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…