach as well. There are a lot of tide pools with interesting sea life, many seashells, and very interesting rock formations. Surfers appeared today and it looked like they were doing well. We returned to pack up and have lunch before leaving mid afternoon. The drive back was uneventful other than it seemed there were even more children along the side of the road begging. They knew where the potholes were bad so that we would slow down and they were very aggressive. This stopped once we got close to Mthatha.
This is our last week here. It does seem like a blur. I am starting to pack some things. On Tuesday we are going to try to organize a more detailed plan about what is needed to start doing laparoscopy. I still have reservations about that because of the unreliable electricity. The first step is to see what is here to work with and start planning. If we can get equipment we’ll start working on training. The laparoscopy equipment here is used primarily by the general surgeons and the suggestion has been made that there may be some difficulty in sharing equipment. I still would like to build on what they have if possible because it would make it so much simpler for the staff to be comfortable with the equipment
We are sending one orthopedic resident home on Tuesday and the next one arrives tomorrow. Harringtons and I leave at the end of the week. There is a constant turnover of volunteers. Some like Jesse will be here for a year. Megan will be here for 5 months. I know there will be many difficult things about leaving but the most difficult will be leaving Megan here. We have become very good friends in a short time. She is an amazing young woman and I have truly enjoyed living with her. It seems to have been a perfect match. She has friends here and the other volunteer, Jesse, lives just up the road so she will have company but I still feel badly leaving her here. I think she is down to her last 6 weeks before she returns to Manchester.
After we leave we go to Johannesburg and then on to Kruger National Park to see some of Africa’s wild animals known as the big five: lions, elephants, buffalo, rhino and leopards. We spend 5 days there and then after making the connections back to Johannesburg, we start the 2 day trip home.
The last 2 days have been very interesting. Yesterday I went to morning report as usual and then did ward rounds before going to the clinic. There was one colposcopy scheduled. I had understood that they had done colposcopy here in clinic previously but found they weren’t sure what to have set up for colposcopy. Once we had everything we needed, we got started. Although we had one patient scheduled, three showed up. No one knows how that happened but I was glad that we could do several since it would be the only chance we would have. Everything went very well. I was able to do all 3 colposcopies and show the residents and students quite a bit since the system they have has a video set up so they could all watch on the video screen. The colposcope has the video screen but not a direct view eyepiece so that took some adjustment on my part. Overall it was a great experience and it felt like the most effective thing I had done since I got here. Following that, I had lunch with Dr Mdaka and we discussed the colposcopies we had done and then how they might structure an ongoing colposcopy clinic. Then we discussed how to start doing laparoscopic surgery at NMAH. This would be such a benefit for the patients but also hopefully use significantly less hospital resources and open a severely clogged system allowing more patients to be treated.
Last week I had asked the interns about foods that were part of the local traditional diet and that I wanted to find a place that served these foods. They were going to think about where to send me but had concluded that there wasn’t anywhere that served good local cuisine so they were going to cook for me. They decided to have a braai which they described as an African barbecue. It was held at one of the intern’s homes and there must have been 30 people from the department there. They asked me to invite the other volunteers as well so 5 of us went. The meal is largely centered around meats. They have a large grill outside and cook massive amounts of sausage, pork and chicken. They served it with chakalaka, a dish called pap which is a stiff porridge made of maize and spinach cooked in a sauce. The chakalaka is cooked tomatoes, peppers and cabbage and can be quite spicy. It was all very good. I made chocolate chip cookies to bring as my American contribution. We had a chance for conversations outside of medicine. I heard some of their stories about coming to South Africa and the political unrest they experienced before leaving their home countries. We spoke about the fall of apartheid. Dr Mdaka was at the university during apartheid. He spoke about being involved in demonstrations. There were several banned political groups and the students formed new ones to replace them but much of it was done in secrecy. They got a copy of Roots and smuggled it in because it was banned. They had to watch it secretly and it had a profound effect on many students that motivated them to fight apartheid. It was quite a dangerous time for them. He was arrested once with a large group of student protesters. They were jailed for several days and eventually convicted en masse but then released since it wasn’t practical to keep them all locked up. In spite of the risks, his family was supportive. It was a risk to be in the movement to fight apartheid but it was also a risk for a university student in the Transkei not to join. After dinner they turned up the music and danced in the living room. It was a very nice evening. I was so pleased that they included all of us and how willing they all were to share themselves and their culture with me. It felt like a very successful day.
I have a new appreciation for the term African although I am not sure exactly what it meant to me before. The term is used on forms that ask for race but they use it in conversation as an identity of heritage and at the same time to identify where they live. The country of origin is also an identifier as is their native language. South Africa has been an attractive destination for refugees of other African countries affected by political and ethnic violence or by suppressive regimes, even before apartheid, but much more so since. After living here for years they will still refer to themselves as Ugandan or Nigerian etc. but also as African. I am having difficulty describing it but it’s very different than saying I am white. Black is used only as an adjective for skin coloring. There is a sense of identity in being African and there isn’t a similar term for me. Being American seems more like a political than even a geographic term. To me it is a statement of collective commitment to freedom and democracy rather than nationality. African is a description of origin and of culture at least as diverse as American but doesn’t seem associated with a philosophical identity. There is a definite pride in their tribal heritage and histories. They recognize their different backgrounds but the African concept brings them together.
Friday morning starts with the usual morning report but also is the time set aside for educational presentations. I gave an update on contraception today. They have a somewhat vigorous style of discussion following a presentation. For some reason it seems like the difference in style of debate that I have observed between US congress and British parliament…..perhaps not quite as loud as the British. In any case, I had not thought of this topic as being controversial but they found points to discuss. Some of them were things I had thought about but didn’t put into the presentation such as the lack of availability of some of the options because of economics. I didn’t see the abortion issue coming but it did. One of the doctors expressed his objection to offering contraception to teenagers because it would encourage them all to be promiscuous and get HIV. I obviously disagreed with him and was pleased to see that several others strongly voiced their disagreement as well. What I thought would be a 20 minute presentation took most of an hour with all the discussion. Everyone seemed pleased with the discussion. I was also thankful that the power didn’t go off until the time for discussion so I was able to use the power point with my video of the Essure procedure. We finished our ward rounds. I gave a photo to a couple of the patients who had requested one when I was taking pictures earlier this week.
I went home and packed and we set off for Coffee Bay. It is very quiet little town on the Indian Ocean. We are hoping for a nice sunny weekend.
27 October 2007
It has been a relaxing day on the coast. It is a very different environment from Mthatha although not that far away. Some of it is simply being away from the city.
Shortly after breakfast, Megan noticed a group of Africans on the beach having some sort of ceremony. There was a group of twenty or so. They had drums and did chanting and eventually some were taken into the ocean and appeared to be dunked reminiscent of a baptism. There were some chickens being held and a goat tied up nearby but I never saw them being harmed or really involved. So the event was interesting to watch but no one seemed to know what it was about.
Some of our group decided to rent ATVs to make a 15km trip to a site called hole in the wall. It’s really the only thing to ‘see’ here. It’s a massive rock formation just off the coast that has an area in the middle that literally came out leaving the ‘hole in the wall’. This wall creates a protected area of ocean that provides a fabulous place to swim and we took advantage of it. The rest of the coastline has much rougher seas and other nearby beaches aren’t as nice for swimming. The wild coast, as it is called, seems very aptly named. The ATVs had some technical problems but the man who owned them rode along and was very nice and knowledgeable and got everyone back safely after a variety of problems en route. I had no interest in riding an ATV but we were told we could hike out to the ocean after parking the ATVs so 3 of us followed in the car since there were only 3 ATVs available for hire. The weather was gorgeous as were the views. The ocean behind the wall was a different place and wonderful for swimming. The hike was unfortunately short so we spent much of the day in the car especially since the ATV problems really slowed the trip down. This is a tourist area and unfortunately the local children have developed the culture of asking the tourists for money. Some come right up to you when on foot or in the car and ask for money or “sweets”. They also may have necklaces made of shells they wish to sell. This has become a real problem in the area from the standpoint of numbers of children and also how aggressive they have become. Tourism is important to the economy and being constantly barraged made it so unpleasant that I preferred not to leave the hotel grounds. I had been warned by many people that this is a problem in this area. If you give them any money you will be swarmed by more children. It is a terrible situation and honestly the children do not appear to be starving. The children in Mthatha seem much worse off to me.
The rest of the day has been spent relaxing. Perhaps I’ll get to hike tomorrow, depending on the weather.
28 October 2007
We have returned to Mthatha. This morning Megan and I hiked up a large hill that looked over the ocean and surrounding area. It was a very easy hike but we had great views. She spotted a group of dolphins playing off the coast and we watched them for a while. The ocean was not as wild today and we enjoyed walking the beach as well. There are a lot of tide pools with interesting sea life, many seashells, and very interesting rock formations. Surfers appeared today and it looked like they were doing well. We returned to pack up and have lunch before leaving mid afternoon. The drive back was uneventful other than it seemed there were even more children along the side of the road begging. They knew where the potholes were bad so that we would slow down and they were very aggressive. This stopped once we got close to Mthatha.
This is our last week here. It does seem like a blur. I am starting to pack some things. On Tuesday we are going to try to organize a more detailed plan about what is needed to start doing laparoscopy. I still have reservations about that because of the unreliable electricity. The first step is to see what is here to work with and start planning. If we can get equipment we’ll start working on training. The laparoscopy equipment here is used primarily by the general surgeons and the suggestion has been made that there may be some difficulty in sharing equipment. I still would like to build on what they have if possible because it would make it so much simpler for the staff to be comfortable with the equipment
We are sending one orthopedic resident home on Tuesday and the next one arrives tomorrow. Harringtons and I leave at the end of the week. There is a constant turnover of volunteers. Some like Jesse will be here for a year. Megan will be here for 5 months. I know there will be many difficult things about leaving but the most difficult will be leaving Megan here. We have become very good friends in a short time. She is an amazing young woman and I have truly enjoyed living with her. It seems to have been a perfect match. She has friends here and the other volunteer, Jesse, lives just up the road so she will have company but I still feel badly leaving her here. I think she is down to her last 6 weeks before she returns to Manchester.
After we leave we go to Johannesburg and then on to Kruger National Park to see some of Africa’s wild animals known as the big five: lions, elephants, buffalo, rhino and leopards. We spend 5 days there and then after making the connections back to Johannesburg, we start the 2 day trip home.
Thursday, October 25, 2007
23 October 2007
This is another day that didn’t go according to plan. We knew the electricity was to be turned off for 1 hour. By 10 am the power went off as scheduled for maintenance. Unfortunately, it never came back on consistently. Over the next few hours it went on and off for 5-15 minutes at a time. They won’t start cases in those circumstances, so our day was done after just 3 of 9 cases. Hopefully a few more will get done this week. The others may wait in the hospital until next Tuesday.
I’ve had some interesting conversations with some of the other doctors, especially during these unscheduled down times. One of the doctors is from Congo. He described to me what he saw happen to his country’s government and economy. The prior corrupt Congolese government was supported by the US and other western countries by giving cash that was supposed to be used to for specified projects but often instead was used for the personal benefit of the government officials. Western governments chose to ignore this in order to keep the governments in these countries on their side in world politics. A few years ago the government decided that the Congolese and not foreigners, should own all businesses and resources. They simply gave ownership to the people who had worked in the area. He saw a lot of businesses fail because the new owners did not having any training or support. He was glad the western government involvement was largely gone because it seemed to do more harm than good. I asked about the new Chinese presence. He said the Chinese were after the same things, natural resources and political influence, but went at it more openly. The Chinese come in and tell the Congo government exactly what they are going to do, i.e. build a road or a bridge, and then do it. They bring in the majority of the workers from China rather than give the jobs to the local people. In exchange, they expect access to the natural resources. He was less uncomfortable with the way the Chinese operate because it appears open and he feels the outcome will be to add infrastructure rather than just build the wealth of a few people in government. He felt that this helped the Congo but with the acknowledged loss of their natural resources. I have read about this problem in several countries in Africa and his description was very similar to what I have read. The countries with the largest oil reserves and other resources have been developed and access committed, leaving the Chinese to look to the next tier when trying to gain access to the resources they need to supply their large and growing needs.
There are so many problems for which government seems to be totally ineffective in designing solutions. I don’t think that is different in Africa or the western countries but the types of problem and the scale are very different. The corrupt politicians and the bureaucratic barriers are everywhere but the consequences here seem so much greater than at home. Maybe it’s partly my location in one of the poorest areas that makes it seem so profound. I have met many wonderful people who are so poor they can’t see anything different for their future. Their priorities are to have enough to eat most days and keep some type of shelter for their families. What they seem willing to accept as having accomplished this is very hard for me to accept. Seeing the children going to school dressed in their nice uniforms coming out of some of the most awful housing and hearing the people express their commitment to their education, tells me that they see this as the way forward. Of course there are others who have given up and survive by stealing. Not all of the children succeed and finish school. As a whole, the problems I see here are not so unfamiliar to me as is the scale.
It’s easy for me to get focused on what problems I see here although most of my experience has been meeting wonderful people and being surrounded by beautiful mountain landscapes contrasted with almost desert like areas. I have a comfortable but very simple house to live in. It has been good to see how simply we can live and be quite content. We make do with what we have. Megan and I have had more fun trying to bake cookies as we laugh about how hard it is to mix by hand, chop our own chocolate (no chocolate chips here!), trying to get them baked and not burned in this challenging oven and appreciating them so much more because of it.
24 October 2007
Today started with our normal morning report. This was followed by teaching ward rounds. Dr Mdaka and I had lunch in the cafeteria. I was disappointed because they ran out of samp and beans. This is one of the local staples. It is a corn and bean dish. It is fairly bland. Another local favorite is fat cakes which they serve in the cafeteria several days a week. They look like a large roll or small loaf of bread but it is fried like a doughnut. I had been told they were fried in fish oil which surprised me since it sure doesn’t taste like fish oil. I have since learned that years ago the only oil available was cod liver oil and it was used for anything that was fried. Now that there are other options, it is rarely used but people still refer to oil for frying as fish oil although it is generally vegetable oil of some type. To me fat cakes are something like a large doughnut without the hole. They really are called fat cakes. The third food they tell me I should consider a local staple is a sour milk drink that they often serve for breakfast. I’m told they serve it to patients every morning here at the Bedford Hospital. I admit I haven’t sought out an opportunity to sample this one.
Dr Mdaka and I spoke about how fast this month is going and what we both thought about it. I think they could get a lot more out of the volunteers if they had an organized plan for what they wanted from us and spent a little more time getting us oriented. A specific role for us would make it much easier to feel like something was being accomplished. He seemed to feel that I did help more than I appreciated and asked if I would be willing to come back. I was totally surprised. He would really like to be able to do laparoscopy and I agree that would be a great step forward for them. If he is able to get the equipment, they should have help to start this up and it would be a great role for one of us. I wish that we could have done more with colposcopy while I was here too. We’re going to try again tomorrow. I already have my bottle of vinegar at the hospital so I am hopeful. If they can get colposcopy established and add LEEP they would be able to benefit a lot of women. Currently, any woman with dysplasia that requires treatment is admitted for a cone biopsy (usually without having had colposcopy). This admission is usually for several days in order to hold their bed so they can have the surgery and then many of them stay in the hospital while waiting for results. I’ve been seeing 8-10 day hospitalizations for a cone biopsy. It’s situations like this that could easily change and open up beds for those that are waiting for hospitalization and really need it.
We had another nice dinner at the McConnachies tonight. Caroline made a very rich chocolate cake for dessert that was a big hit.
This is another day that didn’t go according to plan. We knew the electricity was to be turned off for 1 hour. By 10 am the power went off as scheduled for maintenance. Unfortunately, it never came back on consistently. Over the next few hours it went on and off for 5-15 minutes at a time. They won’t start cases in those circumstances, so our day was done after just 3 of 9 cases. Hopefully a few more will get done this week. The others may wait in the hospital until next Tuesday.
I’ve had some interesting conversations with some of the other doctors, especially during these unscheduled down times. One of the doctors is from Congo. He described to me what he saw happen to his country’s government and economy. The prior corrupt Congolese government was supported by the US and other western countries by giving cash that was supposed to be used to for specified projects but often instead was used for the personal benefit of the government officials. Western governments chose to ignore this in order to keep the governments in these countries on their side in world politics. A few years ago the government decided that the Congolese and not foreigners, should own all businesses and resources. They simply gave ownership to the people who had worked in the area. He saw a lot of businesses fail because the new owners did not having any training or support. He was glad the western government involvement was largely gone because it seemed to do more harm than good. I asked about the new Chinese presence. He said the Chinese were after the same things, natural resources and political influence, but went at it more openly. The Chinese come in and tell the Congo government exactly what they are going to do, i.e. build a road or a bridge, and then do it. They bring in the majority of the workers from China rather than give the jobs to the local people. In exchange, they expect access to the natural resources. He was less uncomfortable with the way the Chinese operate because it appears open and he feels the outcome will be to add infrastructure rather than just build the wealth of a few people in government. He felt that this helped the Congo but with the acknowledged loss of their natural resources. I have read about this problem in several countries in Africa and his description was very similar to what I have read. The countries with the largest oil reserves and other resources have been developed and access committed, leaving the Chinese to look to the next tier when trying to gain access to the resources they need to supply their large and growing needs.
There are so many problems for which government seems to be totally ineffective in designing solutions. I don’t think that is different in Africa or the western countries but the types of problem and the scale are very different. The corrupt politicians and the bureaucratic barriers are everywhere but the consequences here seem so much greater than at home. Maybe it’s partly my location in one of the poorest areas that makes it seem so profound. I have met many wonderful people who are so poor they can’t see anything different for their future. Their priorities are to have enough to eat most days and keep some type of shelter for their families. What they seem willing to accept as having accomplished this is very hard for me to accept. Seeing the children going to school dressed in their nice uniforms coming out of some of the most awful housing and hearing the people express their commitment to their education, tells me that they see this as the way forward. Of course there are others who have given up and survive by stealing. Not all of the children succeed and finish school. As a whole, the problems I see here are not so unfamiliar to me as is the scale.
It’s easy for me to get focused on what problems I see here although most of my experience has been meeting wonderful people and being surrounded by beautiful mountain landscapes contrasted with almost desert like areas. I have a comfortable but very simple house to live in. It has been good to see how simply we can live and be quite content. We make do with what we have. Megan and I have had more fun trying to bake cookies as we laugh about how hard it is to mix by hand, chop our own chocolate (no chocolate chips here!), trying to get them baked and not burned in this challenging oven and appreciating them so much more because of it.
24 October 2007
Today started with our normal morning report. This was followed by teaching ward rounds. Dr Mdaka and I had lunch in the cafeteria. I was disappointed because they ran out of samp and beans. This is one of the local staples. It is a corn and bean dish. It is fairly bland. Another local favorite is fat cakes which they serve in the cafeteria several days a week. They look like a large roll or small loaf of bread but it is fried like a doughnut. I had been told they were fried in fish oil which surprised me since it sure doesn’t taste like fish oil. I have since learned that years ago the only oil available was cod liver oil and it was used for anything that was fried. Now that there are other options, it is rarely used but people still refer to oil for frying as fish oil although it is generally vegetable oil of some type. To me fat cakes are something like a large doughnut without the hole. They really are called fat cakes. The third food they tell me I should consider a local staple is a sour milk drink that they often serve for breakfast. I’m told they serve it to patients every morning here at the Bedford Hospital. I admit I haven’t sought out an opportunity to sample this one.
Dr Mdaka and I spoke about how fast this month is going and what we both thought about it. I think they could get a lot more out of the volunteers if they had an organized plan for what they wanted from us and spent a little more time getting us oriented. A specific role for us would make it much easier to feel like something was being accomplished. He seemed to feel that I did help more than I appreciated and asked if I would be willing to come back. I was totally surprised. He would really like to be able to do laparoscopy and I agree that would be a great step forward for them. If he is able to get the equipment, they should have help to start this up and it would be a great role for one of us. I wish that we could have done more with colposcopy while I was here too. We’re going to try again tomorrow. I already have my bottle of vinegar at the hospital so I am hopeful. If they can get colposcopy established and add LEEP they would be able to benefit a lot of women. Currently, any woman with dysplasia that requires treatment is admitted for a cone biopsy (usually without having had colposcopy). This admission is usually for several days in order to hold their bed so they can have the surgery and then many of them stay in the hospital while waiting for results. I’ve been seeing 8-10 day hospitalizations for a cone biopsy. It’s situations like this that could easily change and open up beds for those that are waiting for hospitalization and really need it.
We had another nice dinner at the McConnachies tonight. Caroline made a very rich chocolate cake for dessert that was a big hit.
Tuesday, October 23, 2007
19 October 2007
We are in Mbotyi on the Indian Ocean. Caroline has been so good to us by making the arrangements for places to visit that are located near some beautiful locations in SA which allows us to get away on weekends when the medical system in Mthatha seems to essentially shut down. As volunteer doctors we generally aren’t expected to provide after hours care so our weekends are free. The environment we work in is so different than what we normally experience at home. It is difficult to explain the stress of working in a place with an unfamiliar language and culture, where the patients are so disadvantaged, resources are limited and we try to work within locally accepted practices while providing the level of care we consider acceptable. Going away on the weekends offers the chance to take a break from this intensity. Visiting areas within reasonable driving distance has offered some additional and unexpected insights. I have seen some of what are called peripheral hospitals. I am amazed at the distance they transport patients in labor and even more at the terrible roads they must use. When people we meet find out why we are here, we often get thanks for coming and occasionally questions about why we went Mthatha rather than their small communities where they see a much greater need. It helps to just get out of medicine and be a tourist for a day or two each week and see what people’s lives are like. It’s amazing at how inexpensive it is to eat and travel in the Eastern Cape. It feels like such a bargain and yet we know that in part, it reflects the level of poverty in the area.
Mboyti River resort is an interesting place. It is remote in that it is rather difficult to get here because of the bad roads. The hotel functions like what I imagine was done in 5 star hotels in the 1920s….without the dress code. The service is fantastic but the facilities are old and simple. The staff seems so sincere about a making sure you are happy with your experience. Tomorrow we will be off to see some of the local sights. After last week’s adventure, I am agreeable to going on hikes with a group rather than by myself. It looks like a lovely day. The ocean is quite loud but will be great for sleeping.
Earlier today at the hospital, we started with Grand Rounds which was about Ophthalmic Problems in HIV patients. It was very interesting. We had our normal morning report and find that we have an ongoing and perhaps worsening problem with lack of linens preventing surgical cases from being done. The residents even tried to do surgery with sterile drapes wrapped around them because there aren’t any gowns at the moment. It is difficult for me to comprehend this. I did the teaching ward rounds again so Dr Buga could go to the CEO to solve this problem. The residents and I are really getting along well now. It’s a nice feeling but sad it took until now.
Before leaving this afternoon, we went to Itipini where Ed and Scott saw a few orthopedic patients. Caroline and I had a tour of Itipini. I am told Itipini means “on a dump” in Xhosa (the local language). It is a village literally built on a dump with the materials they found in the dump. You will see photos but I don’t think I can communicate what this place is like. The people here have no where else to go. They take what they find in the dump and make shelters, their homes. The houses (I have trouble using that word) are usually about 8x10ft and made of metal pieces. I can’t tell what holds them together but I’m sure it’s whatever fastening material they find. The metal is corrugated metal pieces left over from construction, barrels opened and flattened, old car parts (hoods, roofs etc). The roofs are often held on by rocks set on top. The floors are dirt. There isn’t running water or electricity except in the community center. They have a central water faucet where people can fill their water jugs to take home. There are paths between the houses that randomly sprang up as more houses were built. There are pieces of glass and other debris all over the paths that make me nervous for the children walking around but realistically it’s the least of their problems. Our connection at Itipini is Jenny McConnachie. She has worked here for years. Through her efforts, they have built a series of small building for schoolrooms and other community activities and a medical clinic where they provide basic primary care. The facilities are very basic. They have single faucet to provide clean water for the 2000+ people estimated to live there. The people are involved in helping to provide the services. I can’t say I understand how the people live here our how the community functions but I have never experienced this degree of poverty before. It was a profound, uncomfortable experience. The people were generally happy to see us. They usually like to have their picture taken if we will show it to them on the camera. Some of the kids ask to have their picture taken just to see it. We all noticed the lack of a single request for money by anybody there which is notably different from our experiences elsewhere in poor areas in South Africa. It was a sobering experience as we left Mhatha for the weekend.
20 October 2007
We had a great day here in Mboyti. There’s something relaxing about hearing the ocean all night and waking up to the sunrise coming over the ocean horizon. The meals here are served in their dining room and are included in the daily room rate. It would be impractical to have it any other way because of the remote location. After breakfast we went on a driving and walking tour with a local guide. He took us to 3 gorgeous waterfalls and a tea factory.
The waterfalls were truly beautiful. We enjoyed them all and have great pictures. The area is covered with tea plantations. We are told there are only 2 areas in South Africa that are suitable to grow tea. The tea factory is a locally owned cooperative. It was quite interesting to see how the tea is processed and packaged for shipping to tea manufacturers. We also happened to see some really interesting examples of daily living here. We saw people washing their clothes in the river and hanging them on fences and bushes to dry. Kids were swimming in the river just above the waterfalls. Boys were herding their goats and cattle with these shepherds on foot or horseback. Craig was our guide and doing local guided tours is only job. He would arrange any activity we wanted. He is looking forward to the start of high season and increased business. He was a great guide and took us places where it felt like we were seeing how people here really live as well as taking us to places I am sure we would not have found on our own. It was a very good morning. It is usually difficult to see what a place is really like beyond the tourist sites and hotel grounds. There isn’t much here beyond the beach and scenery but they are magnificent.
We returned for lunch and then I had planned to go to the beach. I didn’t last long. It was so windy that I couldn’t stand the sand blowing in my face. I took some photos and had to come back to the resort. Caroline had a horseback riding tour with a guide arranged by Craig. It was too windy for Scott to go fly fishing in the Mboyti River so they postponed that to try in the morning.
After dinner, the big even tonight is watching South Africa compete with England for the World Cup in Rugby. Hopefully tomorrow morning will be more comfortable to spend some time on the beach before we head back to Mthatha.
21 October 2007
By luck, I woke up just before sunrise and had an east facing room with a little balcony overlooking the beach. I took some sunrise pictures. I was glad to see my camera working well. Last night I had trouble because sand had blown into the camera during the short time I was on the beach yesterday afternoon. The tea dust in the factory may have also contributed. I had to really clean it out to get the lens to go in and out and the shutter to close as it should. I think it’s OK now. I doubt I will find a camera store in Mthatha that could do anything for me this week, so I am hopeful it continues to work well. I also have to try to find an extra battery this week since I lost one with the camera bag that was stolen.
It was still very windy so after only a brief walk to the beach (without a camera this time!) I stayed up at the resort for the morning until we checked out. Everyone was pretty happy after South Africa beat England for the Rugby World Cup last night; everyone that is except probably Megan. As a consolation, she will be happy that her Manchester football (soccer) team won. She was in Durban this weekend and returns Monday afternoon.
After lunch we headed home. We took a few minutes to drive through Port St Johns which is where the Mzimvubu River enters the Indian Ocean. The view of the beach was beautiful but there wasn’t much more to see so we headed back. After a beautiful weekend the rain started on the way back. We felt lucky for the timing. It has been pouring ever since. I’m just thankful we haven’t lost power yet.
22 October 2007
It rained hard all night and stopped early this morning. It was a sunny day but another storm moved in tonight, although not nearly as intense. The weather here seems to follow this pattern of being quite intense and moving through quickly. The rainy season is starting but at least it is starting to warm up. It is definitely spring here. The trees are starting to bloom now. The colors are different as well as the trees themselves but really beautiful.
I have noticed how many people are on the road walking….and hitchhiking. Walking is a very normal method of getting around, so unlike in the US. Some of this is probably economic but much of it is cultural. There are many cars here of course, but there are always people walking and not only in town. In fact the roads outside of the city seem busier with the walkers than in town.
Each morning as we drive into town, the road we take is teeming with students going to school. The schools all seem to require uniforms and the children look fabulous. It’s such a contrast to seeing them at any other time. I know there is some help for families who can’t afford the clothes and somehow all the kids get their uniforms.
There seems to be a very diverse pattern of dress for women. Women can wear very traditional styles and others wear very modern clothes. The traditional attire usually includes a headscarf and a dress with a coordinated apron. Some add a blanket wrapped around them. When we were in Lesotho, they said the blanket was a sign of respect to their king. When I asked about the use of the blanket here, they told me it doesn’t have a meaning. I guess what strikes me the most is the lack of uniformity and the acceptance of all the styles. Men have less diversity in their dress styles in Mthatha. They seem to wear western style clothing of pants and t-shirts. Professional men wear suit coats. There seems to be very few who wear anything I could call traditional.
There is a system of how one refers to other women and I am trying to learn the nuances. Nurses are called sisters. Nuns are also called sisters. If you are talking to someone of near to your own age, she is also sister. If you address a woman older than you, you may call her mama. This one seems to correlate to addressing someone as Ma’am. These terms have meaning and are used as a sign of respect. The men use less slang to refer to each other. I never hear the brother or bro terms. I do hear ‘hey man’ or ‘man’ occasionally when young men address each other. ‘Man’ is pronounced like mahn. I have heard that more on radio than in conversation on the street.
We had a typical clinic day. Our beds are more than full in preparation for our main surgery day tomorrow. I am doing more ultrasounds each week but it is very difficult with the equipment available. We are going to try to do the colposcopy clinic again this week. (I’ll be bringing my own bottle of vinegar!!!) It’s hard for me to believe that I am getting to the end of my time here. I know that if I were able to be here a few more weeks, I could accomplish much more. It takes this long to know the system enough to operate somewhat independently. Megan asked me last night if I would come back. I can’t answer that question now. I think I will feel differently about it in a few months. I told her I could only come if I could live with her again. It seems to have been a great match for both of us which I find odd considering our age difference.
We are in Mbotyi on the Indian Ocean. Caroline has been so good to us by making the arrangements for places to visit that are located near some beautiful locations in SA which allows us to get away on weekends when the medical system in Mthatha seems to essentially shut down. As volunteer doctors we generally aren’t expected to provide after hours care so our weekends are free. The environment we work in is so different than what we normally experience at home. It is difficult to explain the stress of working in a place with an unfamiliar language and culture, where the patients are so disadvantaged, resources are limited and we try to work within locally accepted practices while providing the level of care we consider acceptable. Going away on the weekends offers the chance to take a break from this intensity. Visiting areas within reasonable driving distance has offered some additional and unexpected insights. I have seen some of what are called peripheral hospitals. I am amazed at the distance they transport patients in labor and even more at the terrible roads they must use. When people we meet find out why we are here, we often get thanks for coming and occasionally questions about why we went Mthatha rather than their small communities where they see a much greater need. It helps to just get out of medicine and be a tourist for a day or two each week and see what people’s lives are like. It’s amazing at how inexpensive it is to eat and travel in the Eastern Cape. It feels like such a bargain and yet we know that in part, it reflects the level of poverty in the area.
Mboyti River resort is an interesting place. It is remote in that it is rather difficult to get here because of the bad roads. The hotel functions like what I imagine was done in 5 star hotels in the 1920s….without the dress code. The service is fantastic but the facilities are old and simple. The staff seems so sincere about a making sure you are happy with your experience. Tomorrow we will be off to see some of the local sights. After last week’s adventure, I am agreeable to going on hikes with a group rather than by myself. It looks like a lovely day. The ocean is quite loud but will be great for sleeping.
Earlier today at the hospital, we started with Grand Rounds which was about Ophthalmic Problems in HIV patients. It was very interesting. We had our normal morning report and find that we have an ongoing and perhaps worsening problem with lack of linens preventing surgical cases from being done. The residents even tried to do surgery with sterile drapes wrapped around them because there aren’t any gowns at the moment. It is difficult for me to comprehend this. I did the teaching ward rounds again so Dr Buga could go to the CEO to solve this problem. The residents and I are really getting along well now. It’s a nice feeling but sad it took until now.
Before leaving this afternoon, we went to Itipini where Ed and Scott saw a few orthopedic patients. Caroline and I had a tour of Itipini. I am told Itipini means “on a dump” in Xhosa (the local language). It is a village literally built on a dump with the materials they found in the dump. You will see photos but I don’t think I can communicate what this place is like. The people here have no where else to go. They take what they find in the dump and make shelters, their homes. The houses (I have trouble using that word) are usually about 8x10ft and made of metal pieces. I can’t tell what holds them together but I’m sure it’s whatever fastening material they find. The metal is corrugated metal pieces left over from construction, barrels opened and flattened, old car parts (hoods, roofs etc). The roofs are often held on by rocks set on top. The floors are dirt. There isn’t running water or electricity except in the community center. They have a central water faucet where people can fill their water jugs to take home. There are paths between the houses that randomly sprang up as more houses were built. There are pieces of glass and other debris all over the paths that make me nervous for the children walking around but realistically it’s the least of their problems. Our connection at Itipini is Jenny McConnachie. She has worked here for years. Through her efforts, they have built a series of small building for schoolrooms and other community activities and a medical clinic where they provide basic primary care. The facilities are very basic. They have single faucet to provide clean water for the 2000+ people estimated to live there. The people are involved in helping to provide the services. I can’t say I understand how the people live here our how the community functions but I have never experienced this degree of poverty before. It was a profound, uncomfortable experience. The people were generally happy to see us. They usually like to have their picture taken if we will show it to them on the camera. Some of the kids ask to have their picture taken just to see it. We all noticed the lack of a single request for money by anybody there which is notably different from our experiences elsewhere in poor areas in South Africa. It was a sobering experience as we left Mhatha for the weekend.
20 October 2007
We had a great day here in Mboyti. There’s something relaxing about hearing the ocean all night and waking up to the sunrise coming over the ocean horizon. The meals here are served in their dining room and are included in the daily room rate. It would be impractical to have it any other way because of the remote location. After breakfast we went on a driving and walking tour with a local guide. He took us to 3 gorgeous waterfalls and a tea factory.
The waterfalls were truly beautiful. We enjoyed them all and have great pictures. The area is covered with tea plantations. We are told there are only 2 areas in South Africa that are suitable to grow tea. The tea factory is a locally owned cooperative. It was quite interesting to see how the tea is processed and packaged for shipping to tea manufacturers. We also happened to see some really interesting examples of daily living here. We saw people washing their clothes in the river and hanging them on fences and bushes to dry. Kids were swimming in the river just above the waterfalls. Boys were herding their goats and cattle with these shepherds on foot or horseback. Craig was our guide and doing local guided tours is only job. He would arrange any activity we wanted. He is looking forward to the start of high season and increased business. He was a great guide and took us places where it felt like we were seeing how people here really live as well as taking us to places I am sure we would not have found on our own. It was a very good morning. It is usually difficult to see what a place is really like beyond the tourist sites and hotel grounds. There isn’t much here beyond the beach and scenery but they are magnificent.
We returned for lunch and then I had planned to go to the beach. I didn’t last long. It was so windy that I couldn’t stand the sand blowing in my face. I took some photos and had to come back to the resort. Caroline had a horseback riding tour with a guide arranged by Craig. It was too windy for Scott to go fly fishing in the Mboyti River so they postponed that to try in the morning.
After dinner, the big even tonight is watching South Africa compete with England for the World Cup in Rugby. Hopefully tomorrow morning will be more comfortable to spend some time on the beach before we head back to Mthatha.
21 October 2007
By luck, I woke up just before sunrise and had an east facing room with a little balcony overlooking the beach. I took some sunrise pictures. I was glad to see my camera working well. Last night I had trouble because sand had blown into the camera during the short time I was on the beach yesterday afternoon. The tea dust in the factory may have also contributed. I had to really clean it out to get the lens to go in and out and the shutter to close as it should. I think it’s OK now. I doubt I will find a camera store in Mthatha that could do anything for me this week, so I am hopeful it continues to work well. I also have to try to find an extra battery this week since I lost one with the camera bag that was stolen.
It was still very windy so after only a brief walk to the beach (without a camera this time!) I stayed up at the resort for the morning until we checked out. Everyone was pretty happy after South Africa beat England for the Rugby World Cup last night; everyone that is except probably Megan. As a consolation, she will be happy that her Manchester football (soccer) team won. She was in Durban this weekend and returns Monday afternoon.
After lunch we headed home. We took a few minutes to drive through Port St Johns which is where the Mzimvubu River enters the Indian Ocean. The view of the beach was beautiful but there wasn’t much more to see so we headed back. After a beautiful weekend the rain started on the way back. We felt lucky for the timing. It has been pouring ever since. I’m just thankful we haven’t lost power yet.
22 October 2007
It rained hard all night and stopped early this morning. It was a sunny day but another storm moved in tonight, although not nearly as intense. The weather here seems to follow this pattern of being quite intense and moving through quickly. The rainy season is starting but at least it is starting to warm up. It is definitely spring here. The trees are starting to bloom now. The colors are different as well as the trees themselves but really beautiful.
I have noticed how many people are on the road walking….and hitchhiking. Walking is a very normal method of getting around, so unlike in the US. Some of this is probably economic but much of it is cultural. There are many cars here of course, but there are always people walking and not only in town. In fact the roads outside of the city seem busier with the walkers than in town.
Each morning as we drive into town, the road we take is teeming with students going to school. The schools all seem to require uniforms and the children look fabulous. It’s such a contrast to seeing them at any other time. I know there is some help for families who can’t afford the clothes and somehow all the kids get their uniforms.
There seems to be a very diverse pattern of dress for women. Women can wear very traditional styles and others wear very modern clothes. The traditional attire usually includes a headscarf and a dress with a coordinated apron. Some add a blanket wrapped around them. When we were in Lesotho, they said the blanket was a sign of respect to their king. When I asked about the use of the blanket here, they told me it doesn’t have a meaning. I guess what strikes me the most is the lack of uniformity and the acceptance of all the styles. Men have less diversity in their dress styles in Mthatha. They seem to wear western style clothing of pants and t-shirts. Professional men wear suit coats. There seems to be very few who wear anything I could call traditional.
There is a system of how one refers to other women and I am trying to learn the nuances. Nurses are called sisters. Nuns are also called sisters. If you are talking to someone of near to your own age, she is also sister. If you address a woman older than you, you may call her mama. This one seems to correlate to addressing someone as Ma’am. These terms have meaning and are used as a sign of respect. The men use less slang to refer to each other. I never hear the brother or bro terms. I do hear ‘hey man’ or ‘man’ occasionally when young men address each other. ‘Man’ is pronounced like mahn. I have heard that more on radio than in conversation on the street.
We had a typical clinic day. Our beds are more than full in preparation for our main surgery day tomorrow. I am doing more ultrasounds each week but it is very difficult with the equipment available. We are going to try to do the colposcopy clinic again this week. (I’ll be bringing my own bottle of vinegar!!!) It’s hard for me to believe that I am getting to the end of my time here. I know that if I were able to be here a few more weeks, I could accomplish much more. It takes this long to know the system enough to operate somewhat independently. Megan asked me last night if I would come back. I can’t answer that question now. I think I will feel differently about it in a few months. I told her I could only come if I could live with her again. It seems to have been a great match for both of us which I find odd considering our age difference.
Friday, October 19, 2007
18 October 2007
The last 2 days I have had more highs and lows than usual. On Wednesday, I did more classroom teaching with students as well as ward rounds. It went very well and it seemed that I had a better connection with everyone. We had arranged for the first colposcopy clinic for today. There is a great need and I was pleased I was going to be able to help set it up. The pathology report came back on the young woman with HIV and ovarian tumors who died last week. Although I thought it was likely either lymphoma or dysgerminoma, it surprised us all with Burkitt’s lymphoma. It is one of the AIDS defining malignancies which also include cervical cancer and Kaposi’s sarcoma. Sadly, I am getting the education on HIV that I anticipated and more. I also am getting a chance to see more VVF than I thought.
The evening was spent at McConnachies with another great dinner. I met a friend of Jenny’s who is a nurse from Canada and is here to help at Itipini for 2 months. I also met 2 women from New Zealand who are here working in a children’s home for 2 years. I met Astrid who now lives here permanently and works as a physiotherapist at Bedford. She set up a club foot clinic and has made a tremendous impact for these kids.
Today it has been rainy and a little cold. The hospital day started with our normal morning report. After that, I found myself put in charge of ward rounds. Dr Mdaka is gone to a family funeral. Dr Buga was off trying to solve some of the bureaucracy challenges that seem to be preventing our ability to get surgery done. There continues to be a problem with linens and lack of a variety of supplies. I was trying to manage the ward rounds and also had to get to this new colposcopy clinic. I hoped that the patients would show up. That didn’t turn out to be the problem. They came but the nurses had sent the patients away because they didn’t have any vinegar. Now you may think you misread that but you didn’t. If they had only called me I would have gone out and bought the vinegar needed to do the colposcopy. This just seems to be how things get done or rather don’t get done. The patients were gone and there was nothing for me to do about it. We’ll try again next week and I’ll bring the vinegar!
I returned to ward rounds. I found the intern seeing a patient with twins and polyhydramnios. She told me that there was increased discharge suspicious for possible ruptured membranes. One of the lectures with the medical students yesterday was about ruptured membranes. I asked them how we were going to tell if she this was amniotic fluid and one of them actually knew. Unfortunately, the intern had clearly never learned this. I had to convince her that we needed to test and suggested we keep it simple starting with a simple nitrazine (pH) test. The students were quick to tell me that there was no litmus paper in the hospital. I finally convinced them that there had to be pH paper somewhere in the hospital and we did find it. I talked her through this although she asked me if I wouldn’t rather do it myself! It was such a simple thing but so rewarding to see her accomplish this. After that the students were off to their lecture and I continued on ward rounds with the 3 interns. Things were different with them today…I can’t explain it. We discussed the patients, they listened and respected my recommendations. It really seemed to go well. They have gone from being confused about my presence to a little resentful and suddenly accepting. I think it took being put in a setting where there weren’t any other interactions and they could see I was willing to help that changed our relationship. After we finished at Nelson Mandela Hospital (NMAH) we went to the adjoining Umthatha General Hospital(UGH). This is considered a secondary hospital and generally run by family practitioners. Any complicated cases get referred to NMAH. The NMAH staff has one ward there because there isn’t enough room at NMAH. Patients who have less active problems are held there. More about that in a minute. The residents were astounded that I wanted to accompany them to UGH. I think they were a little suspicious of my motives but I finally convinced them I was going out of genuine interest in seeing it. As it turned out I think I answered several questions and helped them significantly. After a while, we started talking on a personal level about where they were from and what life is like here. They were surprised that I was interested in trying local foods and eventually offered to take me to a local restaurant where I could try some authentic food. I’m interested to see if they actually do. One of them offered to show me around more of UGH and after a brief tour she went back to finish the work needed for the patients we discussed.
There is such a shortage of beds that when a patient gets seen in the clinic on Monday and is determined to need surgery, she is scheduled for the following week but immediately admitted to UGH. If she is ill, she might be admitted to NMAH where she will have closer observation. She then waits in the hospital until surgery so she won’t lose her place. If she needs any testing, she will have it done while she waits. If they don’t follow this procedure, there won’t be a bed available for her the next week when she is supposed to have surgery. It’s hard to understand this waste of medical resources when I see so many needs all over the hospital. There’s so much I don’t understand. I see problems that we know how to fix and I know that solution won’t be sustainable here. Frustration just doesn’t describe it.
I was able to go home early and decided to go with Jesse and Megan back into town. We had heard about an interesting fabric store and they were willing to go with me. It is downtown and we parked on the street and went into the store. They had some very interesting fabrics and we had a good time. Unfortunately, when we returned to the car, Jesse found someone had broken into the car. We all knew that there was a high crime rate here but until now we hadn’t experienced it personally. We try to be so careful. We all felt like we had to give in and accept the reality and were pretty sad about it. They took the radio and my camera case. Fortunately, I had the camera with me and that was the important thing. We aren’t quite sure how they did it since there is a car alarm and it wasn’t going off. It obviously could have been much worse. We were thankful to still have the car but it made us all a little sad. When we got back home, I started to cook dinner and the power went off. That didn’t help my attitude. It did eventually come back on so I cooked then and had a late dinner.
Tomorrow evening we are going to Mbotyi which is on the Indian Ocean coast. It should be an hour or two to drive. Look for Port St Johns on the map and it’s a little north from there but not likely on any of your maps. There is a nature reserve on a river as it goes into the ocean. I’m told it is a beautiful place and I am looking forward to some nice weather and a more relaxing environment for a couple of days.
The last 2 days I have had more highs and lows than usual. On Wednesday, I did more classroom teaching with students as well as ward rounds. It went very well and it seemed that I had a better connection with everyone. We had arranged for the first colposcopy clinic for today. There is a great need and I was pleased I was going to be able to help set it up. The pathology report came back on the young woman with HIV and ovarian tumors who died last week. Although I thought it was likely either lymphoma or dysgerminoma, it surprised us all with Burkitt’s lymphoma. It is one of the AIDS defining malignancies which also include cervical cancer and Kaposi’s sarcoma. Sadly, I am getting the education on HIV that I anticipated and more. I also am getting a chance to see more VVF than I thought.
The evening was spent at McConnachies with another great dinner. I met a friend of Jenny’s who is a nurse from Canada and is here to help at Itipini for 2 months. I also met 2 women from New Zealand who are here working in a children’s home for 2 years. I met Astrid who now lives here permanently and works as a physiotherapist at Bedford. She set up a club foot clinic and has made a tremendous impact for these kids.
Today it has been rainy and a little cold. The hospital day started with our normal morning report. After that, I found myself put in charge of ward rounds. Dr Mdaka is gone to a family funeral. Dr Buga was off trying to solve some of the bureaucracy challenges that seem to be preventing our ability to get surgery done. There continues to be a problem with linens and lack of a variety of supplies. I was trying to manage the ward rounds and also had to get to this new colposcopy clinic. I hoped that the patients would show up. That didn’t turn out to be the problem. They came but the nurses had sent the patients away because they didn’t have any vinegar. Now you may think you misread that but you didn’t. If they had only called me I would have gone out and bought the vinegar needed to do the colposcopy. This just seems to be how things get done or rather don’t get done. The patients were gone and there was nothing for me to do about it. We’ll try again next week and I’ll bring the vinegar!
I returned to ward rounds. I found the intern seeing a patient with twins and polyhydramnios. She told me that there was increased discharge suspicious for possible ruptured membranes. One of the lectures with the medical students yesterday was about ruptured membranes. I asked them how we were going to tell if she this was amniotic fluid and one of them actually knew. Unfortunately, the intern had clearly never learned this. I had to convince her that we needed to test and suggested we keep it simple starting with a simple nitrazine (pH) test. The students were quick to tell me that there was no litmus paper in the hospital. I finally convinced them that there had to be pH paper somewhere in the hospital and we did find it. I talked her through this although she asked me if I wouldn’t rather do it myself! It was such a simple thing but so rewarding to see her accomplish this. After that the students were off to their lecture and I continued on ward rounds with the 3 interns. Things were different with them today…I can’t explain it. We discussed the patients, they listened and respected my recommendations. It really seemed to go well. They have gone from being confused about my presence to a little resentful and suddenly accepting. I think it took being put in a setting where there weren’t any other interactions and they could see I was willing to help that changed our relationship. After we finished at Nelson Mandela Hospital (NMAH) we went to the adjoining Umthatha General Hospital(UGH). This is considered a secondary hospital and generally run by family practitioners. Any complicated cases get referred to NMAH. The NMAH staff has one ward there because there isn’t enough room at NMAH. Patients who have less active problems are held there. More about that in a minute. The residents were astounded that I wanted to accompany them to UGH. I think they were a little suspicious of my motives but I finally convinced them I was going out of genuine interest in seeing it. As it turned out I think I answered several questions and helped them significantly. After a while, we started talking on a personal level about where they were from and what life is like here. They were surprised that I was interested in trying local foods and eventually offered to take me to a local restaurant where I could try some authentic food. I’m interested to see if they actually do. One of them offered to show me around more of UGH and after a brief tour she went back to finish the work needed for the patients we discussed.
There is such a shortage of beds that when a patient gets seen in the clinic on Monday and is determined to need surgery, she is scheduled for the following week but immediately admitted to UGH. If she is ill, she might be admitted to NMAH where she will have closer observation. She then waits in the hospital until surgery so she won’t lose her place. If she needs any testing, she will have it done while she waits. If they don’t follow this procedure, there won’t be a bed available for her the next week when she is supposed to have surgery. It’s hard to understand this waste of medical resources when I see so many needs all over the hospital. There’s so much I don’t understand. I see problems that we know how to fix and I know that solution won’t be sustainable here. Frustration just doesn’t describe it.
I was able to go home early and decided to go with Jesse and Megan back into town. We had heard about an interesting fabric store and they were willing to go with me. It is downtown and we parked on the street and went into the store. They had some very interesting fabrics and we had a good time. Unfortunately, when we returned to the car, Jesse found someone had broken into the car. We all knew that there was a high crime rate here but until now we hadn’t experienced it personally. We try to be so careful. We all felt like we had to give in and accept the reality and were pretty sad about it. They took the radio and my camera case. Fortunately, I had the camera with me and that was the important thing. We aren’t quite sure how they did it since there is a car alarm and it wasn’t going off. It obviously could have been much worse. We were thankful to still have the car but it made us all a little sad. When we got back home, I started to cook dinner and the power went off. That didn’t help my attitude. It did eventually come back on so I cooked then and had a late dinner.
Tomorrow evening we are going to Mbotyi which is on the Indian Ocean coast. It should be an hour or two to drive. Look for Port St Johns on the map and it’s a little north from there but not likely on any of your maps. There is a nature reserve on a river as it goes into the ocean. I’m told it is a beautiful place and I am looking forward to some nice weather and a more relaxing environment for a couple of days.
Wednesday, October 17, 2007
16 October 2007
Our surgery day was shortened because one patient didn’t pass the anesthesia ‘fitness test’. They found she had mild heart failure and would need to be evaluated by a physician. I’ve learned that physician seems to be their equivalent of an internist. They don’t seem to understand when I refer to internal medicine. The patients are rarely seen by anyone except the surgical doctors. So my day ended a little earlier than usual.
I was back early enough to wash clothes and get them outside to dry while there were still a couple of hours of sunshine left. We went to dinner tonight at one of the nice restaurants here. There aren’t many and Caroline really wanted to go to this one while we’re here. It is in a nicer area of town in a large old home remodeled to be a restaurant. Because we live in the housing near the orthopedic hospital, we are also near some of the poorest areas. Admittedly there is mostly an assortment of degrees of poverty here, but there are a few nice areas like where the restaurant is located. My clothes were almost dry when we returned.
We spoke today about trying to get the gyn department to the point of being able to do laparoscopic surgeries. They have the equipment but the technical aspects of making this happen seem daunting. If I find that they actually have enough instruments to start, I am still hesitant because of the shortages of everything. The other side of this is that the benefit to these patients of being able to avoid a laparotomy is so great and it would really save health care costs. When a patient is scheduled for a tubal, she is admitted the night before and surgery is done through a standard laparotomy. She will be in the hospital for at least 2 days. The wound infection rate is significant. There are many reasons to make this transition but until the hospital infrastructure is improved and stabilized I don’t know if it can be safely done. It seems that the staff has given up in fighting for these changes because of how little it has helped in the past. The community is so poor that they have a huge problem with theft from the hospital as well as everywhere else. When we came to the hospital the first day they had a guarded security gate as we find almost every where. (The restaurant we went to tonight had an electronic gate controlling its entrances.) The hospital is different. There is no check on the way in, but on the way out they inspect your vehicle to be sure there isn’t hospital property inside.
We notice more things the longer we are here and each of us has different experiences that help explain what we see. Tonight we discussed how few people smoke here. I have also noticed that very few of the patients drink alcohol. In some of our poor populations the use of drugs, tobacco and alcohol are quite high. The students were discussing risk factors for pregnancy complications at one of their tutorials. When one of them suggested drug use, the others were a little critical stating that this is a rare problem. I asked them more about it and they find that very few people use drugs and cocaine is extremely rare here. Even alcohol is not common. I don’t know how much is the culture and how much is lack of access or even that they are so poor.
Our surgery day was shortened because one patient didn’t pass the anesthesia ‘fitness test’. They found she had mild heart failure and would need to be evaluated by a physician. I’ve learned that physician seems to be their equivalent of an internist. They don’t seem to understand when I refer to internal medicine. The patients are rarely seen by anyone except the surgical doctors. So my day ended a little earlier than usual.
I was back early enough to wash clothes and get them outside to dry while there were still a couple of hours of sunshine left. We went to dinner tonight at one of the nice restaurants here. There aren’t many and Caroline really wanted to go to this one while we’re here. It is in a nicer area of town in a large old home remodeled to be a restaurant. Because we live in the housing near the orthopedic hospital, we are also near some of the poorest areas. Admittedly there is mostly an assortment of degrees of poverty here, but there are a few nice areas like where the restaurant is located. My clothes were almost dry when we returned.
We spoke today about trying to get the gyn department to the point of being able to do laparoscopic surgeries. They have the equipment but the technical aspects of making this happen seem daunting. If I find that they actually have enough instruments to start, I am still hesitant because of the shortages of everything. The other side of this is that the benefit to these patients of being able to avoid a laparotomy is so great and it would really save health care costs. When a patient is scheduled for a tubal, she is admitted the night before and surgery is done through a standard laparotomy. She will be in the hospital for at least 2 days. The wound infection rate is significant. There are many reasons to make this transition but until the hospital infrastructure is improved and stabilized I don’t know if it can be safely done. It seems that the staff has given up in fighting for these changes because of how little it has helped in the past. The community is so poor that they have a huge problem with theft from the hospital as well as everywhere else. When we came to the hospital the first day they had a guarded security gate as we find almost every where. (The restaurant we went to tonight had an electronic gate controlling its entrances.) The hospital is different. There is no check on the way in, but on the way out they inspect your vehicle to be sure there isn’t hospital property inside.
We notice more things the longer we are here and each of us has different experiences that help explain what we see. Tonight we discussed how few people smoke here. I have also noticed that very few of the patients drink alcohol. In some of our poor populations the use of drugs, tobacco and alcohol are quite high. The students were discussing risk factors for pregnancy complications at one of their tutorials. When one of them suggested drug use, the others were a little critical stating that this is a rare problem. I asked them more about it and they find that very few people use drugs and cocaine is extremely rare here. Even alcohol is not common. I don’t know how much is the culture and how much is lack of access or even that they are so poor.
Tuesday, October 16, 2007
13 October 2007
It has been a busy couple of days. Tonight I am in the Sani Pass Hotel. We started our drive from Mthatha early in the afternoon Friday. The day couldn’t have been more beautiful. It was one of the nicest days I’ve seen here. It was sunny and the temperatures were up to the high 70s. We went through the outskirts of Mthatha and houses spaced out and the landscape became rural. When we left the Eastern Cape province we entered the province of KwaZulu-Natal. As you might expect, this is the home of the Zulus. The Zulu language is similar to the Xhosa spoken in much of the Eastern Cape, but with fewer clicks in it. There was a larger town of Kokstad to pass through as we turned off the large highway. As we stopped for gas, it looked rather familiar as a rest stop on the highway. Besides the gas station there was a fast food restaurant (Wimpy’s) and a gift shop but with a nicer selection than I would expect. As we drove closer to the Drakensberg Mountains, I noticed more European style buildings. There were many more signs of the European settlers who had settled here but mixed in with African culture as well. As we approached the towns of Underberg and Himeville just before reaching Drakensberg Park, it appeared that these are much wealthier communities. Entering the Drakensbergs, the roads became much rougher. We reached the hotel about dinner time and found the usual fenced site with guarded gates. After registering, we checked in to our rooms which are in a building with a thatched roof. The inside was a fairly typical hotel room. We each have a little patio that looks out over the grounds, which are beautiful. There is a pool but it is definitely still too cold for swimming. Meals are all included so we went to dinner at 7pm. It is basic but nice food. After dinner there was a group of about 20 young Africans that sang a cappella. Their repertoire included a variety of Christian and African music. They are a group that is trying to speak to young Africans about preventing HIV and decreasing violence which is also a major problem here. They asked for donations after their program. They ended their program with 2 traditional Zulu dances. It was very interesting and a delightful surprise.
Today started with a walk following one of the walking paths the hotel has laid out. This one goes to the waterfall nearest the hotel. It was beautiful and we could get very close. The view with the early morning light was spectacular. We returned to the hotel for breakfast. After breakfast we got into our 4 wheel drive vehicle with our guide to take us up the Drakensbergs to Sani Pass. This is the only way to enter the kingdom of Lesotho from the east. This mountain range was thought to be the highest in southern Africa until a few years ago when it was demoted to 2nd place. The vehicle has obviously been on many rough roads before. The driver, Martin, brought his father along and besides Caroline, Ed and I there was a young couple from Paris. Caroline and I were packed into the back seat. Finding 2 pillows to sit on in the back seat should tell you about the condition of the seat and the condition of the roads. I’m pretty sure the middle seat was not much better. Ed had a little more room for his legs there and shared the middle row with the French couple. The trip was well worth the ride. The road went from winding to hairpin turns with the surface getting rougher as we went. There were waterfalls, one after another. The views were spectacular. I was glad to be in a small 4 wheel drive vehicle with an experienced driver rather than one of the tour buses. I don’t think there are frequent accidents but those buses just look like they could tip over more easily.
Once we reached the South African border we went into what is called no man’s land where no one claims responsibility for maintaining the road, such as it is. It got steeper and rougher and more beautiful at every turn. At the top we went through Lesotho customs and then the guide took us a few km further to a small Lesotho village. The people support themselves with herding but have little else. They say farming has never been successful here. We were taken into one of the rondovals whose owner was there with goods to sell. As a signal to the guides, they put a white flag (a white plastic bag) on a pole outside the house if they have goods for sale. The guides had a short program describing the Lesotho people’s lifestyle and customs which was interesting. They made a big point of telling us that the woman depended on tourism for her income. She made the traditional hat from Lesotho and these hats are supposed to emulate a specific mountain. She also had a homemade beer that smelled very much of yeast. She had bread cooking in an iron pot in the coals in the middle of her rondoval. The glowing embers of the fire surrounded it. The fuel ‘bricks’ are made of dried cow dung, the only fuel they can afford. There was a solar panel outside the door which created enough electricity to power their radio. The people wear a blanket around them and this is said to be a sign of respect for their king. The guide said Lesotho is the 3rd poorest country in the world. South Africa pays several million a year for water coming out of Lesotho and this income allows the kingdom to provide free medical care and education for the entire population. They must pay only for transportation to the services. The children generally live at boarding schools since they are at distances too great to travel daily. The boys are brought into the hills by an adult male at around age 13 and taught what they need to know to survive. They come back to the village and undergo a public circumcision after which they are considered a man. They are give a stick made of ironwood and decorated with a pattern specific to their family. The stick is very important for their identity as an adult male in their family, is used as a weapon and is carried with them at all times. When asked about female circumcision, the guide said that it was done to some degree but it is done very quietly and often at night but not a publicly acknowledged ceremony as for the boys. He was clearly uncomfortable answering the question. The guide seemed to have a lot of scripted answers and I suspect some of what he told us is exaggerated or untrue but makes for a good story. The whole point being to get us to purchase goods or simply give her some money of which some percentage goes to the guide as well. We all bought some bread for R5, about 75cents and some of her other goods were also purchased.
Next we headed back to the border where there is a pub said to be he highest in the world. We had lunch and then headed back down the mountains. It began to rain but this cleared as we got back to lower elevations. They returned us to the hotel in one piece with fantastic photos. After dinner we looked at some of the pictures and now I will head to bed.
14 October 2007
It was another adventure in Africa today. Early this morning I woke up and spent some of the early morning hours bird watching. I will have to get a book on local birds so I can identify some of these by name.
After breakfast we each went to a separate activity. Caroline was able to sign up for a horseback riding tour of the area for a couple of hours. She said it went well considering an unfamiliar horse, tack and terrain. Ed went golfing. I went on a hike.
The hotel has 4 marked trails. We had been on the trail to the waterfall yesterday morning. In the afternoon I had gone on portions of the other 2 as well. Today I went on the ‘3 hour’ trail up the mountain to a plateau said to have incredible views both north and south. It isn’t an organized or guided event. The trails are marked with stones painted by color to guide you. As it happens, a South African family was starting out at the same time on the same trail. It didn’t take long for the grandparents to drop out. Then one of the children turned back. The mother and one boy, about 10 years old, continued with me. It was a very steep climb and was much longer than we were led to believe. They eventually turned back also. I had checked at the desk before leaving and having been told this was well marked and safe to do alone, I continued. I did reach the plateau and was rewarded with an incredible view. To the north I could see the road we took yesterday to the Sani Pass. The mountains were gorgeous and Hodgson’s Twin Peaks stood out making the Giant’s cup you can read about. Across the plateau to the south, the valley was as beautiful. I could see Himeville, one of the towns we would eventually drive through on our way back, as well as 2 lakes and a dam. All in all, well worth the steep climb.
I started across the plateau to the north to reach another trail which was to take me back to the hotel. Unfortunately, I never found it. I had the written description that told me the trail would be following a seasonal stream. I thought I could see the trail by a creek bed and headed for that. I found my way down but it wasn’t because there was a trail to follow. Because the road and the hotel were constantly in sight, I just worked my way down using them to guide me. It took a little longer than planned and I got pretty hot and tired. I managed to twist my ankle a little but had no other problems. Fortunately I have considerable experience in management of ankle sprain thanks to my children! I also had the luxury of having my own orthopedist waiting for me and have been certified as having a mild ankle sprain….nothing more. Once I got back I was able to get a quick shower and we headed out. When we reached Underberg, we stopped at a gallery and studio for which we had seen an interesting advertisement. It was wonderful. It is run by a couple that does photography and pottery and they have a few rooms where they show their own work as well as other local artists. Had I been more confident that I could safely transport this beautiful and fragile work home, I am sure I would have purchased more.
Then we stopped for lunch at a small restaurant and gift shop (of course) just down the road, at the recommendation of the gallery owner. It was called Ducks and Doolittles. It also had a petting zoo. Many of the small creatures roam freely and occasionally must be shooed out of the open dining room doors. It no longer surprises me to find no locally produced items in these gift shops. They have things from India, China and other Far East countries. This is a highly rated tourist and vacation area and they seemed to stock the traditional junk souvenirs.
Then we were back on the road to Mthatha again. This is the longest weekend trip we will take. The weeks are filled with the hospital work but these places do truly shut down except for emergencies at noon on Friday. Generally, only the resident staff and students go in on weekends. There is little to do in Mthatha so this gives us the opportunity to do some weekend sight seeing. We will go to the Indian Ocean next weekend.
It’s sad to see the landscape change as we entered the Eastern Cape province again. It’s not the terrain; it’s the housing in terrible condition and the garbage strewn along the roadside. The farm animals are allowed to roam and create traffic hazards. It is known as one of the places to avoid because it is so poor and unattractive. The gallery owner commented on this, saying she was sorry we had to have our experience based out of Mthatha although she recognized the needs there. We discussed why it would come to be that a community would allow their roadways to be so littered with garbage and so many buildings to deteriorate. She described it as a combination of poverty as well as a poverty of spirit. That seems to describe it to well to me. I often get the feeling of despair of hope for anything to improve in their lives or their community.
We had a brief discussion of how difficult it is for any of us to do the volunteer work needed in our own communities. When a Canadian couple started a project for the poor and HIV affected children in her relatively well off community, she and her husband began to volunteer there also. It seemed to her that it took the perspective of coming from somewhere else to recognize the need to act and be willing to do it. The culture and politics are so complex here. I think I will only have a limited understanding from this month. I have had conversations about politics with many of the doctors from other African countries. I find their perspectives interesting and educational. I believe I need to hear the stories from many perspectives because if I think about how our politics and government would be described by a single individual how inaccurate that might be. It would be different from a Democrat, Republican or Libertarian viewpoint or from a rural or inner city or suburban viewpoint and so on. So, many stories probably make a more complete picture. I keep listening and learning.
15 October 2007
Monday morning and we’re back to work. We reviewed the 22 C-sections done in the last 3 days. One patient returned this weekend after being sent out on ‘home leave’. She had been admitted earlier last week after PROM but when she didn’t labor and there was no sign of infection, she was sent home to wait as there were no elective surgeries being done for lack of linen. She had a healthy baby.
They are noticing a new group of problems in their HIV patients; at least it seems this is the link between them. They are developing hemolysis and thrombocytopenia and renal failure. Only the one I described last week died. The others are on dialysis. It seems to be a manifestation of HIV. They are putting together a case list to study.
Today was our firm’s clinic day. The patients start coming at 0700 but we don’t start until after 10. It is a long day for patients and staff and no one stops for lunch. The patients can go to a small canteen where they can buy snacks or they can buy fresh fruit and bread from women who walk through the clinic and hospital waiting areas with a box of this food balanced on their head. When someone wishes to buy, they quite easily set the box down, squat beside it and complete the sale. She seems to lift the box back onto her head with little effort. The clinic fills up quickly in the morning and then slowly dwindles as the afternoon progresses. I was able to do more in clinic today as they assigned one of the nurses to interpret for me. The first one seemed rather annoyed with this task. The second was delightful. I thought she was so helpful but around 3 or4 she told me all the patients had been seen. After that I saw about 6 more people with Dr Mdaka. It appears that she was ready to be done for the day and so she just told me we were done! She was still pleasant to work with and I will simply need to ask about the people still in the waiting room and not take the answer at face value.
Tomorrow is our main surgery day. The schedule is always full and the hospital beds will get filled tomorrow.
It has been a busy couple of days. Tonight I am in the Sani Pass Hotel. We started our drive from Mthatha early in the afternoon Friday. The day couldn’t have been more beautiful. It was one of the nicest days I’ve seen here. It was sunny and the temperatures were up to the high 70s. We went through the outskirts of Mthatha and houses spaced out and the landscape became rural. When we left the Eastern Cape province we entered the province of KwaZulu-Natal. As you might expect, this is the home of the Zulus. The Zulu language is similar to the Xhosa spoken in much of the Eastern Cape, but with fewer clicks in it. There was a larger town of Kokstad to pass through as we turned off the large highway. As we stopped for gas, it looked rather familiar as a rest stop on the highway. Besides the gas station there was a fast food restaurant (Wimpy’s) and a gift shop but with a nicer selection than I would expect. As we drove closer to the Drakensberg Mountains, I noticed more European style buildings. There were many more signs of the European settlers who had settled here but mixed in with African culture as well. As we approached the towns of Underberg and Himeville just before reaching Drakensberg Park, it appeared that these are much wealthier communities. Entering the Drakensbergs, the roads became much rougher. We reached the hotel about dinner time and found the usual fenced site with guarded gates. After registering, we checked in to our rooms which are in a building with a thatched roof. The inside was a fairly typical hotel room. We each have a little patio that looks out over the grounds, which are beautiful. There is a pool but it is definitely still too cold for swimming. Meals are all included so we went to dinner at 7pm. It is basic but nice food. After dinner there was a group of about 20 young Africans that sang a cappella. Their repertoire included a variety of Christian and African music. They are a group that is trying to speak to young Africans about preventing HIV and decreasing violence which is also a major problem here. They asked for donations after their program. They ended their program with 2 traditional Zulu dances. It was very interesting and a delightful surprise.
Today started with a walk following one of the walking paths the hotel has laid out. This one goes to the waterfall nearest the hotel. It was beautiful and we could get very close. The view with the early morning light was spectacular. We returned to the hotel for breakfast. After breakfast we got into our 4 wheel drive vehicle with our guide to take us up the Drakensbergs to Sani Pass. This is the only way to enter the kingdom of Lesotho from the east. This mountain range was thought to be the highest in southern Africa until a few years ago when it was demoted to 2nd place. The vehicle has obviously been on many rough roads before. The driver, Martin, brought his father along and besides Caroline, Ed and I there was a young couple from Paris. Caroline and I were packed into the back seat. Finding 2 pillows to sit on in the back seat should tell you about the condition of the seat and the condition of the roads. I’m pretty sure the middle seat was not much better. Ed had a little more room for his legs there and shared the middle row with the French couple. The trip was well worth the ride. The road went from winding to hairpin turns with the surface getting rougher as we went. There were waterfalls, one after another. The views were spectacular. I was glad to be in a small 4 wheel drive vehicle with an experienced driver rather than one of the tour buses. I don’t think there are frequent accidents but those buses just look like they could tip over more easily.
Once we reached the South African border we went into what is called no man’s land where no one claims responsibility for maintaining the road, such as it is. It got steeper and rougher and more beautiful at every turn. At the top we went through Lesotho customs and then the guide took us a few km further to a small Lesotho village. The people support themselves with herding but have little else. They say farming has never been successful here. We were taken into one of the rondovals whose owner was there with goods to sell. As a signal to the guides, they put a white flag (a white plastic bag) on a pole outside the house if they have goods for sale. The guides had a short program describing the Lesotho people’s lifestyle and customs which was interesting. They made a big point of telling us that the woman depended on tourism for her income. She made the traditional hat from Lesotho and these hats are supposed to emulate a specific mountain. She also had a homemade beer that smelled very much of yeast. She had bread cooking in an iron pot in the coals in the middle of her rondoval. The glowing embers of the fire surrounded it. The fuel ‘bricks’ are made of dried cow dung, the only fuel they can afford. There was a solar panel outside the door which created enough electricity to power their radio. The people wear a blanket around them and this is said to be a sign of respect for their king. The guide said Lesotho is the 3rd poorest country in the world. South Africa pays several million a year for water coming out of Lesotho and this income allows the kingdom to provide free medical care and education for the entire population. They must pay only for transportation to the services. The children generally live at boarding schools since they are at distances too great to travel daily. The boys are brought into the hills by an adult male at around age 13 and taught what they need to know to survive. They come back to the village and undergo a public circumcision after which they are considered a man. They are give a stick made of ironwood and decorated with a pattern specific to their family. The stick is very important for their identity as an adult male in their family, is used as a weapon and is carried with them at all times. When asked about female circumcision, the guide said that it was done to some degree but it is done very quietly and often at night but not a publicly acknowledged ceremony as for the boys. He was clearly uncomfortable answering the question. The guide seemed to have a lot of scripted answers and I suspect some of what he told us is exaggerated or untrue but makes for a good story. The whole point being to get us to purchase goods or simply give her some money of which some percentage goes to the guide as well. We all bought some bread for R5, about 75cents and some of her other goods were also purchased.
Next we headed back to the border where there is a pub said to be he highest in the world. We had lunch and then headed back down the mountains. It began to rain but this cleared as we got back to lower elevations. They returned us to the hotel in one piece with fantastic photos. After dinner we looked at some of the pictures and now I will head to bed.
14 October 2007
It was another adventure in Africa today. Early this morning I woke up and spent some of the early morning hours bird watching. I will have to get a book on local birds so I can identify some of these by name.
After breakfast we each went to a separate activity. Caroline was able to sign up for a horseback riding tour of the area for a couple of hours. She said it went well considering an unfamiliar horse, tack and terrain. Ed went golfing. I went on a hike.
The hotel has 4 marked trails. We had been on the trail to the waterfall yesterday morning. In the afternoon I had gone on portions of the other 2 as well. Today I went on the ‘3 hour’ trail up the mountain to a plateau said to have incredible views both north and south. It isn’t an organized or guided event. The trails are marked with stones painted by color to guide you. As it happens, a South African family was starting out at the same time on the same trail. It didn’t take long for the grandparents to drop out. Then one of the children turned back. The mother and one boy, about 10 years old, continued with me. It was a very steep climb and was much longer than we were led to believe. They eventually turned back also. I had checked at the desk before leaving and having been told this was well marked and safe to do alone, I continued. I did reach the plateau and was rewarded with an incredible view. To the north I could see the road we took yesterday to the Sani Pass. The mountains were gorgeous and Hodgson’s Twin Peaks stood out making the Giant’s cup you can read about. Across the plateau to the south, the valley was as beautiful. I could see Himeville, one of the towns we would eventually drive through on our way back, as well as 2 lakes and a dam. All in all, well worth the steep climb.
I started across the plateau to the north to reach another trail which was to take me back to the hotel. Unfortunately, I never found it. I had the written description that told me the trail would be following a seasonal stream. I thought I could see the trail by a creek bed and headed for that. I found my way down but it wasn’t because there was a trail to follow. Because the road and the hotel were constantly in sight, I just worked my way down using them to guide me. It took a little longer than planned and I got pretty hot and tired. I managed to twist my ankle a little but had no other problems. Fortunately I have considerable experience in management of ankle sprain thanks to my children! I also had the luxury of having my own orthopedist waiting for me and have been certified as having a mild ankle sprain….nothing more. Once I got back I was able to get a quick shower and we headed out. When we reached Underberg, we stopped at a gallery and studio for which we had seen an interesting advertisement. It was wonderful. It is run by a couple that does photography and pottery and they have a few rooms where they show their own work as well as other local artists. Had I been more confident that I could safely transport this beautiful and fragile work home, I am sure I would have purchased more.
Then we stopped for lunch at a small restaurant and gift shop (of course) just down the road, at the recommendation of the gallery owner. It was called Ducks and Doolittles. It also had a petting zoo. Many of the small creatures roam freely and occasionally must be shooed out of the open dining room doors. It no longer surprises me to find no locally produced items in these gift shops. They have things from India, China and other Far East countries. This is a highly rated tourist and vacation area and they seemed to stock the traditional junk souvenirs.
Then we were back on the road to Mthatha again. This is the longest weekend trip we will take. The weeks are filled with the hospital work but these places do truly shut down except for emergencies at noon on Friday. Generally, only the resident staff and students go in on weekends. There is little to do in Mthatha so this gives us the opportunity to do some weekend sight seeing. We will go to the Indian Ocean next weekend.
It’s sad to see the landscape change as we entered the Eastern Cape province again. It’s not the terrain; it’s the housing in terrible condition and the garbage strewn along the roadside. The farm animals are allowed to roam and create traffic hazards. It is known as one of the places to avoid because it is so poor and unattractive. The gallery owner commented on this, saying she was sorry we had to have our experience based out of Mthatha although she recognized the needs there. We discussed why it would come to be that a community would allow their roadways to be so littered with garbage and so many buildings to deteriorate. She described it as a combination of poverty as well as a poverty of spirit. That seems to describe it to well to me. I often get the feeling of despair of hope for anything to improve in their lives or their community.
We had a brief discussion of how difficult it is for any of us to do the volunteer work needed in our own communities. When a Canadian couple started a project for the poor and HIV affected children in her relatively well off community, she and her husband began to volunteer there also. It seemed to her that it took the perspective of coming from somewhere else to recognize the need to act and be willing to do it. The culture and politics are so complex here. I think I will only have a limited understanding from this month. I have had conversations about politics with many of the doctors from other African countries. I find their perspectives interesting and educational. I believe I need to hear the stories from many perspectives because if I think about how our politics and government would be described by a single individual how inaccurate that might be. It would be different from a Democrat, Republican or Libertarian viewpoint or from a rural or inner city or suburban viewpoint and so on. So, many stories probably make a more complete picture. I keep listening and learning.
15 October 2007
Monday morning and we’re back to work. We reviewed the 22 C-sections done in the last 3 days. One patient returned this weekend after being sent out on ‘home leave’. She had been admitted earlier last week after PROM but when she didn’t labor and there was no sign of infection, she was sent home to wait as there were no elective surgeries being done for lack of linen. She had a healthy baby.
They are noticing a new group of problems in their HIV patients; at least it seems this is the link between them. They are developing hemolysis and thrombocytopenia and renal failure. Only the one I described last week died. The others are on dialysis. It seems to be a manifestation of HIV. They are putting together a case list to study.
Today was our firm’s clinic day. The patients start coming at 0700 but we don’t start until after 10. It is a long day for patients and staff and no one stops for lunch. The patients can go to a small canteen where they can buy snacks or they can buy fresh fruit and bread from women who walk through the clinic and hospital waiting areas with a box of this food balanced on their head. When someone wishes to buy, they quite easily set the box down, squat beside it and complete the sale. She seems to lift the box back onto her head with little effort. The clinic fills up quickly in the morning and then slowly dwindles as the afternoon progresses. I was able to do more in clinic today as they assigned one of the nurses to interpret for me. The first one seemed rather annoyed with this task. The second was delightful. I thought she was so helpful but around 3 or4 she told me all the patients had been seen. After that I saw about 6 more people with Dr Mdaka. It appears that she was ready to be done for the day and so she just told me we were done! She was still pleasant to work with and I will simply need to ask about the people still in the waiting room and not take the answer at face value.
Tomorrow is our main surgery day. The schedule is always full and the hospital beds will get filled tomorrow.
Friday, October 12, 2007
11 October 2007
No VVF surgery today as the doctor who does it is still gone. It appears that he has trouble with his papers and had to go to Johannesburg to get them in order. They are very stringent with allowing foreign workers here as they are trying to make sure that the jobs in any field go to foreigners only when there isn’t a qualified South African available.
Well, no matter about the surgery since the theatre was open only to emergencies because we had no linens. All the drapes and gowns and essentially everything are made of fabrics that are reused and so require washing. There as been some problem with the laundry and we ran out of linens yesterday. They keep disposables on hand for emergencies but truly hold them for that. I have to say lack of linens wasn’t something that I had thought of for reasons that might limit surgery. So our new list of requirements to do surgery (in addition to qualified surgeons and anesthetists and nurses) includes electricity, water, linens and anesthetics. I can picture myself laughing in the future when I have a case delayed for a short time for some minor reason. The linen appeared after 10am and the theatre reopened.
The young women we operated Tuesday did not have a good outcome. She had mild anemia and low platelet count before surgery and things went badly after that. She turned out to have HIV and although this likely has nothing to do with the ovarian tumors it probably caused all her other problems. Her muscle swellings are probably HIV myositis although they could be lymphoma which is much more common in HIV pts. HIV patients can also have these low RBC and platelet counts from a variety of reasons. They have a particular problem with a TTP like syndrome which causes destruction of the blood cells and that’s what happened to her I think. It’s possible this will all be related to lymphoma but it seems less likely. She died this afternoon. She was the oldest still living in the family and was acting as head of the household of all her siblings as their parents had died. Her 23 yr old brother will now take that role. It’s a sad situation but one that is way too common here with HIV.
Today after work, Megan and I were feeling a little down as we both had a difficult day. We managed to find enough ingredients to make oatmeal cookies. It’s rather fun to find a way to make recipes work in way less than ideal conditions. It was fun to do and nice to see that it lifted her spirits. Now we had a birthday gift for Caroline! It was a good way to end the day. And we didn’t even lose power until after the cookies were done and then only for a short time.
Tomorrow, I will go with Ed and Caroline to Sani pass. It is in the mountains on the border with Lesotho. (I can hear those atlases coming off the shelves unless you are of the age to go for mapquest!) It will be quite a drive but it should be beautiful. I hope we have some lovely weather although I know it will be cold in the mountains.
No VVF surgery today as the doctor who does it is still gone. It appears that he has trouble with his papers and had to go to Johannesburg to get them in order. They are very stringent with allowing foreign workers here as they are trying to make sure that the jobs in any field go to foreigners only when there isn’t a qualified South African available.
Well, no matter about the surgery since the theatre was open only to emergencies because we had no linens. All the drapes and gowns and essentially everything are made of fabrics that are reused and so require washing. There as been some problem with the laundry and we ran out of linens yesterday. They keep disposables on hand for emergencies but truly hold them for that. I have to say lack of linens wasn’t something that I had thought of for reasons that might limit surgery. So our new list of requirements to do surgery (in addition to qualified surgeons and anesthetists and nurses) includes electricity, water, linens and anesthetics. I can picture myself laughing in the future when I have a case delayed for a short time for some minor reason. The linen appeared after 10am and the theatre reopened.
The young women we operated Tuesday did not have a good outcome. She had mild anemia and low platelet count before surgery and things went badly after that. She turned out to have HIV and although this likely has nothing to do with the ovarian tumors it probably caused all her other problems. Her muscle swellings are probably HIV myositis although they could be lymphoma which is much more common in HIV pts. HIV patients can also have these low RBC and platelet counts from a variety of reasons. They have a particular problem with a TTP like syndrome which causes destruction of the blood cells and that’s what happened to her I think. It’s possible this will all be related to lymphoma but it seems less likely. She died this afternoon. She was the oldest still living in the family and was acting as head of the household of all her siblings as their parents had died. Her 23 yr old brother will now take that role. It’s a sad situation but one that is way too common here with HIV.
Today after work, Megan and I were feeling a little down as we both had a difficult day. We managed to find enough ingredients to make oatmeal cookies. It’s rather fun to find a way to make recipes work in way less than ideal conditions. It was fun to do and nice to see that it lifted her spirits. Now we had a birthday gift for Caroline! It was a good way to end the day. And we didn’t even lose power until after the cookies were done and then only for a short time.
Tomorrow, I will go with Ed and Caroline to Sani pass. It is in the mountains on the border with Lesotho. (I can hear those atlases coming off the shelves unless you are of the age to go for mapquest!) It will be quite a drive but it should be beautiful. I hope we have some lovely weather although I know it will be cold in the mountains.
Thursday, October 11, 2007
10 October 2007
My day did not go quite as planned which is something I think I should start planning on. We did get power for a short while this morning which was very convenient while getting ready and making breakfast. Unfortunately it went off again just before I got home. So I am back to battery power computer and heat by hot water bottle.
I didn’t get to the VVF (vesicovaginal fistula) today because that doctor was unexpectedly gone. Maybe tomorrow….
Tonight we are off to McConnachies and tonight the dinner will be even more welcome because of the hot meal and warm house.
My day did not go quite as planned which is something I think I should start planning on. We did get power for a short while this morning which was very convenient while getting ready and making breakfast. Unfortunately it went off again just before I got home. So I am back to battery power computer and heat by hot water bottle.
I didn’t get to the VVF (vesicovaginal fistula) today because that doctor was unexpectedly gone. Maybe tomorrow….
Tonight we are off to McConnachies and tonight the dinner will be even more welcome because of the hot meal and warm house.
Wednesday, October 10, 2007
9 October 2007
Another interesting day in Mthatha. We could do without rain for a while though. It has been so cold that I have had the Reynaud’s start up. I am looking forward to some more summer like weather but I suppose then I will complain about the heat without air conditioning. The high today was about 20Celsius which is mid 60’sF but with the cold rain it felt much colder and we have only a space heater in this house.
Today was to be my first full surgery day. I was glad I had been told to bring my own masks, etc. They often run out of those. They wear scrubs with the next layer a plastic apron then a sterile cloth gown and double gloves. There are very few disposables. Drapes are cloth; suction is a metal suction tip. The residents do most of the simple hysterectomies…on their own. The attending scrubs in as needed and does the complicated cases. Today we did the patient with the painful abdominal mass. It was bilateral solid ovarian tumors. My guess is dysgerminoma. Frozen sections are not available here. We don’t know what the painful muscle masses are. We will go back to try to drain them under US guidance but it seems unlikely they are related to the ovarian masses. We found another on her left upper arm. If that wasn’t interesting enough the power went out during the case. I didn’t know it was possible to do surgery by the light of 3 cell phones! Within a few minutes, the generator did kick in. The main power to the hospital came on later in the day. All the other elective cases were canceled and I came home early for the first time. It was interesting how each part of the crew had a different problem to deal with and knew what to do. For example, anesthesia also had to go ‘manual’ and bag the patient and go without any monitors.
I am struck by the contrast of the limited resources within the hospital and the large new hospital itself. It looks to me like a hospital that would have no need of volunteer physicians or donated materials, but both are truly appreciated. I certainly would be of more help if I could speak the language. Later this week I will start to work with the colposcope in the clinic.
The afternoon was still cold and rainy and tonight, just as I was fixing supper, the power went out here. It is still off. I am thankful for the lovely battery I have on this computer. Megan and I are going to watch a movie while sitting under blankets with our hot water bottles from the last of the hot water. We would make popcorn if we had power or popcorn!!
Tomorrow I start learning vesicovaginal fistula repair, assuming we keep the power on.
Another interesting day in Mthatha. We could do without rain for a while though. It has been so cold that I have had the Reynaud’s start up. I am looking forward to some more summer like weather but I suppose then I will complain about the heat without air conditioning. The high today was about 20Celsius which is mid 60’sF but with the cold rain it felt much colder and we have only a space heater in this house.
Today was to be my first full surgery day. I was glad I had been told to bring my own masks, etc. They often run out of those. They wear scrubs with the next layer a plastic apron then a sterile cloth gown and double gloves. There are very few disposables. Drapes are cloth; suction is a metal suction tip. The residents do most of the simple hysterectomies…on their own. The attending scrubs in as needed and does the complicated cases. Today we did the patient with the painful abdominal mass. It was bilateral solid ovarian tumors. My guess is dysgerminoma. Frozen sections are not available here. We don’t know what the painful muscle masses are. We will go back to try to drain them under US guidance but it seems unlikely they are related to the ovarian masses. We found another on her left upper arm. If that wasn’t interesting enough the power went out during the case. I didn’t know it was possible to do surgery by the light of 3 cell phones! Within a few minutes, the generator did kick in. The main power to the hospital came on later in the day. All the other elective cases were canceled and I came home early for the first time. It was interesting how each part of the crew had a different problem to deal with and knew what to do. For example, anesthesia also had to go ‘manual’ and bag the patient and go without any monitors.
I am struck by the contrast of the limited resources within the hospital and the large new hospital itself. It looks to me like a hospital that would have no need of volunteer physicians or donated materials, but both are truly appreciated. I certainly would be of more help if I could speak the language. Later this week I will start to work with the colposcope in the clinic.
The afternoon was still cold and rainy and tonight, just as I was fixing supper, the power went out here. It is still off. I am thankful for the lovely battery I have on this computer. Megan and I are going to watch a movie while sitting under blankets with our hot water bottles from the last of the hot water. We would make popcorn if we had power or popcorn!!
Tomorrow I start learning vesicovaginal fistula repair, assuming we keep the power on.
Tuesday, October 9, 2007
5 October 2007
Friday is generally a short day in all the hospitals. After we finished for the day, I had lunch with Dr Mdaka who is the head of Firm A. The OBGYN service is divided into 3 teams they call firms. The cases are assigned somewhat evenly between the firms. Our main clinic day is Monday which is a very busy day from my one day of experience. Our main operating day is Tuesday. The other days are a mixture of teaching in a variety of formats and patient care. Dr Mdaka is a very patient and dedicated man. He grew up about 80km from here and moved back here after his training to be near family. He seems to enjoy the challenging cases and the teaching. He answered a lot of questions about the South African medical care system and society in general. After medical school, the students have 2 years of general internship followed by a year of public service which usually means working in a remote underserved area to repay some of the subsidized medical education. These are often referred to as peripheral areas or clinics. A few stay in a city to do this. They get paid a small amount and are still supervised. I think there must be an exam and then they are considered “qualified” which sounds like licensed. Then they can go into practice and seem to be called general practitioners, a term which the students tell me is used interchangeably with family practitioner here. Alternatively they can apply to become specialists. They are called medical officers during what we would call residency. After the specialty training they are called consultants. I am a visiting consultant. The department heads are referred to as Prof (not professor) and this is a highly regarded title. As I learn more, I may have clarifications to this. It is hard for them to explain since I want to compare it to familiar terms and they don’t know exactly what those terms mean.
There are still many social changes occurring here. He explained how the “old government” seemed to divide the people into whites, coloreds, Indians and Africans. This was also the order of their status in society although there was a bigger gap between white and colored than between each of the other groups. Colored were those that didn’t fit clearly into one of the others, usually a mixed background of some combination. There was significant Indian immigration years ago, especially to the East Cape area, which is where we are. Now some of the South Africans are not happy with the amount of immigration from some of the poorer countries in Africa. When I mentioned our Somalian immigrants he told me that many here don’t like the Somalians and they have been the target of some violence. Apparently there is resentment from the competition for jobs, even the low paying positions and that the Somalians and other African immigrants work for less and don’t join unions. They are supposed to get visas but many don’t. (Heard any of this somewhere before?) This problem is somewhat ignored because many of those now in power in the government, lived in these countries while they fought the old apartheid government. They feel an allegiance to those that helped them in those difficult times. I hope to hear more about this. The medical students here are mostly from this area and a smaller percentage is from these immigrant groups. Many of them have come from disadvantaged backgrounds and have overcome a lot to get this far.
I took over a “tutorial” today while he attended to a problem elsewhere in the hospital. The subject was postpartum hemorrhage. They were better prepared than I expected and made the same mistakes we would at that stage. Their enthusiasm is noticeable….especially for students in their last 3 months of school. They graduate in December and become interns in January. They find out where they will go in about 2 weeks.
I think they have just started doing some colposcopy. When he found out I do colposcopy, he wants me to get the colposcope out and help teach them how to use it since it has been many years since any of the consultants were trained. Apparently they just got a colposcope. It seems like they would have it going full time with the amount of abnormal PAPs they see. They just don’t have the time and staff to do all that needs to be done.
The housing we live in has been built by donations. The furnishings are a mixture of donated items and things that volunteers leave behind for the next volunteer. We found an old notebook computer in one of the cupboards. It is a Dell Inspiron 3800 and I suspect it is from 1999. They thought it didn’t work but after I charged it up and fiddled with it a little, it is working fine…..with limitations. One of the other volunteers would like to use it simply to write word documents and transfer them to the internet or other computers via a jump drive. It has Windows 98 and didn’t recognize her jump drive (it does have a USB port!). On the internet, I found the company (Kingston) that made her jump drive and downloaded the corresponding driver onto a disc at the internet café. Unfortunately, after I installed it into the computer it still doesn’t recognize the jump drive. I tried copying a small word document onto a CD so she could transfer it that way but still no luck. It said the CD was unavailable. I will get a new CD to try and check the internet again to make sure I found the right driver. If any of you techies out there have another idea, I’d like to be able to have this computer running for her before I am done here. Until then of course, she can use this one, but I’d like to leave her with some computer access since she is here until December.
Tonight, when we got back we saw a large insect that looks like a grasshopper sitting on our fence and Megan called it a locust. It was dark out so difficult to see well. I actually was able to photograph this creature. I will try to add some photos to the blog after this weekend.
Scooby sends his greetings!
6 October 2007
Today we went to the Nelson Mandela Museum. It is in a building next to the downtown area. The first floor has a large room with photographs and information and some historical artifacts. There are 2 large wings with many of the gifts that he has received over the years from countries and cities all over the world. The 2nd floor is not finished. The whole area around it is planned out to eventually be part of a large park.
Following that we walked through the downtown. There are many small shops with mostly the same thing from one to the next. There will be some clothing but mostly household goods and some appliances. The sidewalks in front of the stores are lined with small vendors. They have scarves, clothing, food etc. There are quite a few who have hair extensions for sale and will have several chairs going where women are having them put in and/or having their hair braided. There are some little tents set up for men to have haircuts but those are not done out in the open. Scattered around are tables, usually covered with an umbrella, and a phone or two available to make calls.
We went to back to where we had parked at ‘the mall’. This is new in the last year and there are signs that another mall is coming in another part of town. It is a series of stores linked together with uncovered walkways between them. There are a couple of grocery stores and one that is like a variety/department/hardware store. There are several clothing and shoe stores. The town is growing. I am told it is people from rural areas coming to look for work. There are housing areas sprouting up all over. These houses consist of a small brick/cement building with a few windows. They do not have water or electricity. They each have an outhouse. Some have a large round tank next to the house to collect rainwater. There are a variety of sizes but all are degrees of small. Some have fencing around them. Animals (cattle, goats and dogs) roam or occasionally are fenced. The roadsides are filled with garbage. People are usually walking along the roadside and some are waiting for the unofficial taxis which are usually small white vans. Many people also hitchhike in town, standing on the edge of the road with a sign showing where they want to go. The area is surrounded by rolling hills and from a distance the landscape is quite beautiful.
The mornings are filled with the sounds of very loud birds. They are so loud that it can be hard to sleep through it. The rain seems to come out of nowhere and after a downpour is gone for awhile. I washed clothes in the washer at the rondoval (one of the other volunteer houses) this morning but I have not been able to hang them out to dry because of the rain. They are slowly drying in a variety of locations around the house. Although the metal roofs are practical, they make any amount of rain sound like much more than it is. It is really loud but we are dry so it is not a problem.
7 October 2007
Sunday is a quiet day. Everything shuts down. The Harringtons took me on a tour of the Bedford Hospital. It is a pretty stark contrast to our hospitals and even to the hospital where I work in town. There was a group of people who came to see some of the patients. Their clothes suggested they were part of a church group. The closest comparison I would make is like a group of nuns and priests. They visited patients but then also stopped around the bed of a few that perhaps were from their village or church. They sang in prayer over them and with them in beautiful harmony and with incredible emotion.
In the afternoon, Megan and Jesse and I went on a walk in the hills outside our compound. There is a herd of cattle up there but I don’t know the breed yet. I am told they are a specific type that has particular value in this area. Scooby followed us which was nice until he decided to bark at one of the cows he thought was coming too close. Since he didn’t appear qualified to defend us against this rather large cow, which had impressive horns, I asked him not to do that. We slowly made a wider circle around the cow as it seemed to be considering the amount of trouble it would be to deal with us. It was an uneventful trip back after that. We started out under clear skies and in a matter of half an hour, the clouds came in and we only just made it back before the rain. This is a pattern that seems quite common.
Later this afternoon, 2 new volunteers arrived. Scott is a 4th year resident in orthopedics and Emily is his wife who is an OB nurse at UCSF. They will be here for a month. All the volunteers had dinner together tonight. Megan and I even figured out how to make a small cake out of the ingredients we had. It was quite interesting to do. I had a few recipes on my computer. All the measuring options we have are in metric so we made the conversions, substituted ingredients with what we had and ended up with a cake that was like a pound cake. We had some fresh local oranges and put sections on top. Then we covered it all with custard that we flavored with juice squeezed from the oranges. It was good enough that there was none left, but not exactly what I thought it was going to be when we started! She has a cookbook that she found with African recipes and we are going to try some of those that are simple. One of them is Xhosa pot bread. Xhosa are the people of this area. I have learned a few Xhosa words but it is a difficult language especially because of the clicks in it particularly when combined with another sound. I will be lucky to figure out 10 words before I leave.
8 October 2007
Today has been cold and it has been raining on and off all day. There are a variety of animals around here that seem to have a home but they truly roam at will and go ‘home’ when they feel like it. Cattle and goats and dogs are common but now there is a mare and young filly around. Outside our house tonight, I could hear the mare sounding rather upset. When she persisted, we looked out and I saw her run down the lane with Scooby chasing her half heartedly. She continued to call from the end of the lane and as I was considering going out into the rain to look for the filly, she came tearing down the lane to mama. I think she had taken off earlier and the mare had been looking for her. Mother and child are reunited and I didn’t have to get wet.
Today is clinic day for Firm A. I started out with a woman who is 67 and likely has Stage III ovarian cancer. She had been clinically diagnosed at the end of July and was finally able to get into the surgery schedule this week. Then I saw a primary infertility. There are several secondary infertility patients each day who have hydrosalpinx/tubal obstructions from prior infections. They have no other options available than an attempt at tubal reconstruction so they come here for that. Next was a primary amenorrhea in an 18 year old with very short stature. She had a cough and my differential had to include malnutrition, TB as well chromosomal and some of the other things we might not normally consider. Can’t say those are on my top ten list at home. The last case of the day was a young woman who has a large pelvic mass that we first thought might be an ovarian torsion of a large cyst. It didn’t have the typical US characteristics of torsion and when the intern took us to examine her and we found that her left thigh was significantly enlarged with a 10cm mass anteriorly in the muscle and another just superior to the patellar tendon measuring 4cm. All 3 masses were exquisitely tender. There were no peritoneal signs. She is pale (labs pending) and dehydrated. They will get labs back tonight and anticipate taking her “to theatre” (go to the OR) in the morning. This is a disclaimer for the faint of heart not to read the next part. They had a case of conjoined twins over the weekend with one delivered vaginally and the other requiring a C-section after unfortunately converting to a back down transverse lie. The babies had died long before she came in labor. I’m leaving out the more graphic details.
I am told that October is a quieter month on OB and September is usually the worst. Many men work in Johannesburg and come home in December resulting in an unusually high birth rate the following September. Last month they did 17 C-sections in one day. It is typically 5-7/day this month.
Tomorrow is our day in theatre. Thankfully, I have the scrubs I brought as well as the shoe covers and masks suggested by Dr Barr since I understand they often run out of those. We have a full schedule. We are going to start doing colposcopy later in the week. I have seen the scope but haven’t had the chance to check it out yet.
Friday is generally a short day in all the hospitals. After we finished for the day, I had lunch with Dr Mdaka who is the head of Firm A. The OBGYN service is divided into 3 teams they call firms. The cases are assigned somewhat evenly between the firms. Our main clinic day is Monday which is a very busy day from my one day of experience. Our main operating day is Tuesday. The other days are a mixture of teaching in a variety of formats and patient care. Dr Mdaka is a very patient and dedicated man. He grew up about 80km from here and moved back here after his training to be near family. He seems to enjoy the challenging cases and the teaching. He answered a lot of questions about the South African medical care system and society in general. After medical school, the students have 2 years of general internship followed by a year of public service which usually means working in a remote underserved area to repay some of the subsidized medical education. These are often referred to as peripheral areas or clinics. A few stay in a city to do this. They get paid a small amount and are still supervised. I think there must be an exam and then they are considered “qualified” which sounds like licensed. Then they can go into practice and seem to be called general practitioners, a term which the students tell me is used interchangeably with family practitioner here. Alternatively they can apply to become specialists. They are called medical officers during what we would call residency. After the specialty training they are called consultants. I am a visiting consultant. The department heads are referred to as Prof (not professor) and this is a highly regarded title. As I learn more, I may have clarifications to this. It is hard for them to explain since I want to compare it to familiar terms and they don’t know exactly what those terms mean.
There are still many social changes occurring here. He explained how the “old government” seemed to divide the people into whites, coloreds, Indians and Africans. This was also the order of their status in society although there was a bigger gap between white and colored than between each of the other groups. Colored were those that didn’t fit clearly into one of the others, usually a mixed background of some combination. There was significant Indian immigration years ago, especially to the East Cape area, which is where we are. Now some of the South Africans are not happy with the amount of immigration from some of the poorer countries in Africa. When I mentioned our Somalian immigrants he told me that many here don’t like the Somalians and they have been the target of some violence. Apparently there is resentment from the competition for jobs, even the low paying positions and that the Somalians and other African immigrants work for less and don’t join unions. They are supposed to get visas but many don’t. (Heard any of this somewhere before?) This problem is somewhat ignored because many of those now in power in the government, lived in these countries while they fought the old apartheid government. They feel an allegiance to those that helped them in those difficult times. I hope to hear more about this. The medical students here are mostly from this area and a smaller percentage is from these immigrant groups. Many of them have come from disadvantaged backgrounds and have overcome a lot to get this far.
I took over a “tutorial” today while he attended to a problem elsewhere in the hospital. The subject was postpartum hemorrhage. They were better prepared than I expected and made the same mistakes we would at that stage. Their enthusiasm is noticeable….especially for students in their last 3 months of school. They graduate in December and become interns in January. They find out where they will go in about 2 weeks.
I think they have just started doing some colposcopy. When he found out I do colposcopy, he wants me to get the colposcope out and help teach them how to use it since it has been many years since any of the consultants were trained. Apparently they just got a colposcope. It seems like they would have it going full time with the amount of abnormal PAPs they see. They just don’t have the time and staff to do all that needs to be done.
The housing we live in has been built by donations. The furnishings are a mixture of donated items and things that volunteers leave behind for the next volunteer. We found an old notebook computer in one of the cupboards. It is a Dell Inspiron 3800 and I suspect it is from 1999. They thought it didn’t work but after I charged it up and fiddled with it a little, it is working fine…..with limitations. One of the other volunteers would like to use it simply to write word documents and transfer them to the internet or other computers via a jump drive. It has Windows 98 and didn’t recognize her jump drive (it does have a USB port!). On the internet, I found the company (Kingston) that made her jump drive and downloaded the corresponding driver onto a disc at the internet café. Unfortunately, after I installed it into the computer it still doesn’t recognize the jump drive. I tried copying a small word document onto a CD so she could transfer it that way but still no luck. It said the CD was unavailable. I will get a new CD to try and check the internet again to make sure I found the right driver. If any of you techies out there have another idea, I’d like to be able to have this computer running for her before I am done here. Until then of course, she can use this one, but I’d like to leave her with some computer access since she is here until December.
Tonight, when we got back we saw a large insect that looks like a grasshopper sitting on our fence and Megan called it a locust. It was dark out so difficult to see well. I actually was able to photograph this creature. I will try to add some photos to the blog after this weekend.
Scooby sends his greetings!
6 October 2007
Today we went to the Nelson Mandela Museum. It is in a building next to the downtown area. The first floor has a large room with photographs and information and some historical artifacts. There are 2 large wings with many of the gifts that he has received over the years from countries and cities all over the world. The 2nd floor is not finished. The whole area around it is planned out to eventually be part of a large park.
Following that we walked through the downtown. There are many small shops with mostly the same thing from one to the next. There will be some clothing but mostly household goods and some appliances. The sidewalks in front of the stores are lined with small vendors. They have scarves, clothing, food etc. There are quite a few who have hair extensions for sale and will have several chairs going where women are having them put in and/or having their hair braided. There are some little tents set up for men to have haircuts but those are not done out in the open. Scattered around are tables, usually covered with an umbrella, and a phone or two available to make calls.
We went to back to where we had parked at ‘the mall’. This is new in the last year and there are signs that another mall is coming in another part of town. It is a series of stores linked together with uncovered walkways between them. There are a couple of grocery stores and one that is like a variety/department/hardware store. There are several clothing and shoe stores. The town is growing. I am told it is people from rural areas coming to look for work. There are housing areas sprouting up all over. These houses consist of a small brick/cement building with a few windows. They do not have water or electricity. They each have an outhouse. Some have a large round tank next to the house to collect rainwater. There are a variety of sizes but all are degrees of small. Some have fencing around them. Animals (cattle, goats and dogs) roam or occasionally are fenced. The roadsides are filled with garbage. People are usually walking along the roadside and some are waiting for the unofficial taxis which are usually small white vans. Many people also hitchhike in town, standing on the edge of the road with a sign showing where they want to go. The area is surrounded by rolling hills and from a distance the landscape is quite beautiful.
The mornings are filled with the sounds of very loud birds. They are so loud that it can be hard to sleep through it. The rain seems to come out of nowhere and after a downpour is gone for awhile. I washed clothes in the washer at the rondoval (one of the other volunteer houses) this morning but I have not been able to hang them out to dry because of the rain. They are slowly drying in a variety of locations around the house. Although the metal roofs are practical, they make any amount of rain sound like much more than it is. It is really loud but we are dry so it is not a problem.
7 October 2007
Sunday is a quiet day. Everything shuts down. The Harringtons took me on a tour of the Bedford Hospital. It is a pretty stark contrast to our hospitals and even to the hospital where I work in town. There was a group of people who came to see some of the patients. Their clothes suggested they were part of a church group. The closest comparison I would make is like a group of nuns and priests. They visited patients but then also stopped around the bed of a few that perhaps were from their village or church. They sang in prayer over them and with them in beautiful harmony and with incredible emotion.
In the afternoon, Megan and Jesse and I went on a walk in the hills outside our compound. There is a herd of cattle up there but I don’t know the breed yet. I am told they are a specific type that has particular value in this area. Scooby followed us which was nice until he decided to bark at one of the cows he thought was coming too close. Since he didn’t appear qualified to defend us against this rather large cow, which had impressive horns, I asked him not to do that. We slowly made a wider circle around the cow as it seemed to be considering the amount of trouble it would be to deal with us. It was an uneventful trip back after that. We started out under clear skies and in a matter of half an hour, the clouds came in and we only just made it back before the rain. This is a pattern that seems quite common.
Later this afternoon, 2 new volunteers arrived. Scott is a 4th year resident in orthopedics and Emily is his wife who is an OB nurse at UCSF. They will be here for a month. All the volunteers had dinner together tonight. Megan and I even figured out how to make a small cake out of the ingredients we had. It was quite interesting to do. I had a few recipes on my computer. All the measuring options we have are in metric so we made the conversions, substituted ingredients with what we had and ended up with a cake that was like a pound cake. We had some fresh local oranges and put sections on top. Then we covered it all with custard that we flavored with juice squeezed from the oranges. It was good enough that there was none left, but not exactly what I thought it was going to be when we started! She has a cookbook that she found with African recipes and we are going to try some of those that are simple. One of them is Xhosa pot bread. Xhosa are the people of this area. I have learned a few Xhosa words but it is a difficult language especially because of the clicks in it particularly when combined with another sound. I will be lucky to figure out 10 words before I leave.
8 October 2007
Today has been cold and it has been raining on and off all day. There are a variety of animals around here that seem to have a home but they truly roam at will and go ‘home’ when they feel like it. Cattle and goats and dogs are common but now there is a mare and young filly around. Outside our house tonight, I could hear the mare sounding rather upset. When she persisted, we looked out and I saw her run down the lane with Scooby chasing her half heartedly. She continued to call from the end of the lane and as I was considering going out into the rain to look for the filly, she came tearing down the lane to mama. I think she had taken off earlier and the mare had been looking for her. Mother and child are reunited and I didn’t have to get wet.
Today is clinic day for Firm A. I started out with a woman who is 67 and likely has Stage III ovarian cancer. She had been clinically diagnosed at the end of July and was finally able to get into the surgery schedule this week. Then I saw a primary infertility. There are several secondary infertility patients each day who have hydrosalpinx/tubal obstructions from prior infections. They have no other options available than an attempt at tubal reconstruction so they come here for that. Next was a primary amenorrhea in an 18 year old with very short stature. She had a cough and my differential had to include malnutrition, TB as well chromosomal and some of the other things we might not normally consider. Can’t say those are on my top ten list at home. The last case of the day was a young woman who has a large pelvic mass that we first thought might be an ovarian torsion of a large cyst. It didn’t have the typical US characteristics of torsion and when the intern took us to examine her and we found that her left thigh was significantly enlarged with a 10cm mass anteriorly in the muscle and another just superior to the patellar tendon measuring 4cm. All 3 masses were exquisitely tender. There were no peritoneal signs. She is pale (labs pending) and dehydrated. They will get labs back tonight and anticipate taking her “to theatre” (go to the OR) in the morning. This is a disclaimer for the faint of heart not to read the next part. They had a case of conjoined twins over the weekend with one delivered vaginally and the other requiring a C-section after unfortunately converting to a back down transverse lie. The babies had died long before she came in labor. I’m leaving out the more graphic details.
I am told that October is a quieter month on OB and September is usually the worst. Many men work in Johannesburg and come home in December resulting in an unusually high birth rate the following September. Last month they did 17 C-sections in one day. It is typically 5-7/day this month.
Tomorrow is our day in theatre. Thankfully, I have the scrubs I brought as well as the shoe covers and masks suggested by Dr Barr since I understand they often run out of those. We have a full schedule. We are going to start doing colposcopy later in the week. I have seen the scope but haven’t had the chance to check it out yet.
Friday, October 5, 2007
4 October 2007
Dinner last night was very nice and relaxed. The McConnachies have lived here fulltime for about 12 years. He was an orthopedic surgeon in No Carolina before that. After trying to balance going back and forth for stints of volunteer work they felt they needed to make a choice and just do one thing. He works at the Bedford Orthopedic Hospital. She is a nurse and runs the community center I mentioned previously. It is called Itipini. They live in a house near Mthatha General Hospital which is adjacent to Nelson Mandela Hospital. They have 2 Newfoundlands which are beautiful. I obviously found a few minutes to get large (and sloppy) hugs from these 2 wonderful dogs. It felt really good after being dogless for a week. We do have a dog (of questionable heritage) who roams the compound where I live and I am told is called Scooby. He is very friendly and makes it seems safer here. He seems to have a sense of who belongs. He accepted me immediately but barked at Ed when he dropped me off last night. Once I told him it was OK, he was fine. This is a dog I have only known for 3 days! So now you can all worry about me a little less. Scooby is watching over me.
Stan will be proud of my accomplishment in finding that 2nd twin as it appears it didn’t really disappear as one of the interns suspected! I found that my US skills, while quite rusty, seem to be well matched to this machine as it appears to of about the same vintage (OK it’s a little newer) as my US training.
For such well trained and knowledgeable physicians, I am amazed at how they accept the limited equipment and supplies they have. The students were unable to scrub on Tuesday because they ran out of shoe covers. They can’t do endometrial biopsies because they can’t get pipelles. All those women are admitted for a D&C. Cervical dysplasia is almost all treated by cold cone biopsy. Unfortunately there seems to be as much Stage IIIb as dysplasia.
What I learned today:
*Schistosomiasis is in the differential of splenomegaly and most commonly is S. mansoni in liver or splenic disorders. However if it is found in the bladder, think of S. haematobium. Obviously, don’t forget malaria in your differential for splenomegaly!!!
*Glucose is measured as mmol/l which I have determined as requiring approximately a factor of 18 to convert to familiar numbers. It still seems wrong to talk about normal values of 7.0
*Normal CD4 counts (to follow HIV)should be 500-1400 or can be reported as a percentage. The normal value isn’t changed by pregnancy but will be by stress or steroids among other things.
*The medical students are very enthusiastic and seem to be well prepared to work hard. They are very interested in differences in practice between the US and Africa.
*Malpractice suits are becoming an issue in South Africa, especially obstetrical (what a surprise!)
How to get the internet working, so I can blog now!
Dinner last night was very nice and relaxed. The McConnachies have lived here fulltime for about 12 years. He was an orthopedic surgeon in No Carolina before that. After trying to balance going back and forth for stints of volunteer work they felt they needed to make a choice and just do one thing. He works at the Bedford Orthopedic Hospital. She is a nurse and runs the community center I mentioned previously. It is called Itipini. They live in a house near Mthatha General Hospital which is adjacent to Nelson Mandela Hospital. They have 2 Newfoundlands which are beautiful. I obviously found a few minutes to get large (and sloppy) hugs from these 2 wonderful dogs. It felt really good after being dogless for a week. We do have a dog (of questionable heritage) who roams the compound where I live and I am told is called Scooby. He is very friendly and makes it seems safer here. He seems to have a sense of who belongs. He accepted me immediately but barked at Ed when he dropped me off last night. Once I told him it was OK, he was fine. This is a dog I have only known for 3 days! So now you can all worry about me a little less. Scooby is watching over me.
Stan will be proud of my accomplishment in finding that 2nd twin as it appears it didn’t really disappear as one of the interns suspected! I found that my US skills, while quite rusty, seem to be well matched to this machine as it appears to of about the same vintage (OK it’s a little newer) as my US training.
For such well trained and knowledgeable physicians, I am amazed at how they accept the limited equipment and supplies they have. The students were unable to scrub on Tuesday because they ran out of shoe covers. They can’t do endometrial biopsies because they can’t get pipelles. All those women are admitted for a D&C. Cervical dysplasia is almost all treated by cold cone biopsy. Unfortunately there seems to be as much Stage IIIb as dysplasia.
What I learned today:
*Schistosomiasis is in the differential of splenomegaly and most commonly is S. mansoni in liver or splenic disorders. However if it is found in the bladder, think of S. haematobium. Obviously, don’t forget malaria in your differential for splenomegaly!!!
*Glucose is measured as mmol/l which I have determined as requiring approximately a factor of 18 to convert to familiar numbers. It still seems wrong to talk about normal values of 7.0
*Normal CD4 counts (to follow HIV)should be 500-1400 or can be reported as a percentage. The normal value isn’t changed by pregnancy but will be by stress or steroids among other things.
*The medical students are very enthusiastic and seem to be well prepared to work hard. They are very interested in differences in practice between the US and Africa.
*Malpractice suits are becoming an issue in South Africa, especially obstetrical (what a surprise!)
How to get the internet working, so I can blog now!
Thursday, October 4, 2007
1 October 2007
I have arrived safely in Mthatha, South Africa and expect the rest of my luggage to do the same tomorrow!
It is Monday night and I am in the house where I will live for the next few weeks. It is a little 2 bedroom brick house in the “compound” of Bedford Orthopedic Hospital. When I figure out how, I will try to post some pictures. I have a roommate named Megan from Manchester, England. She is a very nice young woman working here as a physiotherapist (aka physical therapist) for 6 months.
I will work in the Nelson Mandela Hospital. I spent most of today there and I have already seen amazing disease processes. The style of delivering medicine is so different but the medical care itself seems the same so far. This is the place where those who cannot afford care come from the entire area. They have diseases that reflect their poverty and lack of access to preventive care. They are amazingly patient and grateful for the care they receive.
2 October 2007
The luggage has arrived! It seems to be all intact.
There were some patients who had surgery canceled today so they told me to take the day and get settled. So I picked up the luggage and started to find my way around town and pick up a few supplies.
There was a bad accident not far from here this morning. People drive in very reckless ways and many of the vehicles are loaded with people in the back of pickups and very full minivans. They often stand by the side of the road, well sort of to the side, and are waiting for someone to pick them up. It appears to be an unofficial taxi system. They are expected to pay a small amount for the ride. The driving here reminds me of Ireland only far worse. The roads are worse, the rules are not clear when they exist and seem to be only guidelines. One of the Harrington boys refers to stop signs as ‘stoptional’ signs and that appears to be accurate. Stoplights seem to mean that only 1 or 2 cars may go after it turns red.
It is cool in the evenings and has been getting warm during the days. It rained last night. The house seems humid but the surrounding land looks very dry. Tonight there was a series of downpours. We lost power 3 times so far. We keep candles set around all the time. I hope the Harringtons stayed dry. They live in a rondoval which is a house with a thatched roof.
I had dinner with Ed and Caroline and 2 of the other volunteers. Jesse is here for a year, I believe. He was born in Canada and grew up in the states. He has a degree n political science and a master’s degree that I think is in international relations. Robert is here from Leipzig Germany. He is in college studying social work and I suspect he has had more experience here than you can imagine. He returns to school next week for his final year. They both work at a community center outside of town that was literally built on a garbage dump. It has approximately 3000 residents and is growing. The center provides some primary medical care, child care and support for all kinds of problems for these people.
3 October 2007
This morning we started with morning review of patients admitted overnight. Then the bedside rounds started and I met the medical students there. No AC so it gets very hot for pts and staff. It is the first wk of a six week rotation in OBGYN for these students. They are 5th yr students. Med school is 5yrs here; starting directly after high school. Apparently most schools have gone from 7yrs to 6yrs and a few to 5 but they then do a required general intern yr before deciding on a specialty. Rounds are similar with student presenting and staff questioning and critiquing, but done at the bedside as if the pt was not there. It is done in English and therefore most pts don't understand what is spoken and seem to sleep through most of it. Students are timid, so very soft spoken, making it even harder to understand their British style South African accents,
Lunch at the cafeteria: beans, rice, meat, carrots and peas +soda for R13 (less than $2). The only choice is whether you eat it all of it. They fill the plates the same for everyone. It’s interesting that as I look around it suddenly occurs to me that I am the only white person in the cafeteria and I haven't seen another white person today since leaving the house.
There is no recycling here. It is so difficult to throw away cans, bottles etc. I wonder if they recycle in the cities although I didn't see any during our overnight in Jo'burg, as they call Johannesburg. Among other things this is probably contributing to the littering. I simply cannot describe the trash on the roadside and almost everywhere. I don’t think I would have believed the degree without seeing it. You will have to see the pictures when I get them up here.
It appears that they are going to let me do some teaching which I will like and students and residents are very interested in any help they can get. Tomorrow I will talk to a doctor who does most of the fistula surgery and arrange to work with him. Unfortunately it is a growing problem so I will get some experience. There are 2 OB pts who are very complicated and the residents seemed so grateful when I offered to help. One is an insulin dependent diabetic whose DM control seems to be hospitalization for 1 day per week for a series of glucose tests followed by the insulin dose schedule for the week which is adjusted in between by “how she feels”. The other is a pt with twins at 26 weeks with polyhydramnios. They tell me her AFI is 52. She couldn’t tell me if this is is diamnionic or monoamnionic. In fact she can’t see the 2nd twin any more when she scanned her and she hasn’t had an attending with time to help her scan this week. She wants my help. That ought to make Stan laugh!
All the volunteers eat together on Wednesday night at Dr McConnachie’s house so I am off to go there now.
I have arrived safely in Mthatha, South Africa and expect the rest of my luggage to do the same tomorrow!
It is Monday night and I am in the house where I will live for the next few weeks. It is a little 2 bedroom brick house in the “compound” of Bedford Orthopedic Hospital. When I figure out how, I will try to post some pictures. I have a roommate named Megan from Manchester, England. She is a very nice young woman working here as a physiotherapist (aka physical therapist) for 6 months.
I will work in the Nelson Mandela Hospital. I spent most of today there and I have already seen amazing disease processes. The style of delivering medicine is so different but the medical care itself seems the same so far. This is the place where those who cannot afford care come from the entire area. They have diseases that reflect their poverty and lack of access to preventive care. They are amazingly patient and grateful for the care they receive.
2 October 2007
The luggage has arrived! It seems to be all intact.
There were some patients who had surgery canceled today so they told me to take the day and get settled. So I picked up the luggage and started to find my way around town and pick up a few supplies.
There was a bad accident not far from here this morning. People drive in very reckless ways and many of the vehicles are loaded with people in the back of pickups and very full minivans. They often stand by the side of the road, well sort of to the side, and are waiting for someone to pick them up. It appears to be an unofficial taxi system. They are expected to pay a small amount for the ride. The driving here reminds me of Ireland only far worse. The roads are worse, the rules are not clear when they exist and seem to be only guidelines. One of the Harrington boys refers to stop signs as ‘stoptional’ signs and that appears to be accurate. Stoplights seem to mean that only 1 or 2 cars may go after it turns red.
It is cool in the evenings and has been getting warm during the days. It rained last night. The house seems humid but the surrounding land looks very dry. Tonight there was a series of downpours. We lost power 3 times so far. We keep candles set around all the time. I hope the Harringtons stayed dry. They live in a rondoval which is a house with a thatched roof.
I had dinner with Ed and Caroline and 2 of the other volunteers. Jesse is here for a year, I believe. He was born in Canada and grew up in the states. He has a degree n political science and a master’s degree that I think is in international relations. Robert is here from Leipzig Germany. He is in college studying social work and I suspect he has had more experience here than you can imagine. He returns to school next week for his final year. They both work at a community center outside of town that was literally built on a garbage dump. It has approximately 3000 residents and is growing. The center provides some primary medical care, child care and support for all kinds of problems for these people.
3 October 2007
This morning we started with morning review of patients admitted overnight. Then the bedside rounds started and I met the medical students there. No AC so it gets very hot for pts and staff. It is the first wk of a six week rotation in OBGYN for these students. They are 5th yr students. Med school is 5yrs here; starting directly after high school. Apparently most schools have gone from 7yrs to 6yrs and a few to 5 but they then do a required general intern yr before deciding on a specialty. Rounds are similar with student presenting and staff questioning and critiquing, but done at the bedside as if the pt was not there. It is done in English and therefore most pts don't understand what is spoken and seem to sleep through most of it. Students are timid, so very soft spoken, making it even harder to understand their British style South African accents,
Lunch at the cafeteria: beans, rice, meat, carrots and peas +soda for R13 (less than $2). The only choice is whether you eat it all of it. They fill the plates the same for everyone. It’s interesting that as I look around it suddenly occurs to me that I am the only white person in the cafeteria and I haven't seen another white person today since leaving the house.
There is no recycling here. It is so difficult to throw away cans, bottles etc. I wonder if they recycle in the cities although I didn't see any during our overnight in Jo'burg, as they call Johannesburg. Among other things this is probably contributing to the littering. I simply cannot describe the trash on the roadside and almost everywhere. I don’t think I would have believed the degree without seeing it. You will have to see the pictures when I get them up here.
It appears that they are going to let me do some teaching which I will like and students and residents are very interested in any help they can get. Tomorrow I will talk to a doctor who does most of the fistula surgery and arrange to work with him. Unfortunately it is a growing problem so I will get some experience. There are 2 OB pts who are very complicated and the residents seemed so grateful when I offered to help. One is an insulin dependent diabetic whose DM control seems to be hospitalization for 1 day per week for a series of glucose tests followed by the insulin dose schedule for the week which is adjusted in between by “how she feels”. The other is a pt with twins at 26 weeks with polyhydramnios. They tell me her AFI is 52. She couldn’t tell me if this is is diamnionic or monoamnionic. In fact she can’t see the 2nd twin any more when she scanned her and she hasn’t had an attending with time to help her scan this week. She wants my help. That ought to make Stan laugh!
All the volunteers eat together on Wednesday night at Dr McConnachie’s house so I am off to go there now.
Thursday, September 27, 2007
Thursday, 9/27
Tonight I am starting the blog about my trip to Mthatha, South Africa. I am packing and getting ready to go to Eden Prairie tomorrow.
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