Variety is the spice of life!
Hello friends,
It seems like so much has happened since I last sat down to write a few thoughts about my escapades here in the frosty Eastern Cape. We are well and truly in Winter, with the snow capped peaks of Lesotho twinkling behind the town. I seem to have packed for a balmy summers day, so my electricity meter has been ticking away merrily as I am now the proud owner of a third heater for the flat.
I was reluctant to write about work for a few days after a tough week in the nursery. You'll remember our CPAP baby who was very ill with respiratory distress. Unfortunately although her respiratory condition had improved slightly, she went on to have a suspected brain haemorrhage and later a perforated intestine. On Friday evening she deteriorated and it was clear there was nothing more to be done. I made the difficult, but obvious decision to stop our interventions and make the baby comfortable. I have long been a believer that death is not the worst thing that can happen to a person. Our baby would have been blind, she would not have walked, or talked, or gone to school. I called her mother to the nursery and we sat with the baby as I explained to her what would happen next. She spent the next few hours cuddling her daughter and we took pictures of the two of them together. The baby girl passed away on Saturday morning.
Being a doctor is a position of utmost privilege - particularly in this situation. Here, in the very worst moment of this woman's life, I am slap bang in the middle of it. It was clear this baby was going to die, so I tried to make it as non-clinical as possible, thankfully the nursery is quite a peaceful place, usually. The baby was free of wires and tubes, and they had time together before she died. I shall never forget that mother's face, or the sound of her cries.
On Saturday I popped in to the unit to see how things had gone overnight, I was saddened but somewhat relieved that the baby had passed away. Her suffering had ended. I found the mother in the ward and we sat together and shared some koeksisters (an Afrikaans pastry). We said a few words about what had happened, I gave her a hug and then she went on her way. There is something so personal about being a doctor in this environment - there's less staff, so you know your patients better, you spend more time with them. I left the hospital feeling that I had really made an impact on that mother's life, you really get the sense of advocating for your patients here - although overwhelming, I guess that's why we do what we do.
I didn't get up to much at the weekend after that tumultuous week. In addition to our sick baby girl, we also had the usual circus of a district hospital maternity unit. Premature labours, pre-eclampsia and my first post partum haemorrhage. That puts the wind up you. How can one person have so much blood? A swift re-laparotomy to have a look and the guilty party was found - a vessel bleeding down in to the cervix - hence why we hadn't seen it when we closed. That mother bounced back despite her 2L blood loss and is now away home, bouncing baby boy in tow.
The real saving grace of this week has been the casualty. Since there is now a full time obstetrics doctor (me), the patient turnaround is much faster! We have an inpatient population of about 14 mothers now - antenatal, post c section, post stillbirth, post vaginal delivery - positively minuscule from the 40 odd women I was seeing for the first few days. The whole unit is delighted by the change - fingers crossed we keep on top of it.
My ward round now takes about an hour rather than five, and so I lend a hand in casualty in the afternoon. What. A. Place. Variety is the spice of life, as they say!
The range of pathology I have come across in here is mind boggling - to name but a few of the things I get up to - a 59yo man with his second flare of cutaneous TB - I was handed a needle and some betadine and asked to sort it out. Next, I had to remove a contraceptive coil - which had been in there for 17 years, needless to say I didn't find it - what I did find was a recto vaginal fistula...there is concern the coil is in the colon now.
We also had burns. Far too many burns than I care to think about. Babies with burns from nipple to knee, children with facial burns, one man spilt a pan of boiling water all down the back of his thigh, we flattened him with ketamine and set about with blades shredding off the devitalised tissue.
Then several dental issues - never did I think my sufferance as the Max Fax SHO would come in useful - I have eaten my words ten times over.
I'll be covering the paediatric ward for a few days whilst a colleague is away on a course. Mortified myself when reviewing one the babies with her before she went - an 11 month old admitted with severe malnutrition. I noticed he also had burns all over his body - these aren't burns, he is so malnourished that his skin is breaking down and falling off. I swear they didn't tell us that in medical school - or maybe it went in the mental box of things that I would never have to deal with...that box is being destroyed day by day here.
I've now lined up an elective surgical case for myself next week - it's just a lipoma (fatty lump) on the forehead but I attempted to remove it in casualty today (was asked to by a colleague, I was hesitant but didn't want to let the side down) but in the absence of adrenaline, the thing bled everywhere. I promptly closed it up and advised my disgruntled patient to return on Tuesday to have it sorted in theatre. He's walked about with a golf ball on his head for years, a week more won't hurt. Lesson - there is no shame in asking for the appropriate equipment. (I asked for a blood gas for a man in severe DKA and got laughed at, you see my dilemma).
All in all, I realise that in actual fact, it is not working in Africa that scares me, it is Obstetrics and tiny babies. A perfectly rational phobia. I managed to squeeze in celebrations for my friends birthday this week - ridiculous Mexican themed festivities - a welcome relief.
It seems like so much has happened since I last sat down to write a few thoughts about my escapades here in the frosty Eastern Cape. We are well and truly in Winter, with the snow capped peaks of Lesotho twinkling behind the town. I seem to have packed for a balmy summers day, so my electricity meter has been ticking away merrily as I am now the proud owner of a third heater for the flat.
I was reluctant to write about work for a few days after a tough week in the nursery. You'll remember our CPAP baby who was very ill with respiratory distress. Unfortunately although her respiratory condition had improved slightly, she went on to have a suspected brain haemorrhage and later a perforated intestine. On Friday evening she deteriorated and it was clear there was nothing more to be done. I made the difficult, but obvious decision to stop our interventions and make the baby comfortable. I have long been a believer that death is not the worst thing that can happen to a person. Our baby would have been blind, she would not have walked, or talked, or gone to school. I called her mother to the nursery and we sat with the baby as I explained to her what would happen next. She spent the next few hours cuddling her daughter and we took pictures of the two of them together. The baby girl passed away on Saturday morning.
Being a doctor is a position of utmost privilege - particularly in this situation. Here, in the very worst moment of this woman's life, I am slap bang in the middle of it. It was clear this baby was going to die, so I tried to make it as non-clinical as possible, thankfully the nursery is quite a peaceful place, usually. The baby was free of wires and tubes, and they had time together before she died. I shall never forget that mother's face, or the sound of her cries.
On Saturday I popped in to the unit to see how things had gone overnight, I was saddened but somewhat relieved that the baby had passed away. Her suffering had ended. I found the mother in the ward and we sat together and shared some koeksisters (an Afrikaans pastry). We said a few words about what had happened, I gave her a hug and then she went on her way. There is something so personal about being a doctor in this environment - there's less staff, so you know your patients better, you spend more time with them. I left the hospital feeling that I had really made an impact on that mother's life, you really get the sense of advocating for your patients here - although overwhelming, I guess that's why we do what we do.
I didn't get up to much at the weekend after that tumultuous week. In addition to our sick baby girl, we also had the usual circus of a district hospital maternity unit. Premature labours, pre-eclampsia and my first post partum haemorrhage. That puts the wind up you. How can one person have so much blood? A swift re-laparotomy to have a look and the guilty party was found - a vessel bleeding down in to the cervix - hence why we hadn't seen it when we closed. That mother bounced back despite her 2L blood loss and is now away home, bouncing baby boy in tow.
The real saving grace of this week has been the casualty. Since there is now a full time obstetrics doctor (me), the patient turnaround is much faster! We have an inpatient population of about 14 mothers now - antenatal, post c section, post stillbirth, post vaginal delivery - positively minuscule from the 40 odd women I was seeing for the first few days. The whole unit is delighted by the change - fingers crossed we keep on top of it.
 |
| The admission room in Maternity |
The range of pathology I have come across in here is mind boggling - to name but a few of the things I get up to - a 59yo man with his second flare of cutaneous TB - I was handed a needle and some betadine and asked to sort it out. Next, I had to remove a contraceptive coil - which had been in there for 17 years, needless to say I didn't find it - what I did find was a recto vaginal fistula...there is concern the coil is in the colon now.
 |
| What happens when you aspirate TB... |
Then several dental issues - never did I think my sufferance as the Max Fax SHO would come in useful - I have eaten my words ten times over.
 |
| The most blunt ring cutter in the EC |
I've now lined up an elective surgical case for myself next week - it's just a lipoma (fatty lump) on the forehead but I attempted to remove it in casualty today (was asked to by a colleague, I was hesitant but didn't want to let the side down) but in the absence of adrenaline, the thing bled everywhere. I promptly closed it up and advised my disgruntled patient to return on Tuesday to have it sorted in theatre. He's walked about with a golf ball on his head for years, a week more won't hurt. Lesson - there is no shame in asking for the appropriate equipment. (I asked for a blood gas for a man in severe DKA and got laughed at, you see my dilemma).
All in all, I realise that in actual fact, it is not working in Africa that scares me, it is Obstetrics and tiny babies. A perfectly rational phobia. I managed to squeeze in celebrations for my friends birthday this week - ridiculous Mexican themed festivities - a welcome relief.
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| Mexican birthday celebrations |
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| A tiny baby x ray |
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