Happy New Year.
Well its already the 5th of January now. Sunday was one of the warmest, sunny days in a while. I was able to do some surfing which was absolutely splendid. The waves were massive and I caught some perfect breaks. I did get my a blue bottle sting on my arm, which practically wrapped around my wrist. Wow, so painful! Almost like an electecution stinging, left me with a cool string of red dots on my arm where it grabbed me. My departure from coffee bay was delayed a day because my battery had run low, not sure why. At 4 am in the morning I was woken up by one of the hostel staff saying they needed a doctor, someone has been stabbed. Yikes, I wandered over with them to find a white girl with brunette hair sitting in a truck surrounded by people. There were already two other medical students on scene. Turns out they are German and Dutch surgery students who are doing an elective in Tygerberg! The girl was stabbed in her upper left chest, seemed to have missed the vessels. The other students had a proper medical kit so had patched her up, and deduced she had someone of a lung collapse. The girl seemed unconscious so I asked her name, she looks up and it was a girl I know who works at the next door hostel. Her fellow staff friends were hysterical, and the scene was calm yet extremely chaotic. They decided to take her to the local clinic 20km away and then sort out a transfer to Mthatha. One of the foreign students went with her. Still not sure what happened, but I believe it was an armed robbery that ended horribly.
Last I heard she was sent to Mthatha using vehicles of friends, and was stable. Seems so difficult to get professional ambulances and transport in this region. I assume we could have gotten a helicopter if she was not stable… This episode really jolted me. Here I am in this tiny little beach village on the coast of Africa and still violence is just around the corner. Just seeing her patched up, blood on her clothing… Just too close for comfort. Not sure what the impact will be on the community, will word of mouth spread the incident, or will it just be forgotten, maybe there are more stabbings than I know about…
So I returned Monday morning and was still pretty shaken, and tired from poor sleep. Things were compounded when I was called into a resuscitation of a 1 yo baby boy in the OPD. The baby died had vomiting and diarrhea for a week and arrived barely breathing. His lungs sound abosultely horrible, and seemed to have aspirated vomit. We tried for a 30 minutes to get him to restore a heart rate. Jeez. The kid was so beautiful, little button up shirt, shorts, sneakers. The mom was inconsolable. Such a horrible scene to end the day at work.
On a positive note there are new doctors. Two new community service docs, one who was in Cape Town for her internship and another who is a local who speaks xhosa who was trained in Cuba. The sad thing is that some people have left, Duncan the dietician, and Kim the UK community service doctor. It is crazy because it isn’t like they are just moving jobs inside a big city. They are gone gone, leaving the little hospital community.
Some random thingys:
An older guy in his 60s comes to the OPD because of a lesion he has had on his forhead for >10 years. It wa about a 1in in diameter soft round very raised bump above his left eyebrow. I asked him why now did he come in? He turns to look at his wife. “my wife wants it off for the new year.” I grabbed Dr. Nombembe and decided to just remove it. So we prepped him, applied local anesthetic and in the OPD just removed what was most likely a lipoma. Pretty bloody procedure… Sewed him up. He returned 5 days later in my OPD room for stitches removal, he had such a huge smile. The swelling had come down and there was almost not scar. Great success!
-21 yo girl come in for fatigue and cough. I asked if she has any TB hx or other major medical problems. She said, “no.” Go through the TB questions pathway. When I go to listen to the front of her chest she has a huge thoracotomy scar and a very mechanical sounding heart sound! Huh? I flip through her book. Turns out she had severe rheumatic heart disease, with valve replacement and everything. That might be an important thing to know! Still the notes from other clinics were query pulmonary TB… this has gotta be cardiac though. Its neat because she is managed at the cardiothoracic clinic in Mthatha, where she gets monthly warfarin blood level checks.
- Managing elbow injuries without x-rays really sucks. It would be so nice to just see if there was a fracture, before placing someone into a full plaster of paris and causing severe stiffness. In one day I had 3 patients with elbow trauma, various ages. With two of them even after a week of a backslap still had elbows swollen the shape of a butternut squash… So we threw up our hands and just referred them to Bedford for x-ray. Long way to go for something we should have here, but what we gonna do.
- One overweight older patient come in seeming short of breath. I ask her chief complain… or what got them out of bed today and make the trek to see us (this is deliberate otherwise patients here will tell you every problem they’ve had in the past few months). She said “dyspnea.” Huh? I figured this must be a patient who is a medical worker or someone who has seen way too many doctors. Turns out she was a nurse at zithulele for many years and retired a few years ago. She reminded me almost of some of the chronic patients in the US, many problems, lots of somatization likely. She had 4 pillow orthopnea, and sever HPT, like 200/100 regularly. Was on all sorts of drugs, theophylline (strange), digoxin, ACEI, and then was on tegretol and phenobarb for epilepsy.. Poly pharmacy in Africa does exist. Just kinda an interesting one for me that reminded me of family medicine in the states.
-I have been frequently seeing Dr. Meents, the German Doctor who lives in Coffee Bay. He does ultrasound clinic Tuesdays at zithulele. He is the only doctor at Nwanguba clinic, lives in a few rondavels near coffee bay, and is going to marry a wonderful coffee bay born girl named Alicia. He gave me a tour of his home which was really interesting. He lives on the countryside surrounded by other rondavels and locals, has his own sheep, garden. His father in law stopped by, went to visit some other locals who were sitting drinking home brewed beer. He had many wonderful colorful stories. What was funny is that inside his rondavel is a Huge flat screen TV, white shag rug, fancy bed, and white leather sofa. He’s remodeling his kitchen. Such different worlds converging, rural and german urban. Doctors here are just so neat. He was telling me that the other day he was cleaning up the clinic and found a pile of boxes that were from a previous doctors stay. He looked inside one and found a new ECG machine! Haha. He’s all excited cause now he has ECG. Just found it funny.
-One of our patients baby was very sick and we ended up doing a resuscitation. The child was in a room with many other kids and mothers. She showed very little emotion, except for a few seconds she looked like she was going to bawl, then just sat there. I was confused what was happening and later asked Dr. meents about the lack of public displays of emotions. He said that crying and sadness are for behind closed doors in your home. Unless someone is so overcome that they just cannot hold things back, but then it typically will make everyone else in the room get very emotional and weep as well. He also told me that typically people are allowed about a week or two of being sad, and to cry when losing a loved one. After that family will firmly say, “time to move on, and keep living.” Depression and prolonged grieving is not really tolerated, kids who need feeding, family to take care of. Very interesting to here one perspective on this.
-Patients here seem to always be cold!! Many patients who seem perfectly healthy and normal come in with like 9 layers of clothing on a perfectly summer day, and many have pulse rates in the 120-140. Its is so crazy for me. Arent’ they hot?? Seriously, like undershirt, overshirt, dress, sweater, over jacket, rainjacket! Takes sometime minutes to get to their back to listen. Not sure why they are so cold. Maybe it’s a nutritional thing.
-Today we had a patient who was admitted for weakness, and was in end stage AIDS. A U and E was sent and his potassium was 1.7! yikes, that is low! He had severe chronic diarrhea. He was still communication. Can’t believe he is still alive.
Yikers.
I think that is it for now. I haven’t had internet in a while so that’s why I’m consolidating posts. It is already January 6th. Ahh, I’ll be back in the states before I know it. Time just flies so quickly here. Till next time. Cheers.
Pictures will have to wait until I'm back in cape town, since internet is too slow and costly.
Wednesday, January 6, 2010
Happy Festive Season
Happy Festive Season!
Festive season is the time during Christmas and New Years where the entire country of south Africa goes on a huge crazy holiday. It is very strange to be in such a warm climate during this time. I’m used to the cold and snow, its very disorienting. The locals like to blast Christmas music out of their mini-buses, little kids yell “happy Christmas” as you drive by their rondavels, and the nurses are wearing santa red hats…. But no snow.
This time is also the season of car accidents and violence. People get Christmas bonuses, drink and do stupid stuff.
I have fully settled into rural life. Have a refrigerator still stocked full of good Woolworths, started doing hand washing, and waking up the roosters. A group of volunteers have arrived through the Jabalani Foundation to help build some new accommodations. They are a mix of ages and backgrounds, so lots of new faces.
Last week there were few doctors due to turn-over and the holidays. So I was able to do a ton in OPD. With all the stabbings I have been doing chest tubes for the doctors. My last one was practically all by myself, my nurse was giving me a look like, “do you know what you are doing,” but got the tube right in. It feels great to be useful.
I have been seeing patients primarily on my own, just using an interpreter. I am so used to getting a history then having no idea what to do and going to the preceptor. But here, there isn’t always someone to check with immediately, so you are forced to come up with a plan. The more patients I see, the more I trust my clinical judgment, and the plan matches the doctors when I present them. I keep telling the nurses and patients I’m a student doctor, but they just keep calling me doctor so I am just rolling with it.
Some interesting snippets:
-Measles has arrived! A few weeks ago a kid came in with red eyes, and cough, then developed a rash all over his body. IgM for measles came back positive. Since then there have been kids from the similar region coming in with similar sx. So there is now a measles isolation area in peds. Didn’t know kids still got that. Cough, Coryza (runny nose), conjunctivitis with or without systemic rash. Many kids slip through the immunization track.
-Sangoma-o-rama. There are issues with some traditional healers giving very harmful medications to babies. I guess its called plate medicine… not sure what it is but there have been a few kids that came in extremely pale and passed away. Understandably, it is a deep source of frustration for the doctors. Especially since western medical care is typically delayed and patients come in much sicker. It doesn’t seem like this hospital does a lot of outreach to the traditional healers, and vice-versa. I will be exploring this in the next few weeks, who are the sangoma’s in this region, communication lines between the hospital and them… to be continued hopefully
-9 year old girl comes in unable to sit still. She is making writhing movements with her whole body, moving constantly. Had a sore throat a few weeks ago. Turns out she has Chorea and Rheumatic Fever. Wow! Never thought I’d see that. It was sad though cause the girl was very self-conscious. Very interesting stuff.
-18 yo guy was stabbed in the arm during Christmas. Now he has a wrist drop. Crazy, for the rest of his life he won’t be able to use his arm properly. He didn’t seem very upset or anything, wondering what was going through his head.
-Last weekend went to Coffee Bay. A German doctor who does Ultra-sound clinic at zithulele and who lives in Coffee Bay contacted one of our doctors since one of the workers had broken her leg and needed a plaster cast. So before I left I picked up all the supplies and then delivered them. It is so cool to be in a governmental system in a remote area. You just do what you need to get the job done and you help each other out. If someone needs supplies you just get it to them. The German doc was on holiday too, but the docs here are driven by service not financial reward (otherwise they’d leave for the private sector or to Canada).
-Young girl complained of an ear ache. Look inside what do you find? A fly, pus and a ruptured ear drum. Yikes! Young boy’s ear hurts. Look inside what do you find? Some stones! Kinda like getting little surprise hannukah gifts.
-Yesterday I walked into Peds ward at 0800 to find one of the Senior doctors tending to a 3 mo old girl who was in respiratory distress. Her O2 sats were in the 70s, . Previously Very healthy, chubby girl, HIV -, seemed mostly just a pneumonia. After trying all sorts of drugs and nebs, finally decided to intubate. This baby was so wheezy and running out of energy quickly. Liz, one of the com serves, was able to get the helicopter service on phone, and after a few calls and very forceful words was able to get them authorized to pick-up our patient. Within about 45 minutes they arrived at our little Transkei hospital. I had a good breathing rhythm going so I helped in the transport. Then they were on their way. Tons of local kids and patients came out to watch this beautifully painted piece of machinery.
Traditionally dressed…grandma was transported with the baby. Haven’t heard the outcome yet, but I am hopeful. I guess they haven’t had a helicopter come for months. The ambulance service is primarily BLS, so transporting a very unstable baby with an ET tube would be a horrible idea. I can only imagine what it would be like going over all those potholes. The road to Nelson Mandela Academic Hospital has been nicknamed by the doctors as the “road of death,” for how many patients don’t make it. Eeks, hopefully it’ll be smoothed out and paved sooner than later.
That is all for now. Today was in ARV clinic and then assisted in a tubal ligation and c-section. Tomorrow is new years eve, still no snow. Gonna meet some friends in coffee bay, and maybe do some informal medical consultations with local docs…
Festive season is the time during Christmas and New Years where the entire country of south Africa goes on a huge crazy holiday. It is very strange to be in such a warm climate during this time. I’m used to the cold and snow, its very disorienting. The locals like to blast Christmas music out of their mini-buses, little kids yell “happy Christmas” as you drive by their rondavels, and the nurses are wearing santa red hats…. But no snow.
This time is also the season of car accidents and violence. People get Christmas bonuses, drink and do stupid stuff.
I have fully settled into rural life. Have a refrigerator still stocked full of good Woolworths, started doing hand washing, and waking up the roosters. A group of volunteers have arrived through the Jabalani Foundation to help build some new accommodations. They are a mix of ages and backgrounds, so lots of new faces.
Last week there were few doctors due to turn-over and the holidays. So I was able to do a ton in OPD. With all the stabbings I have been doing chest tubes for the doctors. My last one was practically all by myself, my nurse was giving me a look like, “do you know what you are doing,” but got the tube right in. It feels great to be useful.
I have been seeing patients primarily on my own, just using an interpreter. I am so used to getting a history then having no idea what to do and going to the preceptor. But here, there isn’t always someone to check with immediately, so you are forced to come up with a plan. The more patients I see, the more I trust my clinical judgment, and the plan matches the doctors when I present them. I keep telling the nurses and patients I’m a student doctor, but they just keep calling me doctor so I am just rolling with it.
Some interesting snippets:
-Measles has arrived! A few weeks ago a kid came in with red eyes, and cough, then developed a rash all over his body. IgM for measles came back positive. Since then there have been kids from the similar region coming in with similar sx. So there is now a measles isolation area in peds. Didn’t know kids still got that. Cough, Coryza (runny nose), conjunctivitis with or without systemic rash. Many kids slip through the immunization track.
-Sangoma-o-rama. There are issues with some traditional healers giving very harmful medications to babies. I guess its called plate medicine… not sure what it is but there have been a few kids that came in extremely pale and passed away. Understandably, it is a deep source of frustration for the doctors. Especially since western medical care is typically delayed and patients come in much sicker. It doesn’t seem like this hospital does a lot of outreach to the traditional healers, and vice-versa. I will be exploring this in the next few weeks, who are the sangoma’s in this region, communication lines between the hospital and them… to be continued hopefully
-9 year old girl comes in unable to sit still. She is making writhing movements with her whole body, moving constantly. Had a sore throat a few weeks ago. Turns out she has Chorea and Rheumatic Fever. Wow! Never thought I’d see that. It was sad though cause the girl was very self-conscious. Very interesting stuff.
-18 yo guy was stabbed in the arm during Christmas. Now he has a wrist drop. Crazy, for the rest of his life he won’t be able to use his arm properly. He didn’t seem very upset or anything, wondering what was going through his head.
-Last weekend went to Coffee Bay. A German doctor who does Ultra-sound clinic at zithulele and who lives in Coffee Bay contacted one of our doctors since one of the workers had broken her leg and needed a plaster cast. So before I left I picked up all the supplies and then delivered them. It is so cool to be in a governmental system in a remote area. You just do what you need to get the job done and you help each other out. If someone needs supplies you just get it to them. The German doc was on holiday too, but the docs here are driven by service not financial reward (otherwise they’d leave for the private sector or to Canada).
-Young girl complained of an ear ache. Look inside what do you find? A fly, pus and a ruptured ear drum. Yikes! Young boy’s ear hurts. Look inside what do you find? Some stones! Kinda like getting little surprise hannukah gifts.
-Yesterday I walked into Peds ward at 0800 to find one of the Senior doctors tending to a 3 mo old girl who was in respiratory distress. Her O2 sats were in the 70s, . Previously Very healthy, chubby girl, HIV -, seemed mostly just a pneumonia. After trying all sorts of drugs and nebs, finally decided to intubate. This baby was so wheezy and running out of energy quickly. Liz, one of the com serves, was able to get the helicopter service on phone, and after a few calls and very forceful words was able to get them authorized to pick-up our patient. Within about 45 minutes they arrived at our little Transkei hospital. I had a good breathing rhythm going so I helped in the transport. Then they were on their way. Tons of local kids and patients came out to watch this beautifully painted piece of machinery.
Traditionally dressed…grandma was transported with the baby. Haven’t heard the outcome yet, but I am hopeful. I guess they haven’t had a helicopter come for months. The ambulance service is primarily BLS, so transporting a very unstable baby with an ET tube would be a horrible idea. I can only imagine what it would be like going over all those potholes. The road to Nelson Mandela Academic Hospital has been nicknamed by the doctors as the “road of death,” for how many patients don’t make it. Eeks, hopefully it’ll be smoothed out and paved sooner than later.
That is all for now. Today was in ARV clinic and then assisted in a tubal ligation and c-section. Tomorrow is new years eve, still no snow. Gonna meet some friends in coffee bay, and maybe do some informal medical consultations with local docs…
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