Shine in the corners where you are
Despite my best intentions, my promise to jot down more of my thoughts has not come to fruition. The past few weeks have been quite challenging, and it's been easier to just put my head down and keep going rather than think about and reflect on things.
The ward has been a flurry of activity as usual this month. Burns, gastroenteritis, trauma, and pneumonia are the bulk of our work. We've also had three babies with malnutrition. Two of them are now dead. We didn't get to them in time. Despite the best efforts of many incredible health professionals in the community, we are still stuck in an inverse care law - those most in need get the least. Each time I admit a SAM - severe acute malnutrition, it feels surreal. The children look exactly like that TV advert for Save the Children - the reality that I am the doctor now responsible for their care, and potentially for saving their life takes my breath away. We do have success stories, and they are what help us get by. I don't think there is anything that can compare to the feeling of watching these children day by day get stronger. Sitting up, waving, when they gravitate towards the footballs in the playroom I know we are out of the woods.
I'm writing having just finished about 40 hours on call over pay day weekend, and it has left me fairly shell shocked. The stories I'll share tonight are quite upsetting, but this is the reality of healthcare in this area. Reader discretion advised.
For the past few weeks I have been assigned to the paediatric ward. Any medic friends reading this will understand the heavy brick of dread that has been sitting in my stomach for the past month. Paediatrics is an acquired taste, it takes a certain type of doctor to be able to look after children, who are definitely not just small adults.
The children in this area are not like those in the UK. During my attachment in FY2, I dealt with gastroenteritis, chest infections, minor accidents. In the past month, three of my babies have died - one from HIV and PCP, and two from malnutrition. It is incredible to me that in a country which has a growing obesity epidemic, that newborn babies, infants, children - are dying because they do not have enough of the right type of food.
The suffering of the patients I care for in this area is a heavy burden for me this weekend. Last weekend, a couple and their five children were travelling through the town. Somehow they were involved in a horrific accident. All four of the younger children were admitted to my ward. Mostly cuts and bruises, the 3 yo has a skull fracture, the 5yo needs a skin graft after losing most of the tissue on his forearm, the 6 month old baby has a huge scar on his face. The older brother has a nasty femur fracture - a life threatening injury in these parts (and globally actually). Thankfully he was stabilised quickly.
Day 1 of the admission, the 9yo boy said to me 'Oo pi Mama?' - 'Where is Mama?'
No one had told the children she died at the scene of the accident.
My dietician colleagues quickly arranged for formula milk for the 6 month old baby who had still been breast fed at the time of the crash.
On Day 2 of the admission, 7 aunts/grandmothers/female relatives arrived en masse to see the children. They had travelled from the rural areas to visit them after learning of the crash.
There is a South African comedian called Trevor Noah who once spoke about how he would keep going if his career ended - 'I'll always have poverty' - watching these children jump into the arms of the extended family reminded me of the beauty of this culture - no matter how difficult an existence - the family will always get by.
The ward has been a flurry of activity as usual this month. Burns, gastroenteritis, trauma, and pneumonia are the bulk of our work. We've also had three babies with malnutrition. Two of them are now dead. We didn't get to them in time. Despite the best efforts of many incredible health professionals in the community, we are still stuck in an inverse care law - those most in need get the least. Each time I admit a SAM - severe acute malnutrition, it feels surreal. The children look exactly like that TV advert for Save the Children - the reality that I am the doctor now responsible for their care, and potentially for saving their life takes my breath away. We do have success stories, and they are what help us get by. I don't think there is anything that can compare to the feeling of watching these children day by day get stronger. Sitting up, waving, when they gravitate towards the footballs in the playroom I know we are out of the woods.
There has been a lot of sexual violence as usual. It is the rot that creeps through South Africa. This week alone I have written medical reports for four girls aged between 5 and 21 who have been raped either by relatives or by family friends. Xhosa culture doesn't permit open discussion of sex or periods, or the birds and the bees. It is unheard of to talk about sexual violence. The reality is that women are not safe in their own homes in certain areas. I have treated five women in one month who were attacked in their own beds at night. The WHO recently reported that women who have been raped are 1.5 times more likely to have HIV than women who have not been. We are currently in the midst of a campaign highlighting violence against women. I came the closest to breaking point when at hour 37 of my on call, a 25 year old woman was brought to casualty by her boyfriend who was hysterical. Someone (suspected to have been an ex-lover) entered the house and shot her in the face as they slept in bed together. Despite my best efforts, and that of the nurses, she died whilst awaiting an ambulance to the neurosurgeons.
18 men were admitted via Casualty in one night with various stab wounds. Three chest drains were inserted. There were two cardiac arrests. One man lost an eye having been glassed in a bar fight. X Ray broke at about 0230 in the morning. Open fractures were cleaned and closed and splinted. There are no ambulances to transfer patients out. It's no war zone but it's as close to it as I've ever been. Fit and healthy young men are dying because we don't have enough blood for them. There are no beds at the referral hospital anyway, they are safer here than abandoned in a corridor to die in a chair.
It seems like we are taking one step forward and two steps back at the moment. No more so than when in the middle of a post partum haemorrhage in the middle of the night, whilst trying to resuscitate the patient, I got a needle stick from her. She is HIV Positive.
I am not alone, one of the other doctors is also taking anti-retroviral treatment now. I tried to hold it together long enough to get the patient stabilised. The side effects from the meds are terrible. It lets me understand why compliance is an issue among my HIV positive patients. The transmission rate from occupational exposure via needlestick is 0.3%. 27 days to wait until we repeat the test. The nurses are adamant that God is with me, I hope he is listening.
Despite the darkness of what I have just written, this place really is going to be the making of me. The incredible experience I am getting, the lifelong friends I am making are what get me through. During a maternal health meeting this week, our matron told us that we have to 'shine in the corners where we are' and that's exactly what I intend to do.
Some beautiful African Fynbos from a friend - if I wasn't crying about work before, then I was crying about these after! |
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