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.