Putting in a early post for my second week. I’m having a great time here at Zithulele. Its such a gem of a hospital given its location, and service to community.
Bit of some drama over the weekend. I went to Bulungula lodge to meet up with Graem and some other Jo-berg medical students. It is about a 45min-1hr drive on a rough dirt road, then a 45 minute walk unless you have a 4x4 vehicle. The website is: www.bulungula.com. I had a great time, experienced the culture, hung out with locals. I stayed in a rondavel dorm room… which is amusing since I went from a rondavel with electricity and tiled floors, to one with a cow dung floor and only candle lit. The lodge is partially owned by the community, so many of the activities are run by locals, and anyone can hang out there. So lots of little black kids come to drum around the fire at night, and you can go on a tour with local women to see what a typical day is for them. I left Sunday afternoon looking forward to a nice walk and saying hello to the cows and sheep. The weather rapidly changed, and I was drenched with rain. Wearing only shorts and t-shirt, I managed to wrap my waist in a towel, and my rain coat over my bag. I arrived at my car covered in mud, soaked, and shivering. Even the locals at the shop gave me a look of, (what happened to that guy). I start my drive, and within 10 minutes went over a hidded eroded area of road, the front of the car dipped producing a loud “thud.” I stop the car and heard “pssssssss” and my front right tire deflated within a minute! Haha. Bear in mind its raining and no cell phone coverage. Luckily I am not an idiot and was able to sort out putting the spare tire on. Even had a little kid ask me for “sweets,” geez, bad timing kid, I asked him for a new tire. Strangely he just stood with me watching for like 20 minutes. I gave him a cookie for keeping me company. About an hour later I arrived at our rondavel, somehow, and in one piece. What a wild adventure, on the wild coast.
Graem left last week, but a new pre-medical student named Rachel arrived from Cape Town. This week I am on Male ward with Dr. Carl Le Roux, with OPD in the afternoon. Already have a few stories to tell:
I have had a number of patients with the ends of their pinky missing. Confused and curious I asked one of the nurses… apparently for some tribes it is done to ward off evil. Eeks, that must hurt. I guess I don’t use my pinky that much, it would make typing a bit awkward.
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Lots more boys have come in with infections from community circumcisions. They are in good spirits, and healing well. There is actually a specialized male nurse that wears a jacket with says “Traditional Health Services,” and he specializes in circumcision wound care and other medical problems related to traditional practices. Don’t think we have those in the US…
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HIV and TB everywhere! Geez. It totally messes up every differential diagnosis. Stroke? HIV. Skin bumps… TB of skin. Craziness. Then there are all the problems from the TB and HIV drugs. It is such a different type of medicine here by virtue of the disease landscape. Its funny because if you had a patient with HIV at a major hospital, that is a direct referral to an infectious disease specialist. Here everyone just has to learn how to manage.
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In the high care room there is a 14 yo boy with severe full thickness burns to the majority of his left side after his families rondavel was struck by lightning and started on fire. Craziness. Apparantly it is not uncommon because huts are on top of hills and there are few trees. In the US, this kid would be sent immediately to the specialized burn center. The referral hospital in Mthata does not have a burn center! So there is nowhere to send this kid. Well he was sent to Mthata then transferred back to zithulele. So every morning this guy gets diazepam and ketamine to keep him calm during dressing changes. It is such a serious burn, I’m not sure he fully grasps the gravity of the situation. There is no other option, so they are doing the best they can with the resources available... so PT/OT helping out with the dressing and keeping his morale up. He has his own room and has been having nightmares and been really lonely. So one of the physios suggested moving one of the other long term young male patients into the burn kids room. What a cool idea! Even though it’s a hospital, many patients are there a long term so patients often get close with their ward mates. Privacy in US hospitals may be over rated…
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Continue to have issues getting transport from the state ambulance service. Many times no one picks up at the other line, so doctors are forced to waste a lot of time tracking down a responsible party. I imagine it is a tricky drive for a big ambulance along that dirt road. Still not sure what to make of the problem. I’m so used to immediate response of all medical services, from ambulances, to getting into specialisits…
Oh dear, there are too many stories to tell. Well I’ll leave it at that for now. Obviously you can see that I am pointing out interesting differences and things that I didn’t expect. All in all this hospital is providing really great care given the limits of staffing, resources, and referring. Patients are generally happy despite a sometimes excessively long cue. I am slowly running out of food supplies, so will be heading to east London to raid the new love of my life, Woolworths foods. It is a up-market place that somehow produces products that are amazingly good, by products I mean, if it has Woolworths on it, it is always spectacular. No equivalent in the US. Ok, I’ll try to post pictures of my hut sometime soon.
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